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DEMO-16-2667Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL inspection Number: INSP-268117 Inspection Date: December 21, 2016 Inspector: Perez, JanPierre Owner: Cfr Phone: (305)795-2204 Fax: (305)7564972 � ^ ,Iij ( 6_223 2 Job Address: 800 NE 91 Terrace Miami Shores, FL Project: <NONE> Contractor: AIROLQGY INC Permit Number: DEMO -9-16-2667 I Permit Type: Demolition Inspection Type: Final Work Classification: Mechanical Phone Number (786)241-6627 Parcel Number 1132060050390 Phone: (754)366-5380 Building' Department Comments THE REMOVAL OF EXISTING AIR HANDLING AND CONDENSING UNIT Infracli° Comments INSPECTOR COMMENTS False \A(S) LL211 1 inspector Comments Passed 1`111 Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. 1 December 20, 2016 For Inspections please call: (305)762-4949 Page 1 of 1 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC <x� ❑PLUMBING CH NICAI T]PUBLICWORKS JOB ADDRESS: g6 Gue e(` -1)L-P Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 • Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNE PHONE NUMBER: (305) 762-4949 11 9,,S 2016 FBC 20 I '4 Master Permit No. 1) PIN•.0 ILO "(�3 2 Sub Permit NZEMQ Q � 2 G()--i- ROOFING ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL City: ❑ CHANGE OF CONTRACTOR E CANCELLATION SHOP DRAWINGS Miami Shores County: Miami Dade Zip: S / 5E3 NO FFE: Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: / BFE: n OWNER: Name (Fee Simple Titleholder): tit,./ e.13(0-( C/1c e3 eei 1 J ne#: 7� Led& 61° &- 120/ City: ARt4 u C State: )/4_ Zip: c 3 (?' Address: 7 5o )LI L Tenant/Lessee Name: Phone#: -7qe 2.41 lj 627 Email: CONTRACTOR: Company Name: / „7-!LePhone#: Address: `semz� City: e5Y7?76ree /7� 7 I-7)11 State: Zip: 3.3,?r Qualifier Name: ,�% l' -e- �� � Phone#: �35� 0 State Certification or Registration #• / g .4:0/ eel/ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ (C20 Type of Work: ❑ Addition ❑ Alteration Description of Work: Square/Linear Footage of Work: ❑ New ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Scanning Fee $ 3 Technology Fee $ e n0 Submittal Fee $ Permit Fee $ Radon Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ F $ - COQ CO/CC $ DBPR $ 2— Notary $ 020 Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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. 1 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 clone 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 Mw hrorhure vyillbe n'elivr'red 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 The foregoing instrument was acknowledged before me this ') day of .5:-'7) 7t. ,20 4 , by /61)(4 \\\ _5, who is personally known to,.r.jtu 1 7 p L/i7 ho i5ersonally known to me or who has produced f L �}- as or who has produced identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: CONTRACTOR The foregoing instrument was acknowledged before me this 12 day of 5 1 %C r CA , 20 / 6 by Sign:_�� Print:�' o .r� . '-�ROIi *) 'MY COMMISSION #FF 7872 no?.,°' EXPIRES April 14, 2017 04413$8-0153 FloridallotarvServipe,com Seal: *************************** APPROVED BY Sign: �l / (7 /41/5 OIL as a' ��<, SIMO MANSOR Seal: '! �„ . • i MY COMMISSION #FF006468 .p ptio".••' EXPIRES April 9, 2017 407 388-0153 FloridallotaryService.com *********************************************************** ans Examiner Structural Review (Revised02/24/2014) Zoning Clerk on uste Ohio Secretary of State Jon Husted & the Office Elections Volit ri i-1,1 issues Businesr.i , , , , your BUSINESS begins here Corporation Details C 'pora i n Details Entity Number 555208 Business Name OANCROFT INVESTMENTS. LLC FilingType DOMESTIC LIMITED LIAEtILITY COMPANY Status Active Original Filing Date 07/08/2005 Expiry Date Location. County: Slate Agent / Registrant information EDMUND PI L LIPS 224 NORTHWOOD AVE APT 1 DAYTON,01-145405 Effective Date: 07/08/2005 Contact Status. Active Incorporator Information [fLlPS Filings Filing Type Date of filing Document Number/Image ARTICLES OF OPC, ANIZAlIONIDOM LM 1 EU LIABILITY CO W/08/2005 Return To Search List Printer Friendly Report Limited Power of Attorney BE IT ACKNOWLEDGED that I, Social security number / limited power of attorney to • ? 7 Ht 12 c) 7 / 724g heundersigned, do hereby grant a Dyiver icense Full Nape // _ of � Q , 7O /=f ��L. �"' ' ?/ Address , t -� t 713 44"( Phone as my attorney-in-fact. Said attorney-in-fact shall have full power and authority to undertake and perform only the following acts on my behalf sign for and do all things necessary necessary tothis appointment (check only one option): 1. k e q,C (f I , g /491e1 lc. a > ecS ,:r: -37/7>g 2. 3. The authority herein shall include such incidental acts as are reasonably required to carry out and perform the specific authorities granted herein. My attorney-in-fact agrees to accept this appointment subject to its terms, and agrees to act and perforin in said fiduciary capacity consistent with my best interest, as my attorney-in-fact in its discretion deems advisable. This power of attorney is effective upon execution. This power of attorney may be revoked by me at any time, and shall automatically be revoked upon my death, provided any person relying on this power of attorney shall have full rights to accept and reply upon the authority of my attorney-in-fact until in receipt of actual notice of revocation. Signed this e)'7 day of Signature ,2O/‘ . STATE OF FLORIDA COUNTY OF r iant . - Daek Tlfotegoing i r as acknowledged before me this _day of , 20l ((, by arnb n �i _ I who is ► e - rsonally known to me or ❑ who has produced � � tification and who did (did not) take an oath. Signature Print or type name Notary Public - State of goo,t, Commission No. M/ Commission Expires: "YAP''% ;,:�,� � ,,Marie Sandra Pierre ''r°' •'�cCommission #FF065496 >' .3%; p� Expires: Oct 23, 2017 '•;F+on°o W,R,.AAYRONNYTARY.00m KEN LAWSON, SECRETARY 8E0 # 1.1808070001935 RICK SCOTT, GOVERNOR &d 6LO1.017£1796 oW ARmV C:Qg1.9i.des BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30,2017 DBA: Business Name: AIROLOGY, INC. Business ReceiTypept#::E TING6AIRCONDITION (A/Ci Owner Name: KIMROY TURNER Business Opened:08/18/2010 Business Location: 6412 N UNIVERSITY DR STE #117 State!County/Cert/Reg:CAC1816617 TAMARAC Exemption Code: Business Phone: 759 -366-5380 Rooms Seats Employees 1 Machines Professionals Number of Machines: For Vending Business Only Tax Amount Transfer Fee NSF Fee Penalty ',VIM....a , yi,., Prior Years Collection Cost Total Paid 27.00 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 ail County and/or Municipality planning 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. WHEN VALIDATED Mailing Address: KIMROY TURNER 6412 N UNIVERSITY DR STE 117 TAMARAC, FL 33321 2016 -2017 Receipt #01A-15-00007866 Paid 09/13/2016 27.00 {aUiid_NY Q.CALa Bt .S:I: ESS ,-.1A&REQ. 0 0 0 0 cn w '0 Sep 28 16 01:52p Airology Inc ACORIT 9543431019 CERTIFICATE OF LIABILITY INSURANCE p.1 UA I t INAnNW1 T,T) I 7/46/AU10 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 POUCIES 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. It 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 endorsernent(s). PRODUCER Northern Insurance Grou P 6410 N University Drive Tamarac FL 33321 CONTACT Josset Jordan PHON AA NNE0.Ext): (954)721-3337 i Fa Not; (956)721-8180 ADDRESS- INSURER (§) AFFORDING COVERAGE NAIC # INSURER A :ABOeadaat COn>merCial IDB Inc. INSURED Airology, Inc 930 SW 50th Ave Plantation FL 33317 . INSURER B : INSURER C : INSURER D: INSURER E : INSURER F: COVERAtIPC ACerlrrnxrr •r....'....•...... a . _. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR STI $Fi LTR W VO TYPE OF INSURANCE ADOL INSO A X I COMMERCIAL GENERAL UABILITY CLAIMS -MADE: X I OCCUR POLICY NUMBER A GEN'L AGGREGATE LIMIT APPLIES PER: PRO8 POLICY Lj LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS _ HIRED ALTOS UMBRELLA LIAB I EXCESS UAB SCI= E X.S.a) Auros NON --OWNED I AUTOS I GL -36098-6 1 0A375170 POLICY EFF PO UCY EV (MM/OwYYYYI (MM/DD/YYTY1 9/28/2016 9/28/2017 LIMITS EACH OCCURRENCE -017/1T'd-i>; PREMISES fEa accurrefe) MED EXP (Any one person) PERSONAL &ADVINJURY g 1,000,000 $ 100,000 5 5,000 $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 PRODUCTS- COMP/OP AGG $ 1,000,000 TOT 2/25/2016 2/25/2017 COMBINED SINGLE OMIT (Ea accident) 5 5 BODILY INJURY (Per person) $ 100,000 EMILY INJURY (Per accident) $ PROPERT`• DAMAGE (Per accdent) 5 25,000 OCCUR CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATOR AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFF CER/MEMBER EXCLUDED? (Mandatory In NH) Ir yes describe under DESCRIPTION OF OPERATIONS belcv Bodily iniury-tern {urn t EACH OCCURRENCE $ 50,000 s AGGREGATE $ Y/ N N/A PER STAT:JTE 011i - ER 5 E.L EACH ACCIDENT : $ E.L. DISEASE • EA EMPLOYEE 3 E.L. DISEASE- POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS/ VEHICLES (ACORD 101, Additional Remade, Schedule, may be attached I1 more epee Is No:drec AIR CONDIT/OWING SERVICES CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 Northeast 2nd Avenue Waal Shore, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Josset Jordan/JOSSET c",p ArnDirt am tam e ril% 01988-2014 ACORD CORPORATION. All rights reserved. TL.o Af•ns rf nern.. enri 1 .... ere rentaFere,J ��,L n1 APnCt1 1 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION ° CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW W ° CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 8/20/2016 EXPIRATION DATE: 8/20/2018 PERSON: TURNER KIMROY FEIN: 273282223 BUSINESS NAME AND ADDRESS: AIROLOGY INC 930 SW 50TH AVE PLANTATION FL 33317 SCOPES OF BUSINESS OR TRADE: HEATING, VENTILATION, AIR-COND Pursuant to Chapter 440,05(14) F.S., an officer of a corporation who elects exemption frau this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 449.05(13), F.S, Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the Issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate The department shall revoke a OFS-F24DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 0 v 0 0 3>_ 0 0 0 5 0 6L06£b£i96 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner State of Florida County of Miami -Dade The foregoing9was acknowledge before me this n3 day of By ji (O1 • Sn'livl SS2©a` - 2S -a-1 Notary: SEAL: oritla My Commission FF 06355E or h0 Expires 10/16/2017 ,20 10 who is personally known to me or has produced as identification. 1 N(.0a4:ri ive /Zs 06)66-kv", iiTee avb , &,,mt .5kdow, VV e)v.5 a4)) 6/7,4* f �?� wily 60,4)1 R7toodt) 41 0A) 4.5- aeidear e? qtYi's "km,/ 1/ S31567). �.� t c)bsatr bed € ' 27dityloTt6E (26-X6,5r f-tJe 2dv6 --Vy-'e CPI -nth" g W0.S' a eKAO w Iw.dgfe d 'ore _ nth day .of S -ernbi r 2.01k) ---v e Ern tria. 1(LfflCr WINO 1S V>erSOnCilklAV wh ko w e or V 1/4►3 Oro duCte- No Vart,k S %v\alcawe as 1d64f;CO14-;0 paunhrs 4,0 4%Marie Sandra Pierre o� mea, Ott, 23, 2017