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EL-15-1003 "R C_ e Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone:o e: 305 795-2204 Fax: (305)756-8972 Inspection Number: INSP-242033 Permit Number: EL-4-15-1003 Scheduled Inspection Date: August 27, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: RIVERO, MANUEL Work Classification: Low Voltage Job Address:1286 NE 95 Street Miami Shores, FL 33138- Phone Number (305)762-7851 Parcel Number 1132060144050 Project: <NONE> Contractor: C F ALARM INDUSTRY INC Phone: (305)251-1147 Building Department Comments LOW VOLTAGE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Com is Passed Failed Correction Needed Re-Inspection a Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 26,2015 For Inspections please call: (305)762-4949 Page 30 of 44 Y J Miami Shores Village telt Elatrtitratial �t 10050 N.E.2nd Avenue NE z 4 Miami Shores,FL 33138-0000 x e Phone: (305)795-2204 � Ei . ,� 05 Expiration: 1 /27/2015 Project Address Parcel Number Applicant 1286 NE 95 Street 1132060144050 Miami Shores, FL 33138- Block: Lot: MANUEL RIVERO Owner Information Address Phone Cell MANUEL RIVERO 1286 NE 95 Street (305)762-7851 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 C F ALARM INDUSTRY INC (305)251-1147 ,..m__. . . ,.. Total Sq Feet: 0 Type of Work:LOW VOLTAGE Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# EL-4-15-55348 $2.00 04/30/2015 Check#:16293 $60.20 $50.00 DCA Fee $2.00 Education Surcharge $0.40 04/28/2015 Check#:16290 $50.00 $0.00 Permit Fee-Additions/Alterations $100.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $110.20 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informati is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-na d ntr r to do the work stated. April 30, 2015 Authorized Signature:Owner / Applicant / Contracto / Agent Date Building Department Copy April 30,2015 1 Miami Shores Village QQ17� APR 2 8 2015 Building Department 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201 rr BUILDING Master Permit No. PERMIT AP PLI ATION sub Permit No. �—� BUILDING ELECTRIC 0 ROOFING REVISION C-] EXTENSION ORENEWAL ]PLUMBING [] MECHANICAL PUBLIC WORKS 0 CHANGE OF ❑ CANCELLATION SHOP r� (/ CONTRACTOR DRAWINGS JOB ADDRESS: 0 � 'l"e City: Miami Shores ` County: Miami Dade Zip: Folio/Parcel#: I d' J `� ~®I�'' qVI� Is the Building Historically Designated:Yes NO Occupancy Type: Load: / Construction Type: �,�]Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): /"'Q0/I l;e) 't jooi U �^�� Phone#:130 Y_2 6 0` Address: S City: k--,%VNA 1 c'1`@l State: Tt"Cic- Zip: --�: 301, Tenant/Lessee Name: Phone#: Email: -- CONTRACTOR:Company Name: f-9Or " —f'0 . 4-" Phone#:3C Address: '7 e City: _ State: -L OL Zip: J g3 i JT Qualifier Name: arks l kq- ��t��de4 Phone#: 6716)— State Certification or Registration#: f•�Q®0['t 8 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 9 �4_0 D© Square/Linear Footage of Work: Type of Work: AdditiL"' ❑ Alteration New 10 Repair/Replace Demolition Description of Work: (D " Specify color of color thru tile: Submittal Fee$ Permit Fee$ ��•�® CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) 1 Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approv nd nspect. fee will be charged. / Signature Signature OWNER or AGENT CONTRACTOR The foregoi /Strument was acknowledged before me this The foregoing instrum nt was a knowledged before e this day of * 20 ,by day of f 20 by V o is personally known to �ar-�5 ,who is personally known to me or who has produced as me or who has producedF -/V/`6J`ifte. as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: "Pf BEA'TRI���A at tlgsi a P7042M :pctbCo6,2017 Sign: Sig Ptante Pri t: Joanna M Feliciano Seal: °� any Commission FF 082 3 Se ®F FLS Expires 01/12/2018 APPROVED BY 'X 9,+-7—A Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) seen pp.� Miami Shores Village Building Department IOR10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. / COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME:CE A LAW Q 1i bo S-T1 Q , 1 M 0, BUSINESS ADDRESS: QZL42- SW -"3 flu "�jTY� STATE& ZIP � BUSINESS PHONE: (3JS) 25t —11q-1 FAX NUMBER( 36) k430 � CELL PHONE( 23k–LOS 2 QUALIFIER'S NAME: (_49tQS Fjr-9-W NX)D9 QUALIFIER'S LIC NUMBER:. F6--7 1,�(=gg-Z STATE OF FLORIDA . DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 ��s$•�` 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 FERNANDEZ, CARLOS ALBERTO C FALARM INDUSTRY INC P O BOX 560632 MIAMI FL 33256 Congratulationsl With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range }: STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. ' PROFESSCCNAL REGULATION Every day we work to improve the way we do business in order to EG13000482 <. �SUED`: 08/17/2014 Qt- serve you better. For information about our services,please log onto R, v x www.myflaridalloonse.com. There you can find more information CERTALARMS��STF�4t1,CONtRACTOR 11 about our divisions and the regulations that impact you,subscribe FERNANDEZ,C'' t�SALBERTO to department newsletters and loam more about the Department's C F ALARM IND 11. initiatives. Our mission at the Department is:License Efficiently,Regulate Fairty. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED undea the provisions of Ch.469 FS. and congratulations on your new licensel Expo dare:nuc 31.2DIs 1.1408170003ses DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION si ELECTRICAL CONTRACTORS LICENSING BOARD s 1 0 =0482 The-ALARM SYSTEM CON'�ACTOR 1t Nar�be(bw IS CERTIFIED Un r Pie-provisions of Chapter 489 F$..: .. Expitation date. AUG 31 2016 3 _ FERNANDEZ, CARLOS ALBERTt3 ,C F ALARM"INDUSTRY 4NC 4242 SOUTHWEST 73R VE MIAMt FL33155= . ISSUED- 0en712014 DISPLAY AS REQUIRED BY LAW SEQn L1408170003893 Local-Business Tax Receipt x Nliar ri-Dade county, State of Florida TlEEl'.eNt3T�S6M.i-00 NDTPAY ' Bi08ElE< UAWW ACAMCM 4EPEwT NQ C.MMIS CFALAWROUSMINC RBi SVAL SEPTMOMAM51 4242 SW 73 AVE 549 8 dotba�Sa aH�tp�assaTbusnass hAEIL;F. 33155 Ihssua>esetosayd;�ds i (�mplEBi —.d1R 94k 4 i OYYN&R SfiQTrp808rBUSINE88, PAYMENT HIED C F aR1Y.FlR A Itb 1STI�`1f IkC f 198 SPEC llec'Rl & jar Tax es G ! IAhDQ C+ it3$ oNTRACTGR �. f2(!14„ 4�tAQs) 1 EG1300 ` 82 t4 OIZ a' N 16�Loa�idd assTaadsatTjt{only a of Ike Be�dMs�tgcTlNi�ec#�Pl@ Baa�a. 9 Term. as 6catiw11bbolda►$�cafio :U�t 6�iaasttworeimsci *lob of k sea l np q r aad r#Pke D atldah epptj to de itsiaeas. ;' j ThfNO aymladisplsdsa�camamaialvaitaia= Sea Fuaow�For�+i#si.+rk 1�{Rt�roai3 i i i i i i r • i P OP ID:MR DATE(MMIDDIYYYI) �.- CERTIFICATE OF LIABILITY INSURANCE 04/23/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Phone:305-477-0444 CONTACT 34 Combined Underwriters of Miami NAME: AX 8240 N.W.52 Tarr,Suite 408 Fax:305-599-23 PHONE AIC No): Miami,FL 33166 E-MAIL SUSAN SANCHEZ-ARMENGOL ADDRESS: PRODUCER us CFALA-1 INSURER(S) AFFORDING COVERAGE NMC @ INSURED CF ALARM INDUSTRY,INC. INSURER A:MESA UNDEWRITERS SPECIALTY INS 058466 LICENSE NUMBER:EG13000482 INSURER B:NORMANDY HARBOR INS CO 13012 P.O.BOX 560632 MIAMI,FL 33256 INSURER C INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER MM[DDY EFF MPIWDDLl � LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE A X COMMERCIAL GENERAL LIABILITY MP0028002000012 06/29/2014 06/29/2015 PREMISa occurrencRENTEDe) $ 100,00 ES E CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY JECT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STA LIM - TH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE Y N E.L.EACH ACCIDENT Is OFFICER/MEMBER EXCLUDED? , --, N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) ALARMS & ALARMS SYSTEMS- INSTALLATION, SERVICING OR REPAIR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE O" ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD , R o® DATE( Y YYY) 16.VCERTIFICATE OF LIABILITY 04/23/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT Aon Risk Services,Inc of Florida Aon Risk Services,Inc of Florida NAME: 1001 Brickell Bay Drive,Suite#1100 P Miami,FL 331314937 AIC No Ext):800-743-8130 1 rtAU No):800-522-7514 ADDRESS: ADP.COI.Center on.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Illinois National Insurance Co 23817 INSURED INSURER B: ADP TotalSource CO XXI,Inc. 10200 Sunset Drive INSURER C: Miami,FL 33173 ALTERNATE EMPLOYER INSURER D: C.F.Alarm Industry Inc INSURER E 4242 SW 73 eve Ste#2 Miami,FL 33155 INSURER F: COVERAGES CERTIFICATE NUMBER:993952 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DD MMIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DA TO RENTED CLAIMS-MADE D OCCUR PREM SES ,occurrence $ MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ rLOAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ LICYPROJECT❑LOC PRODUCTS-COMPIOP AGG $ THERCOMBINED SINGLE $ AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY Perperson) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ NON-OHIRED AUTOS AUT SEED Per accident A $ UMBRELLA L.IAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEC RETENTION$ WORKERS COMPENSATION XPER OTH- A AND EMPLOYERS'LIABILITY Y/N WC 094179802 FL 07/01/14 07/01/15 STATUTE ER ANY PROPRIETORMARTNERIEXECUTNE E.L.EACH ACCIDENT $ 2,000,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yea.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more space is required) Ali worksite employees working for C.F.ALARM INDUSTRY INC,paid under ADP TOTALSOURCE,INC.'s payroll,are covered under the above stated policy. C.F.ALARM INDUSTRY INC is an alternate employer under this policy. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores,FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE tAon Uwk(u Com, 9AC d ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD