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MC-15-2301 Inspection Worksheet Miami Shores Village LL11 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 _ M Inspection Number: INSP-243197 Permit Number: MC-9-15-2301 Scheduled Inspection Date: December 21,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: TELESCO JR.,THOMAS Work Classification: AIC Replacement Job Address: 64 NW 99 Street Miami Shores,FL Phone Number (305)216-6161 Parcel Number 1131010330060 Project: <NONE> Contractor: MEYER, LADD DAVIS AIR CONDITIONING INC Phone: (954)260-7377 Building Department Comments REMOVE AND REPLACE EXISTING AC FANS In EC Passed comments INSPPEC COMPRESSORS AND DUCT WORK(SEE MECH PLANS) TOR COMMENTS False 3 TONS Inspector Comments Passed Failed o Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 20,2016 For Inspections please call:(305)7624949 Page 2 of 46 2C KS - 2Zgi Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL ,V/ Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-243197 Permit Number: MC-9-15-2301 Inspection Date: April 13, 2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: TELESCO JR.,THOMAS Work Classification: A/C Replacement Job Address:64 NW 99 Street Miami Shores, FL Phone Number (305)216-6161 Parcel Number 1131010330060 Project: <NONE> Contractor: MEYER, LADD DAVIS AIR CONDITIONING INC Phone: (954)260-7377 Building Department Comments REMOVE AND REPLACE EXISTING AC FANS Infractio Passed Comments COMPRESSORS AND DUCT WORK(SEE MECH PLANS) INSPECTOR COMMENTS False 3 TONS Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 April 12, 2016 Page 1 of 1 f a Miami Shores VillageA. Building Department artment I SEP 10 015 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 5+11 FBC 2014 BUILDING Master Permit No. RC ' i5 —22CH PERMIT APPLICATION Sub Permit No. HC - 15- 230L ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County Miami Dade Zip• c`:; 3 1 Folio/Parcel#: 11-20 0 1._03 )Ci d Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): / //(Jzw,5 7&-les cc Phone#:,/--�Ci6-Z L(p,-&/*0/ Address: (o 9 5} fis'-� City: K12i% State: 77 Tenant/Lessee Name: Phone#: M Email: �Q Sna&Y � Cr--.-rte CONTRACTOR:Company Name: H tU fir Ly d jlhV i S aj ✓ (lY�tl�hone#:gsq- 2 (66- 7 j� Address: ��b 1 /Q r,-- 4 1"' t-Ve,. , City Clo 1Li aY 1L Stater, Qualifier Name: ���?? ���l J� (/I's sy-- Phone#:_Q54j 6M1)s:71 _ ���y� [`1�,�► State Certification or Registration#: f�l �i 2 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: ®spa• 6- Square/Linear Footage of Work: C�0 G s,- Type of Work: ❑ Addition Alteration ❑ New J-K Repair/Replace ❑ Demolition Description of Work: I �-G -�- -not 4 G-a—',—r X G j Specify color of color thru tile: I F$ Submittal Fee$ 5b 00 Permit Fee$ 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) /� 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 approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT NTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this a�day of G9 20 Ar- by dayofG!777 20 /f .by Jwho is personally known to �G mol 121kJ'It,who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: •`'• FARIAS s ` IA '0". =• ommission Commission#FF 897808 Seal: �: Seal: *� _My Commission Expires s+� g My Commission Expires '�i','�an�,.�� March 12, 2018 March 12, 2018 """'"•• nnu�• APPROVED BY " pPlans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION �► CONSTRUCTION.INDUSTRY LICENSING BOARD �`` ��'• M t•• - \i ; b CMC057132 - - The MECHANICAL CONTRACTOR a � Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration`date: AUG 31, 2016 %b dh 51 DAVIS, ROBERT J JR MEYER LADD DAVIS`AIR..CO_NDITIONING INC_, 3761 NE 4TH AVENUE L OAKLAND PARK ,_.. FL 33334 ISSUED: 09/04/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1409040002600 - BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 DBA: Receipt#:HEATING/AIRCONDITION CONT T1 Business Name:INCER LADD DAVIS AIR CONDITIONING Business Type:Yp (MECHANICAL CONTRACTOR) Owner Name:ROBERT J DAVIS JR Business Opened:08/03/2007 Business Location: 3761 NE 4 AVE State/County/Cert/Reg:CMc-057132 OAKLAND PARK Exemption Code: Business Phone: 954-522-1470 Rooms Seats Employees Machines Professionals 9 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.0.0 0.00 0.00 0.00 _ 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: MEYER LADD DAVIS AIR CONDITIONING Receipt #ICP-14-00020867 3761 NE 4 AVE Paid 08/12/2015 27.00 OAKLAND PARK, FL 33334 08/11/2015 Effective Date 2015 - 2016 ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY" �.i 9/10/2015 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(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 CONTACT Middle Unit 1 NAME: Setnor Byer Insurance & Risk PHOIC.NE (0. 954)382-4350 FAX N (954)362-2610 900 S. Pine Island Road #300 EpAIADRL .dann s@setnorb er.com INSURERS AFFORDING COVERAGE NAIC# Plantation FL 33324 INSURER A:Wes tern World Ins Co INSURED INSURER B:Associated Industries Ins. Co. Meyer Ladd Davis Air Conditioning, Inc. INSURERC: 3761 NE 4 Ave INSURER D: INSURER E: Oakland Park FL 33334 INSURER F: COVERAGES CERTIFICATE NUMBER:6/9/15 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. IPOLIC LTR TYPE OF INSURANCE AD U POLICY NUMBER MM DDPOLICY EFF MMDDY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE F_x1 OCCUR NPP8195139 /2/2015 1/2/2016 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ PIP-Basic $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION X I WC STATU- X OTH- AND EMPLOYERS'LIABILITY Y/N I ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) WC1040051 /1/2015 1/1/2016 E.L.DISEASE-EA EMPLOYEq$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 I F , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) HVAC Contractor License #: CMC057132 CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Daniel Saunders/DANNY ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IWSf19�ion,nnc�n, rr.., ---]L,——8 wrnnn Additional Named Insureds Other Named Insureds Meyer Air Conditioning Doing Business As OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC