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EL-12-2099Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: City: Miami. Shores County: FBC 2010 NOV 0 6 2012 Permit No. (S U Master Permit No. �ZG J Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple City: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �1 Y W�, ((°� (�� t�1`� Phone #: ,-jo � 7 Address: City: � �. State: I Qualifier Name: Phone #:(�3�3% y State Certification or Registration #: i 17i Certificate of Competency #: O. Contact Phone #: Email Address: Cily&:t DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: s cry „ aTpR.lnan - Footage of Work: ° Type of Work: ❑Address Alteration . {,ONew,,, / ORepair/ /Replace ODemolition Description of Work: �`� �3C9- i/Tl'i (Qrf�l- P�11f(LZ Submittal Fee $ Permit Fee $ .2 g oa' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ @ 12pnw, 7& TOTAL FEE NOW DUE $ 7 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this day of IVN , 201eL , by Wl-It 404-% who is personally known to me or who has produced I 0 ' la As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My C Contractor The foregoing instrument was acknowledged before me this° day of NV*f , 20? �, by who is personally known to me or who has produced /�Z-4 as identification m0mboidW. take an oath. NOTARY PUBLIC: _`\:S!01� ��... Sign: Print: My Commission Expires: `ci •• S8 J1, 149A 116 APPROVED BY 1191t/A% Plans Examiner Zoning Structural Review Clerk (R se(iY3112IV12)(Revigeed 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) KID FbL7 .5 U,1,5 5tait ur rLurcIWA 1,11111ILMI VI 91KIP4IOII— Transfer Fee ` DEPART14ENT;:.OF BUSINESS AND PROFESSIONAL REGULATION *-r ELECTRICAL CONTRACTORS LICENSING aOA St 080707 I Total Paid ::, LICENSE NBR,�=� r.;� , � �� T.t>, , 0.00 A O.s3' 0 JA043861D ;:: .f EC-Q:.001724,-- .. 0.001 h ; ELEC 'i CAL CONTRACTOR BUSINESS TAX RECEIPT. IT C8R'IIFT�D `` 7 Under the is i�nA of Chapty r i t= ,• t . {�' Expiration date.: AVO .31, 20144 1 HOLDER TO VIOLATE ANY ,.BART,: N$IL PaTRICt DO NOT FORWARD .,, ELECT�i,QNIC CJ.NTI(L Si�STffi�IS, :. COUNTY OR CITIES. NOR 6,175 NW 1,67... T SUITE G9 HTl1I,I FL:--*,.`-. 30 FR HOLDOM Aa +LICENSE ItOR KEN LAWSDN PERMIT OR REQUIRED BY LAW. THIS IS SECRETARY DISPLAY AS REQUIRED BY LAW NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA• 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 -831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30,2013 DBA: Receipt ELECTRICAL/ALAMS/CONTRi Business Name: ELECTRONIC CONTROL SYSTEMS INC Business Type: (MASTER ELECTRICIAN) Owner Name: NEIL P HART Business Opened:08/26/1994 Business Location: 6175 NW 167 ST G9 State /County /Cert/Reg:EC 000].724 MIAMI DADE COUNTY Exemption Code: Business Phone* 305-823-1374 Rooms Seats Employees Machines Professionals 1 For vending Business Only Vanrlinn Tvna, Tax-Amount 1,11111ILMI VI 91KIP4IOII— Transfer Fee NSF Fee Penalty — Prior Years Collection Cost I Total Paid 27.00 0.00 0.00 0.00 U.0.0 71 0.001 7.00 THIS IS NOT A BILL - DO NOT PAY FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT 140,231 166522 -4 RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 166522 -4 ELECTRONIC CONTROL SYSTEMS INC STATE# EC0001724 6175 NW 167 ST 609 33015 UNIN DADE COUNTY OWNER ELECTRONIC CONTROL SYSTEMS INC Sec. Type of Business WORKER /S 196 ELECTRICAL CONTRACTOR 1 THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY OR ZONING LAWSLAOFRy'HE DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE FR HOLDOM Aa +LICENSE ELECTRONIC CONTROL SYSTEMS INC PERMIT OR REQUIRED BY LAW. THIS IS . NEIL HART PRES NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA• 1 6175 NW 167 ST 69 TIONS. MIAMI FL 33015 PAYML:NT RECEIVED MIAMI�DADE COUNTY TAX COLLECTOR• 07/24/2012 ita�ajar): 60070000324 irritaaMrf1rrr oil a# ral�l�Ilar�jraa�aal��a�aaa�r�af 000075.00 120 L t ACC, CERTIFICATE OF LIABILITY INSURANCE °A'E`M°°"Y"I' 12/9/2011 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: K the certlflcats holder is an ADDITIONAL INSURED, the policypes) must be endorsed. If SUBROGATION IS WAIVED, subject to the temis 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 Keyes Coverage Insurance 5900 Hiatus Road Tamarac FL 33321 KAREN BRYAN I ONE PAX - NO - ADDRESS: kbryan@keyescoverage.com PRODUCER cusTomeRtom 7283 IN AFFORDING COVERAGE NAILS INSURED Electronic Control Systems, Inc. 6175 NW 167 St. Bay G9 Miami FL 33015 INSURERA:Massachusetts Ba y Ins Co 1/1/2013 INSURERB:Brid efield Emplgyers Ina Co 10701 INSURER C: $100,000 INSURER D $5,000 INSURER E : $1,000,000 INSURER F COVERAGES CERTIFICATE NUMBER: 138523264 REVISION NUMBER: THIS ISM CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENTrTERM 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. MTR TYPE OF INSURANCE POLICY NUMBER �D EFF POLICY E7(P LIMITS A GENERAL LI WUM % COMMERCIAL GENERAL LIABILITY CLAD MADE a OCCUR RDJ4806886 -03 1/1/2012 1/1/2013 EACH OCCURRENCE $1,000,000 $100,000 MEDEXP (Any areperson) $5,000 PERSONAL BADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEML AGGREGATE X POLICY LIMIT APPLIES PM D.M LOC PRODUCTS- COMPIOPAGG $2,000,000 $ AUTOMOBILE LIABUM - - - -- - ANYAUiO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON-0WNEDAUTOS - - AW4807189 -03- - 1/1/2912 1/1/2013 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ;- % BODILY INJURY (Per pew) $ BODILY INJURY (Per acdde" $ PROPERTYDAMAGE (Per acddsM) $ % % COMP $500 COLL $500 UMBRELLA LUIS EXCESSLUIB CLAIMS-MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DEDUCTIBLE RETENTION $ $ B W O�O ��I� YIN ANY PROPRIETOMPARTNERIEXECUTNEEy -1 OFFICERANENBER EXCLUDED? (Maraiatary In*0 U describe wrier DESCRIPTION OF OPERATIONS below NIA 830 -40676 1/1/2012 1/1/2013 S WCSTATU- OTH- EL EACH ACCIDENT $100,000 EL DISEASE -EA EMPLOYSE '$100,000 ELDMWE -PO LIMIT '$500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddMonal Remarks Schedule, H more space Is required) MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES FL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. r ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ' CERTIFICATE OF LIABILITY INSURANCE DATE °°""""' 12//27/227/2012 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: K 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 endorsement(s). PRODUCER Keyes Coverage Insurance 5900 Hiatus Road Tamarac FL 33321 NAME: KAREN BRYAN PHONE FAX 954--72A-7000 c No. - - ADDRESS: kbryan@keyescoverac:te.com PRODUCER 7283 INSURERS) AFFORDING COVERAGE NAIL i INSURED Electronic Control Systems, Inc. 6175 NW 167 St. Bay G9 Miami FL 33015 INSURER A: Massachusetts Bgy Ins Co RDJ4806886 04 INSuRERS:Bridclefield Ewlgyers Ins Co 10701 INSURER C : $1,000,000 INSURER D INSURER E: _$100,000 $5,000 INSURER F $1,000,000 COVERAGES CERTIFICATE NUMBER: 88549888 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. IL SR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS A , GENERAL LIABILITY % CO b IAL GENERAL LIABILI Y CLAIMSMADE Q OCCUR RDJ4806886 04 1/1/2013 1/1/2014 EACH OCCURRENCE $1,000,000 PREMISES ME)EXP one _$100,000 $5,000 PERSONAL8ADV04JURY $1,000,000 GENERALAGGREGATE $2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: % POLICY M LOC PRODUCTS- COMPIOPAGG $2,000,000 $ A AUTOMOBILE LIABILITY % ANYAUiO ALL OWNED AUTOS SCHEDULED AUTOS • HIRED AUTOS • NON-0WNEDAUrOS ADJ4807189 -04 1/1/2013 1/1/2014 COMBINED SINGLE LIMIT (Ea acdd-O $1,000,000 BODS.Y INJURY (Per Pin) $ BODILY INJURY (Per aa9dartt) $ PROPERTY DAMAGE (Pe -cident) $ COMP $500 COLE $500 UMBRELLA LIAR EXCESS LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION S $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXEcu IVEa OFFICERIMEMBER EXCLUDED? (Mandatory in NH) H Yes, describe under DESCRIPTION OF OPERATIONS below NIA 830 -40676 1/1/2013 1/1/2014 % VICSTATU- OTH TORY LIMITS EL EACH ACCIDENT $100,000 E.L. DISEASE. EA PKOYEE $100,000 E.L DISEASE -PO YLIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Add ttonal Remarim Schedule, N more apace is required) CITY OF BAL HAR13OUR 655 96TH STREET BAL HARBOUR FL 33154 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR12ED REPRESENTATIVE �* ap ©1988 -2009 ACORD ACORD 25 (2009 109) The ACORD name and logo are registered marks of ACORD All rights reserved. _.-__ ._.,.�1'Ft�ilr7filiEttt��31Y_i 1 1.VVt'ki.. �7i�ViFa- Vasa-- ;- �a- saaE�s• —�• =-r 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Receipt #'ELECTRICAL /ALARMS /CONTR Business Name' ELECTRONIC CONTROL SYSTEMS INC Business Type' (MASTER ELECTRICIAN) Owner Name: NEIL P HART Business Opened:08/26/1994 Business Location: 6175 NW 167 ST G9 State/County /CorUReg:EC 0001724 MIAMI DADE COUNTY Exemption Code: Business Phone: 305 -823 -1374 Rooms seats Employees Machines Professionals 1 For Vending Business Only s�.....�...s ius..a :..�. Vendine Tvne: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost I Total Paid 27.00 0.00 0.00 0.00 0.00 1 0.001 27.00 x FiftST -CUSS US-POSTAGE t PAID UtM, PERMIT NO. 231 THUS IS NOT A BILL — DO NOT PAY RENEWAL 166522 -4 RECEIPT No. 166522 -4 BUSINESS NAME / LOCATION ELECTRONIC CONTROL SYSTEMS INC STATE# EC0001724 6175 NW 167 ST G09 33015 UNIN DADE COUNTY OVMER ELECTRONIC CONTROL SYSTEMS INC Sec. Type of Business WORKER /S ¢ A k TRICAL CONTRACTOR I , t wmNG "G LAWS Qr 7°E DO NOT FORWARD coumv OR crrw& NOR LITWA S rr E7awi Tm EW ELECTRONIC CONTROL SYSTEMS INC UN °R 7 NEIL HART PRES D sr taw. nN tF OWE o AURC °AF- 6175 NW 167 ST G9 MIAMI FL 33015 pAYrtAENT RECE! EDD —