MC-11-692Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspe
61
Permit Number: MC -4 -11 -692
Sc- eduled Inspection Date: Jun-el-3, 2011 Permit Type: Mechanical - Residential
Inspection Type: Final
Owner: , OROGOOD, DANI Work Classification: Addition /Alteration
In
pector: Hernandez, Rafael
Job Address: 635 NE 105 Street
Miami Shores, FL
Project: <NONE>
Contractor: SANSONE CORPORATION
Phone Number
Parcel Number 1122310120070
Phone: 954-428 -8919
Building Department Comments
INSTALLATION OF EXHAUST FAN
qg
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
June 10, 2011
For Inspections please call: (305)762 -4949
Page 5 of 19
02/13/2002 16:46 9544281405
SANSONE
CERTIFICATE OF LIABILITY INSURANCE
PAGE 01/04
IDATE tMareir YY)
12/30/2010
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
'SLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
!PRESENTATIVE OH PRODUCER, AND THE CERTIFICATE HOLDER.
**'- iMPORTANTI If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WANED, subject to
the terms and conditions of the poboy. certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of suoh endorsements
PRODUCER
Frank B. Purlean„ X c.
1314 East Atlantic Blvd.
P. 0. Box 1927
Pompano Beach FL 33061
INSURED
Saaaone Corp.
590 Goolsby Blvd.
Deerfield Beach Pt 33443
COVERAGES
CONTACT
,NAME?
w
PHONE (954) 943.5050
MDR SS:
CU8 MER 00007973
OUSTOME0.ID M
Ne }1(98A1982 -6310
IN$URER[SI AFFOROIN0 COVERAGE
INSURER A :>I'CCI' Commercial Ins Co
INSURER Et :National Trust Ins Co
NAiS 9
INSURER 0 :FCCI IneuranCe Co.
INSURER DI
INSURER B 3
33472
20141,._—
INSURER P c
• •r,. w1v4,0 nvInvci-i.
THIS IS TO CERTIFY THAT THE POUCiES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDIOATI =D. 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 SY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1 ,7R
TYPE OF INSURANCE
J
POLICY NUMBER
P aYlryyl
[Mf OG�
UMIT°3
aENEIALUAD1LtrY
EACH OCCURRENCE
s 1,000,000
-
a
I COMMERCIAL GENERAL LU1301T/
. PIREMISESIEff affauftwiffeff
$ 100,000
A
I CLAIMS MADE
L?�J OCCUR
ex,00zi2261
10/1/2010
12/1 /2011
mocoonyone m)
s 5,000
PERSONAL to AM INJURY
s 1, 000,000
emu!. A30E0ATE
$ 2, 000, 000
GEM
—1
AGGREGATE LIMTr
APPLIES PER
PRODUCT$. Comp/OP AGG
$ 2,000,000
POLICY X °:
f1 LOC
$
AIROMOBIL
tiAeh n7Y
COINED SINGLE LIMIT
(Ea eetidem)
$ 1, 000,000
- X
ANY AUTO
9ODU.vINJURY (PalielsOn)
`.. —_
8
H
ALL OWNED AUTOS
CA00174021
12/1/2010
7.a /x /x011
_
soapy INJURY (Per ac dill
- - --
8
SCHEDULED AUTOS
X
HIRED AUTOS
(Per DAMAGE
$
N OW NEO AUTOS
PIP ge by Work=
8 10,006
Metteelpmymmet
S 5,000
X
ulasREU a UAB
X
=up
EACH OCCURRENCE
$ 3,000,000
QfCESS UAB
CLAIMS -MADE
AGGREGATE
S
_
DEDUCTi9LE
$
A
X
RETENTION 6 10,000_
00217201 12/1/2010
12/1/2011
$
C
WORKERS COMPENSATION
U
AND EMPLOYER$' LIAOi .rry
ANY pP►FtCPRIETOR/PARTNERIE7iECU11VE
tl 1 N
X 16NCxSTA
7OO�gi EtLc
(Mee eto y EXCLUDEu'r
N/A
a011PC17)1027 a8 1/1/2211
1/1/2012
EL rtDEN7
8 10,000,000
My� eer.�rtbe under
E.L DI$EAl;E • FAA EMPLOYEE
2 1, 000.004
DESCRIPTION OF OPERATIONS
bclgw -
E.L. DISEASE • POUCY UMrT
2 � 0 Q0, 000
o$ecRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (AtteCh ACORD fin, Additional Remarks Schedule, It mere apace In ragedred)
•
CANCELLATION
Village of Miami. Shores
10050 111E 2nd Ave
Miami Shores, FL 33135
ACORD 2a (2009/09)
INS025 (201009)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE will. SE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Frank Paramus, Or /AM `. �...
01986 -2009 ACORD CORPORATION. All rights reserved.
The ACORD name end logo are registered marks of ACORD
02/13/2002 16:46 9544281405 SANSONE
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) ;487 -1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
PAGE 02/04
SANSONE, SCOTT JOHN
SANSONE CORPORATION
4570 GLENWOOD DRIVE
COCONUT CREEK FL 33066
Congratuh banal 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 from architects to yacht brokers, from
boxers to oarbeque restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business In order to serve you better
For information about our services, please log onto www.myfloridalicense.com.
There you can find more information about our divisions and the regulations that
impact you,/subscribe to department newsletters and Iearn more about the
Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for doing business in Florida, end congratulations on your new license!
DETACH HERE
ii ;a +,i,.,.:
f
wcr: N2sr•�'�r wl raw -. ,WI %. +a.
7
' C C . :f} 'ti t iE
4 R • _.��
02/13/2002 16:46 9544281405
(recd d,;V; I I lC/
SANSONE
115 S. Andrews Ave„ Rm, A -100, Ft. Leudsrdele, FL 33301 -1895 — 954- 831 -4000
VALID OCTOBER 1, 202 .0 THROUGH SEPTEMBER 30, 2011
DBA:
Busifteet3 Hams: SANSONE CORPORATION
Otlerter Nairn!: SCOTT J SAN90NS /QUJ L
Businass Location: 590 GOOLSBY BLVD
DEERFIELD BEACH
Business Phone: 954 -42e -5919
Rooms
Seats
Employees
75
PAGE 03/04
"'"?
Reoel. x:183 -1348
Btaslfteea gam: (NICALCCONTTRACTOR)
Business Opened:12 /11/2003
St ICoMnty /CerallRag:C4C7.249260
Exemption Code:NONEXEMPT
Machines
Professionals
Number of Machines:
For Vending [Wetness Only
Tax demount
Transfer Fee
NSF Fee •
Penalty
._.._...0 -.r --
Prior Year
Collection Cost
TOtel PaId
150.00
0.00
0.00
0.00
0.00
0.00
150.00
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 wihin Broward County and is
non - regulatory in nature. You must meet AD County and/or Municipality planning
wHE'.N NAIUDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business le sold, business name has changed or ycu 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:
SCOTT 17 SANSONE /QUAL
590 GOOLSBY BLVD
DEERFIELD BEACH, FL 33442
2 2.0 -2O1
Receipt #LIT -09- 00424123
Paid O1/19/203.0 150.00
Miami Shores Village
Building Departnient
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT ' PLICATION
FBC 20
Permit Type: I CHANICAL
Owner's Name (Fee Simple Titleholder)
Owner's Address
nova
n
7
APR 192011
ee.•...e..,e.e.ddratd
II
Permit No. �� l l (0C1-
Master � Permit No. �c Z -1 1 '3(4
Phone #
City
Tenant/Lessee Name
Email
Mate Zip
Phbne #
Job Address (where the work is being done) 5 ' 14-6 (
City Miami Shores Ville
FOLIO / PARCEL #
Is Building Historica y Designated YES
County Miami -Dade Zip 3--1.e"
Contractor's Compan
Contractor's Address 590 5 goatsify , /��iL%#' .
City Din &73tiel State
Name s,4rV 0AJC 6e,"
Flood Zone
Phbne # r -1sq ' 114e
ip 311 2-
Qualifier Name 0fl 7/906-01tAr Phone # %' ` '6C 8
'station No. C/19C /24 / 2k) Certificate of Coimpetency No.
State Certificate or Re
Contact Phone 9c • 110. 4 91---
E -mail
Architect/Engineer's ame (if applicable) shone #
Value of Work For
Type of Work:
Describe Work:
Permit $ 2 5 D oo Square / Linear F otage Of Work:
p Repair/Replace ❑ Demolition
ddition Alteration DNew
Submittal Fee $
Notary $
Scanning $
Bond $
Structural Review. $
* * * * * * * * * * * * * * * * * * * * * * * * * **** **F ** *********4i* *t* ** * * ** *sae * * * *** **** ** ** * * **
Permit Fee $ � CCF $ CO /CC
Training/Education Fee $
Technology Fee $
Radon $ DPBR $ Zoning $
Code Enforcement $ Double Fee "$
Total Fee Now Due $
See Reverse side -+
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 F..F,CTRICAL 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 YOUR 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 in good faith that a copy of the notice of commencement
and construction l en law brochure exceeding be2dell delivered applicant to the person
son
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
Owner or Agent
The foregoing instrument was acknowledged before me this
day of 14 410 ( 1, by ' �� 1► 'ii
who is personally known to me or who has produced R/1 1)
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
..n, 0 ®19`64 -09'.;
/i , °AI DA.
APPLICATION APPROVED BY
Signature
Contractor
The foregoing instrument was acknowledged before me this
d a y of ,4 P d i ( , 2(/ t , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PULIC:
Sign:
Print: L fti
********************** * * * * ** * * * ** * *** * ** ** ** * * *** ** **
Engineer
(Revised 07/10/07)
Zoning
Clerk checked
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. ( 47'2'
Job Name
Date 7 C �'
MECHANICAL CRITIQUE SHEET
(f(11VJLUt ��5