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ME-03-82PERMIT APPLICATION FOR MIAMI SHORES VILLAGE k , Date 4/28/03 JobAddres b02 I.E. 96th St. LegalDescriptionl0 -37 Lots 1 -10 INC BLK 61 TaxFolio 11- 3206 -014 -1410 Historically Designated: Yes No Owner errant Miami Shores Presbyterian Church Master Permit# Owner's Address 602 N . E . 96th St . Phone Contracting Co. Airstron, Inc. Address1559 S.W. 21st Ave., Ft. Lauderdale, Fl Qualifier James M. Pascucci 954 - 923 -1654 State # CACO23473 Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Installation of one (1) 5 ton split system with two (2) duct drops. Square Ft Estimated Cost (value) $8,475.00 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize the above -named contractor to do the work stated. ignature of owner and/or Condo President Date Notary as to Owner and/or Condo President Date My Commission Expires: O"D FEES: PERMIT 2 RADON Signature of Contractor or Owner- Builder Notary as to Contractor or Owner- Builder My Commission Expires: LINDA B. BUTKA MY COMMISSION # CC 923167 -I EXPIRES: July 29, 2004 Bonded TAru Notary Pu911c Undenmdters 4/28/03 Date 4/28/03 Date TOTAL DUE APPROVED: Zoning Building Electrical Mechanical f 6 47 „s • 7 e) ) Plumbing Engineering Date — Type Insp'n — Permit No. Name �j� Address [Y0a ompany hone #(9 q— For Inspector: Approved Correctio Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Requ: t ° ?)a > 1 ` Time 1 1 05 8 310 .1g7 Name & Date Zt .o�j N D Permit No. Addres Company MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305 -795 -2204 Building Inspection R Time Type Insp'n Phone # q S `� - 9 a 3- ) 6s Q3 Name & Date Approved ‘. //1 63 For Inspector: 6 ) I I j Correction ❑ Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection R N Addres Company Phone# 9 \ \- 9a3- ) S ' For Inspector: 6 ! 11103 Name & Date Approved o r° • iff 6 f Correction ❑ Re- Insp'n Fee ❑ Ac# 046649.8 DATE (BATCH NUM DEPARTINT OF BUSINESS AND PROFESSIONAL REGULATION SEQ #L0206250056 CONSTRUCTION INDUSTRY LICENSING BOARD f6/25/2t102 n11145181 f'.ACO23473 The CLASS A AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2004 JEH HUSH .GOVERNOR NEW CNS 'TRANS FROM 183 -88 Il - LICENSE NBR PASCUCCI "J AMES MICHAEL AIRSTRON INC 1559 SW 21ST AVENUE FT ; LAUDERDALE .. . FL 3p12 312 • FORM NO.' " 401 -2eCVAC 25-051 CI RENEWAL ❑ TRANSFER • SEC # DATE BUSINESS OPENED 05/01/85 STATE OR COUNTY CERT/REG 0 C/ ' C 0 2 3 4 7 3 Business Location Address: 1559 SW 21 AVE FT LAUDERDALE . 33312 -0000 BUSINESS PHONE: (954)923 -1654 THIS LICENSE MUST BE CONSPICUOUSLY DISPLAYED TO PUBLIC VIEW AT THE LOCATION ADDRESS ABOVE. B ■ BROWARD COUNTY REVENUE COLLECTOR 115 S. Andrews Avenue, Governmental Center Annex FORT LAUDERDALE, FL 33301 STATE OF FLORIDA DISPLAY AS REQUIRED BY LAW Board of County Commissioners, Broward County Florida BROWARD COUNTY OCCUPATIONAL LICENSE TAX FOR PERIOD OCTOBER 1, 2002 THRU SEPTEMBER 30, 2003 18 / 183 PAID 0811(/02 9007633.0001 ARD TAX BACK TAX PENALTY T. C. FEE TRANSFER 27'00 TOTAL 27.00 r AIRSTRON INr PASCUCCI JAMES M P 0 BOX 7715 HOLLYWOOD FL TYPE OF LICENSE TAX PAID e+ COUNTY A/C CONTR CLASS A uniminin 4 UNITS 2002 - 2003 PAYMENT RECEIVED AS VALIDATED ABOVE 27.00 PENALTIES IF PAID OCT. -10% NOV. -15% * DEC. - 20% I *After DEC. 31 - 25% *Plus Tax Collection Fee of up to $25.00 Based on Cost of License If Paid On or After November 30, 2002 ACCOUNT NUMBER 183-.0000775 *SEE BACK FOR TRANSFER INFORMATION 33031 -0000 KIM BINKLEY- SEYER° SECRETARY RENEW ON OR BEFORE SEPTEMBER 30, 2003 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR INSI< TYPE OF INSURANCE POLICY NUMBER P D TE (MMIDD� POUCY (MM DD/YY11N LIMITS A INSURER B: Amerisure Insurance Co GENERALUABIUTY COMMERCIAL GENERAL LIABILITY CON98719736 04/01/2003 04/01/2004 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PRFMISFS (Fa nrc in- Pnce) $ 300,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n jEC n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 7 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CON98719777 04/01/2003 04/01/2004 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC1328803 01/01/2003 01/01/2004 1 TORY TIM S I E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS `ACRD,. .CERTIFICATE OF LIABILITY INSURANCE 03/3//200 ' PRODUCER (305)822 -7800 FAX Collinsworth, Al ter, Fowler; Dowl ing & French P. 0. Box 9315 Miami Lakes, FL 33014 -9315 Gladys Masters THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Airstron, Inc. S&S Air Conditiong Co. P 0 Box 7715 Hollywood, FL 33081 INSURER A: Northern Insurance Co of NY INSURER B: Amerisure Insurance Co 09088 INSURER C: INSURER D: INSURER E: a.GR 1 irwn 1 1 wwa.,. Miami Shores Vi 11 age Permitting 10050 NE 2 Avenue Miami Shores, FL 33138 ...- .............,.._.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Richard French ACORD 25 (2001/08) ©ACORD CORPORATION 1988 ft I•• 1 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 5/6/2003 Applicant: Owner: JOB ADDRESS: 602 NE 96 Contractor AIRSTRON, INC Local Phone: 954- 923 -1654 Parcel # 1132060141410 Signed: .9-0(4 ;.705 Signed: d 3: 4 1 : ‘" • Mechanical Permit Permit Number: ME2003 -82 ST Contractor's Address: PO BOX 7715 Page 1 of 1 Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 1 TO 10 INC BLK 61 LOT SIZE if2 ), Total Fees: $0' Sf Total Receipts: $0.00 Permit Status: Approved Permit Expiration: 11/2/2003 Construction Value: $8,475.00 Work: INSTALLATION OD ONE 5 TON SPLIT SYSTEM WITH TWO DUST DROPS (INSPECTOR) 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 1 assume responisibility for all work done by either myself, my agent, servants or employes. (Contractor or Builder) L /.1J.; A• i_iv BY: r._ ,