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MC-09-1318Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 \,1/4.y Inspection Number: INSP - 158332 Permit Number: MC -8 -09 -1318 Scheduled Inspection Date: April 18, 2011 Inspector: Perez, JanPierre Owner: EDELMAN, ALEX Job Address: 9999 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: POWER AIR LLC Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: A/C Replacement Phone Number ()_ Parcel Number 1132060134490 Phone: (786)486 -3291 Building Department Comments REPLACE 4 25 TON CONDENSING UNITS FOR WHOLE BUILDING Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments b (Lb-Ai\ \\Anzi tkb p-sv-- E46 &vs, L., April 15, 2011 For Inspections please call: (305)762 -4949 Page 24 of 27 Miami Shores Village &U Et NOV 2 3 2009 g Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 13 Y..___....Peva.000ep_� Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. MO g Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) _ Owner's Address ` /�/ 9 ' 4/ City/ 0/Y/ Jfi ` State Tenant/Lessee Name V �A Email\71 D1 k1/4-) Phone # dI Zip 3._.3° /gZ Phone # 2g- 77517 Job Address (where the work is being done) �9 ``. `" C ita JAE City Miami Shores Village County Miami -Dade Zip 39/-9i FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name Pous4J Contractor'sA, Address l 7-101 I f( City d\®r 9 ■ Map.; f p PALIA Qualifier Name g f cs Le' LLC OtAN avj State rC- Phone # q8 C- WC -.?21 Zip 33 (CZ Phone # io ;_ o7g State Certificate or Registration No. C 4C t $I tE i- Certificate of Competency No. %(c t Pouw -Z, i r e C. Co/14 . Contact Phone G - 4-3l E -mail Architect/Engineer's Name (ifplicable) Phone # Value of Work For thistiiermii- 000 Square / Linear Footage Of Work: Type of Work: [QAdcdition. - ['Alteration ['New IR Repair/Replace [' Demolition Describe Work: ` Lir 3a �A CONA• %Ant°( . ************************************Fee ************* * * * * * * * ** * ** * * * * * * * * * * * * * * * * * ** Submittal` $ Permit Fee $ /19 U °D . CCF $ CO /CC $ Notary $ Training/Education Fee $ Sca.i ' ' . Radon $ DPBR $ 76, - /�/� Structural Review. $ Total Fee Now Due $ 1400 •00 Violation date: Technology Fee $ Bond $ 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and MR 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 ubject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first ins# 'ction whi, occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will n , t be appro d and a reinspection fee will be charged. The foregoing day of 0c..! er or Agent was acknowledged , 20 061 , by JZ) //O Signature Contractor The foregoing instrument was acknowledged before me this as' day of nt , 20 OS , by 8164 who is personally known to me or who has produced °1 who is personally known to me or who has produced As identification and who did take an oath. MARIA TERESA GROSSO NOTARY PLC; COMMISSION # DD663996 EXPIRES April 16, 2011 Pioride Noto ryservrce. com Sign: Print: 6. (407) 398 -6153 My Commission Expires: frc1— * * * * * * * * * * * * * * * * * * * * * ** * ** * * * * * ** APPROVED BY Plans Examiner Engineer (Revised 07 /10 /07XRevised 06/10/2009) s;'dentfication and who did take an oath. NOTARY P @ a'Y� � MARIA TERESA GROSSO `' MY COMMISSION #DD663996 EXPIRES April 16, 2011 4i )399 -0t53 FI a No ryS -om Sign: Print: My Commission Expires: �� — Zoning Clerk checked Power Air LLC Power Air LLC 17101 NE 9th Ave North Miami Beach, FL 33162 (786)486 -3291 sales @powerairac.com Shoreview Center 9999 NE 2nd Ave Miami Shores, FL 33138 Estimate DATE ESTIMATE , 08/05/2009 1344 Rate Amount 09/04/2009 Stvie Activity Quantity Rate Amount 08/05/2009 Condensing Unit Remove 4 x existing 25 Ton York condensing units off of roof, and install 4 x new 25 Ton Carrier condensing units in the same location.We will have to make some modifications to the existing platform to fit the new units as they are larger than the existing units. 4 8,812.50 35,250.00 This price includes craning the existing units off the roof and disposal of the units, and craning the new Carrier units up to the roof, connecting to existing low voltage connections, and refrigerant liesets. This price does not include any high voltage work at all. This will have to be done by a licensed electrical contractor who must pull his own permit for the electrical work to be done. 08/05/2009 Permit Fee The permit fee will be an additional fee based upon the exact charge to us by the building department plus a 1 0.00 0.00 $275 permit expediting fee. 08/05/2009 Terms $30 000 upon signing of estimate, $2500 upon delivery of equipment, $1500 upon completion of install, and final $1250 upon approved final inspection. 1 0.00 0.00 Continue to the next page. Page 2 of 2 best quality service, . sible. Ask us about our Pr entive Maint ance Agreements Accepted By: Accepted Date: 11/09/2009 Condensing Unit Remove 2 x existing 30 Ton York condensing units off of roof, and install 2 x new 30 Ton Carrier condensing units in the same location.We will have to make some modifications to the existing platform to fit the new units as they are larger than the existing units. This price includes craning the existing units off the roof and disposal of the units, and craning the new Carrier units up to the roof, connecting to existing low voltage connections, and refrigerant linesets. This price does not include any high voltage work at all. This will have to be done by a licensed electrical contractor who must pull his own permit for the electrical work to be done. t 'd 10,000.00 10,000.00 Thank you for giving us the chance !Illy rrrineso or. t o ed , .. +l.e to assess your needs. TOTAL 1...,+ ., ..1:+.. ....tom ...1 ... «l: ..:1,.l.le ...1 +t.e 15 ,250.00 best quality service, . sible. Ask us about our Pr entive Maint ance Agreements Accepted By: Accepted Date: Shoreview Properties 9999 NE 2nd Avenue • Miami Shores Village, FL 33138 October 23, 2009 To Whom It May Concern: Please be advised that Julio Martinez is authorized to represent me in all matters related to the property located at 9999 NE 2nd Avenue, Miami Shores Village, FL 33138 as regards to permits and licensure in the village of Miami Shores. Alex Edelman Owner .RYeu° MARIA TERESA GROSSO . *= MY COMMISSION # 00663998 EXPIRES April 16. 2011 o ' (407 Fla' ,�n,. n rn'h ) 398 -0 53 c ' ' ' • Phone: (718) 327 -2700 • Fax: (718) 327-2223 • WWW.ShoreviewCenter.Com gird Miami Shores Village Buildin g Department e artment Di. ; a 201 � 2 0 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 FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) /tI <X 6"12/410.1 Phone # 30c 7$C°- 77 %7 Owner's Address ``,/ d 1 Ael" 7i Al f .4_ St 30s- City M e 1. State rL Zip 33 / 3 8' Tenant/Lessee Name A%p Phone # Email Jj17 a 1iLZ. (* rilef4.4/Ry4ex -i?l ton. Job Address (where the work is being done) 1971 Ne" 2"1 Ave, Permit No. ' CC `r— Master Permit No. City Miami Shores Village County Miami -Dade Zip 3 31 3 8 FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name Pocn.1 L L(- Contractor's Address I 90t 1D 132.t.41 s+. City DarIAN iia 1, (3.e°16‘ State Qualifier Name 6(4 ¶L L State Certificate or Registration No. CerC at ag-ks Phone# 386-480 -2��� Zip rr kz Phone # 02 if Certificate of Competency No. Contact Phone rt20 ` a`Z$] E -mail 5%.1 2,.1 e o /.trc mac. COM Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Type of Work: ❑Addition Describe Work: ['Alteration Square / Linear Footage Of Work: ❑New ❑ Repair/Replace ❑ Demolition P c r e Ql " S r MC D' — 13)S" t/k Z!<1 1o..Q 4,-k'r aX 3c-r 0ii Cor,io,p,.1 ******** * * * * * * * * * * * * *** * * *** * *** * * * * *** Fees************* ** * * * * * * * * *** * *** * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ te,• Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ 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 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. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commis APPROVEI Signature Contractor The foregoing instrument was acknowledged before me this 8 day of 201/0, bc1 iy`''`"` ,�U , who is personally known to me or who has produced 1`1 as identification and who did take an oath. NORMAN BRUHN BUILDING OFFICIAL/DIRECTOR MIAMI SHORES VILLAGE 10050 N.E. SECOND AVE. MIAMI SHORES, FLORIDA 33138 -2382 Phone: (305) 795 -2204 Fax: (305) 756 -8972 Bruhnn@MiamiShoresVillage.com (Revised 07 /10 /07)(Revised 06/10/2009) NOTARY PUBLIC: Sign: Print: �.cr 6Ya, My Commission Expires.. ; 1.'-'-'' .. p"'\ �� ,\4,...„, ` `nngInnE' 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 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Mechanical Owner's Name (Fee Sim • le Titleholde Owner's Address City/V(414( Tenant/Lessee Name E- MAIL:\_740 /J' 2 State_ Permit No. Nes- 0 igeg Master Permit No. one# 6/7CJg'77)7 Job Address (where the work is bei done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES Zip Phone # Vc c Zip 3 /3er County Miami -Dade NO Contractor's Company Name Peru -or 0 r 1.1( Phone # Contractor's Address 7-t® lye- (f orV9_ 7- %- 4a-Y2jr City (1p f l '` !' `i car atettAA State Pc Zip 7J1C Qualifier Name Bru (R.. LU Phone # 70 6 —701 O Z l State Certifi to or Registration No. C 4C 1 VI 2 4Z,43 Certificate of Competency No. E- MAIL: 5 rut cee 4,c.( ®M Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 35 Z 50 Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration 1 ❑New Repair /Replace ❑ Demolition Describe Work: atp1gta (4 )r Cdn ftn 1.44 e' // J ****x xxxtYxxxsexxoYxxx****xxxxaY**** Yxxxxx xFees****xxxxxaYxa't**.*xxxxxxx ar'k'c'r'`x* Submittal Fee $� Permit Fee $ A i 2- 336 Z5 CCF $ a1.40 Notary $ Training /Education Fee $ A.20 Technology Fee $ .64 Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ n Structural Review. $ Total Fee Now Due $ Y,Oc41, In CO /CC See Reverse side --> Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) . tl' IV/ /wily 4) Mortgage Lender's Addr s 090 �%?/ 7 City V'4 !/ � State Zip 9� /'V 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection wh' h occurs even (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be app . ved and a einspection fee will be charged. Signature Signature .•v . rAgent Contractor The fore oing instru nt w.. acknowledged before m is 0 The foregoing instrument was acknowledged before me this ?//' day of U /5�, 2009 , by Jd21 zi rJ,kk.,day of , 20 0 q, by BV t/Cc (ey , who is personally known to me or who has produced who is personally known to me or who has produced As id entification and who did take an oath. Pi&u'CVS (1C _identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: 6cate ,frtm �S My Commission Expires: ,tx,: xr. xx&,t,Y*9e *,tdexxx,Y,t APPLICATION APPRO 02 /08/06) xx�$pCps ie to ae x4cxx,t x,Yx4c �tx xde 4 1 MARIA TERE A 6W x =t• • °: MY COMMISSION # 00663996 "1 Jam` �� EXPIRES April 16, 2011 O (407 398-01 , Sign: WA 61' Print: TYAr�,/(far1 My Commission Expires: 0-�,n, ****** .. xxx, Yxx ,4xxxx4c�r9rdcvYde*w******dex Icxxdewxitx *r*Twx.i�'Sdx,k,:� Plans Examiner Engineer Zoning . ^. MUAMK'DADE DATE: 04/23/2009 TIME: 15:15:40 ACCOUNT : 544358-5 BUSINESS: NAME: POWER AIR LLC ADDR: OPERATING IN ZIP: 33999 MUN: 30 CORP / OWNER( NAME: POWER AIR LLC ADDR: 17101 NE 9 AVE ZIP: 33162 HOME OTHER INFORMA PP-FOLIO: 00 000000 RE-FOLIO: 00 0000 000 0000 COUNTY, FLORIDA LOCAL BUSINESS TAX ACCOUNT INQUIRY COMM-DATE: 11/2004 DELETE-ST: FINANUEDEPARTWIEMI TAX COLLECTION DIVISION 140 W. FLAGLER STREET MIAMI, FLORIDA 33130 LBTR YEAR 2009 OCLM0107 ENTRY-TYPE-DT: W 11/18/2004 INSP-ID-DTE: DADE COUNTY SUITE: ZONE: 99 PHONE: ( 786 ) 486-3291 MAILING): C/O: BRUCE LEN PRES CITY: NORTH MIAMI BEACH STATE: FL OFFICE: Y TION: SSN/EIN: E 27 0090369 BADCHK: ................... P ................ LBT RCPT SEC TYPE AMOUNT-DUE 568332-2 196 MECHS .00 F1=MENU CLEAR=PREVSCR F4=MOREREC ENTER=REC F12=pRTAPPL IMPORTANT: THE INFORMATION HEREIN DOES NOT NECESSARILY CONTAIN ALL TO REAL ESTATE CLOSINGS AND OTHER SIMILAR ACTIVITIES. MIAMI-DADE COUNTY, FLORIDA DATE: 04/23/2009 LOCAL BUSINESS TAX TIME 15:15:43 RECEIPT INQUIRY ACCOUNT: 544358-5 POWER AIR LLC ........................ RECEIPT: 568332-2 RENEWAL : 11/2004 STATUS: LAST-TRANS-DATE: 04/16/2009 PG 1 ���� ��= ER 30 ~~ �0 _ Ci FINANCE DEPARTMENT TAX COLLECTION DIVISION 140 W. FLAGLER STREET MIAMI, FLORIDA 33130 LBTR YEAR: 2009 OCLM0108 OPERATING IN DADE COUNTY ................0 ENTRY-TYPE-DTE: W 11/18/2004 INSP-ID-DTE: 00/00/0000 SEC TYPE ITEMS DESCRIPTION PRV-YRS: 196 MECHS 1 SPEC MECHANICAL CONTRACTOR CURRENT: JOB CLASS: PENALTY: STATE: CAC1814245 CC: HOLD: Y DELQPEN: EXEMPT-CD: VET-ID: SVC-CHG: _ CITY RECEIPT/ZONING PERMIT: MUN-CONT _TRANSFR: SHERIFF: HOLD-APPLIC: HOLD-REC: ADJUST : LEGAL: WARNING #: INSP RCT#: EXEMPT : PREV-YRS: YEAR: 2008 .00 YEAR: 2007 .00 TOTAL : Y PAID : TRANSF-FROM: TRANSF-TO: ORIG-REC: DUE : NAICS: CAT/NAICS: 238990 F1=MENU CLEAR=PREV SCR F2=FMHIST F3=PYMTS F4=MORE REC F5=MEMINQ F6=MUNINQ F12=PRNT F13=HELP F14=PI F15=CONTR IMPORTANT ThE INFORMATION HEREIN DOES NOT NECESSARILY CONTAIN ALL PERTINENT FACTS WITH REGARDS TO REAL ESTATE CLOSINGS AND OTHER SIMILAR ACTIVITIES. .00 75.00 .00 .00 . 00 .00 .00 . 00. .00' 75.00 75.00 .00' g‘q1.70-4-4SAT 4WW:ii7.13M1674$ lezeR ••wrip, 141k)kt4f4P)AgLYSY14(*) (.3c) PAWPOSAgt.staP gga BATCH NUMBER 're- ,A,00 • , • , "W•g,' f':).4g44121.9 "s'SV Z?a^1,. Baa 71.1 '45 )),A,41(aflf-15(ML..iw ) .t.itrA) 9 'T wfr ep4a • -'`'-•"":4(*) 02-18-2009 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 02/18/2009 EXPIRATION DATE: 02/18/2011 GOLDSMITH 270090369 BUSINESS NAME AND ADDRESS: POWER AIR LLC 901 NE 172ND STREET NORTH MIAMI BEACH FL 33182 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED AC CONTRACTOR ELLIOT IMPORTANT: Pursuant to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation ender this chapter. Pursuant to Chapter 440.05112), 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 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation 0, at any time alter the illing 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -160E DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW EFFECTIVE: 02/18/2009 EXPIRATION DATE: 02/18/2011 PERSON: ELLIOT GOLDSMITH FEIN: 270090369 BUSINESS NAME AND ADDRESS: POWER AiR LLC 901 NE 172ND STREET NORTH MIAMI BEACH, FL 33162 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED AC CONTRACTOR IMPORTANT F Pursuant to Chapter 440.05114), . F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05112), 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 440.05(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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. H E R E QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. • DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 "tc.::?---;;Ibe CERTIFICATE OF LIABILITY INSURANCE o riY; ATE' (MMIDD ........ .. __............ ............._. _ ... _...._ . ........ ......_01/14/08 I PRODUCER Florida Bankers Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 7278 SW 8 Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Miami, FL 33144 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Phone (306)2tiiL 33144 Fax (306)2 ®2.0878 • • AL: E13,THE,CQVERAoE AFFQRJ)•ED B,Y THEPOLICJES BELOW. ,INSURERS AFFORDING COVE .. .......... COVERAGE INSURED Power Alr LIC. INSURER • A; AMERICAN VEHICLE INSURANCE CO. 1122 N.E. 178 Terr. INSURER e: •, • North Miami Beach, FL 33182- INSURER C: I (766) 486.3291 .rnrEURER D: COVERAGES (,INSURER E. INSURER F • THE POLICIES OF INSURANCE LISTED HAVE BEEN isBUEb TO THE IWBUFtio NAMED Xiidiii. FOR THE PI)UBY 'E.iOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITHRESPEOT TO WHICH THIS CERTIFICATE MAYBE 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. LTR A0o'L TYPE OF INSURANCE LTR 1118110 1 POLICY NUMBER I OATS ( EFL @GTE POLIO( mine rra GENERAL LIABILITY f j COMMERCIAL GENERAL LIABILITY on CLAIMS MADE 0 OCCUR u n A I l 0 GEN'L AGGREGATE LIMIT APPLIES PER J POLICY LJ PROJECT C,1 LOC AUTOMOBILE LIABILITY 0 ANY AUTO G ALL OWNED AUTOS u SCHEDULED AUTOS LJ HIRED AUTOS r~I NON OWNED AUTOS 0 GARAGE LIABILITY ANY AUTO u EXCESS /UMBRELLA LIABILITY O OCCUR C „f CLAIMS MADE La DEDUCTIBLE • ID RETENTION $ VYORI(ER8 COIVIPlni8AT10iJ ANR EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER 1 EXECUTIVE OFFICER / MEMBER EXCLUDE07 If yes, dnacribe under $PECrAL PROVISIONS bel9w , OTHER GL- 0610030501 -00 12/20/08 12/20/09 LIMITS EACH OCCURRENCE I 1,000.000.00I DAlilAdE Tq R -ENTE6 ' PREMISE$ (Ea ocourence) 100,000.00' •MED EXP (Any one person). PERSONAL B,ADVINJURY. GENERAL AGGREGATE • PRODUCTS • COMP /OP AGG COMBINED SINGLE LIMIT (Ea accldont) BODILY INJURY (Per par n).. BODILY INJURY (Per occident) PROPERTY DAMAGE per accident) AUTO ONLY • EA ACCIDENT OTHER THAN EA ACC AUTO ONLY FGG EACH OCCURRENCE AGGREGATE u WC emu- LJ 0TH- . TO.RY•LIMS . _ ' .E13 _ E.L. .EACH ACCIDENT E.L. DISEASE • EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATI0N81 VEHICIt:61 EXCi.UBIONE ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER City of North Miami Beach Building department 17050 NE 19th Ave. North Miami Beach, FL 33162-4900 ACtiiio 25 (2001/08) OF 1 r♦ QP..I'oN • • CANCELLATION ,000.00+ 1,000.000.001 1,000.000.001 1,000.000.00'. 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 THCLOrr, BUT FAILURE TO DO 8O SHALL IMPOSE NO OBLIGATION OR LIABILITY 0P ANY HIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE\ ®ACORD CORPORATION 1988 M l/ L A. A A A A, . .. .. .. n n CERTIFICATE OF LIABILITY INSURANCE 04/14/2009 PRODUCER Serial # 150489 CONDON MEEK 1211 COURT STREET CLEARWATER FL 33756 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. NAIL# INSURERS AFFORDING COVERAGE INSURED FrankCrum 1-800 -277 -1820 100 S MISSOURI AVENUE CLEARWATER FL 33756 INSURER A. FRANK WNSTON CRUM INSURANCE, INC. INSURER 9: GEIyQUL INSURER C: INSURER D: INSURER E; S "INE —ADDL LTR THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A90VE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OF OTHER DOCUMENT WITH RESPECT TO WHICH TH18 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED MERSIN I$ SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. BARD TYPE OF INSURANCE TYPE POLICY NUMBER -• ,' - 7 _ IMMIDDM�) ' `' * I 'I " ON DATE (MMmonY) LIMITS GEIyQUL LWBILJTY COMMERCIAL PENERAL LULBILITY EACH OCCURRENCE S FIRE DAMAGE SAny wa Ene) S CLAIMS MADE OCCUR MED EXP (Any one WOOL s P RSONAL A AOV INJURY 5 GENERAL AGGREGATE S _ GENLAGGREGATE LIMIT APPLIES PER: poIEY nPROJECT nLOC PRODUCTS - COMPIOP AGG S - COMBINED SINGLE LIAT (Ea aasMset) AUTOMOBILE — — LIABILITY ANY AUTO ALL OWNED AUTOS BCHEDULEO AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per peresa) - s BODILY INJURY (Pit amaan1) S PROPERTYOAMAGE (Per =Ideal) S GARAGE LIABILITY Th AUTO ONLY- EA ACCIDENT $ OTHER THAN lAACCs AUTO ONLY: AGO S WoRNERs A MESS J LIASI UTY ]OCCUR MAIMS MAOE RDEDUCTIBLE RETENTION $ EACH OCCURRENCE 5 _ AGGREGATE S $ S — S EMPLOYERe ANY PROPRIETOR OFFICER H yes. dwala OP!CIAL I MEMBER PROVISIONS U A ABLI T WC 9 0000 0000 0110112009 01/01/2010 STATU. X I TORY ITS I OTHER WITS EL, EACHACCIDENT $ 1,000,000 $ 1.000,000 I PARTNER, EIHCUTIV! EXCLUDED? UMW' Wow EL DISEASE • EA EMPLOYEE EL DISEASE - POLICY LIMIT - $ 1,000 000 OTHER LEASED EXTENDED TO POWER AIR LLC (CLIENT) FOR TO STATUTORY EMPLOYEES. DEaCRIP IION OP OPERATIONS, LOOAToNS , %NAM !S I EXCLUSIONS ADDED BY EN00RE!MINT I SPECIAL PROVLaIONB EFFECTIVE 03/28/2008, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT CERTIFICATE HOLDER CITY OF MIAMI BEACH ATTN: BUILDING DEPARTMENT 1700 CONVENTION CENTER DR. 2ND FLOOR CITY HALL MIAMI BEACH, FL 33139 Loa /L00Ii CANCELLATION ��- 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 THR LEFT, our FAILURE TO 00 SHALL IMPOSE NO =GAME OR LIABILITY OF ANY RIND uFON THE INSURER, ITS AGENTS 0R REPRESENTA AUTHORED REPRESENTATIVE C�IrJ d(/►,�i wna0 VOLOLBLLZL XVJ ZE :60 6002 /bl /b0 ALEX SINK COD CO' STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. 01 -28 -2009 EFFECTIVE DATE: PERSON: FEIN: 01/28/2009 EXPIRATION DATE: 01/28/2011 LEN BRUCE 270090369 BUSINESS NAME AND ADDRESS: POWER AIR LLC 17101 NE 9TH AVE N MIAMI BEACH FL 33162 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED AC CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05(141, F.S., an officer of a corporation who elects exemption from this chapter by (cling a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(121, 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 440.05(131, F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time alter 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 QUESTIONS? (8501 413 -160E 4 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 01/28/2009 PERSON: BRUCE LEN FEIN: 270090369 BUSINESS NAME AND ADDRESS: POWER AIR LLC 17101 NE 9TH AVE N MIAMI BEACH, FL 33162 EXPIRATION DATE: 01/28/2011 SCOPE OF BUSINESS OR TRADE: 1- CERTIFIED AC CONTRACTOR IMPORTANT OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D 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 440.05(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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. H E R E QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 [POW AIJ IN at q! 44 11114111/61! q iVf1ElB • Power Air LLC Power Air LLC 17101 NE 9th Ave North Miami Beach, FL 33162 (786)486 -3291 sales @powerai rac.com Shoreview Center 9999 NE 2nd Ave Miami Shores, FL 33138 Estimate 08/05/2009 1344 09/04/2009 { r r,.,,�. `� ° "� 1, ,. 08/05/2009 Condensing Unit Remove 3 x existing 25 of roof, and install 3 x units in the same loca modifications to the e units as they are large Ton York condensing units off new.25,Ton,;Carrier condensing onWc %ijl save to make some i.inig platform to -fit the new t the cx�sting s nits � y Q Q B. L " iat2.5(). 35,250.00 This price includes crani g the -existing unit of he roof and disposal of the s,, • crania thenncw Carrier units up to the roo • tart lto exiisting low voltage connections, and refr g `ram.Iiese(s., 1 This price does not "III i iddy l igh voltage, work' at all. This will have to be done by a licensed electrical `` contractor who must pull his own permit for the electrical work to be done. 08/05/2009 Permit Fee The permit fee will be an additional fee based upon the 1 0.00 0.00 exact charge to us by the building department plus a $275 permit expediting fee. 08/05/2009 Terms $30 000 upon signing of estimate, $2500 upon delivery of equipment, 1500% upon completion of install, and 1 0.00 0.00 final $1250 upon approved final inspection. • Continue to the next page.