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MC-12-63Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 170666 Permit Number: MC- 1 -12 -63 Scheduled Inspection Date: March 05, 2012 Inspector: Perez, JanPierre Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Gamer Building Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: KOOL FLOW INC Permit Type: Mechanical - Commercial Inspection Type: Rough Work Classification: Repair Phone Number F� rcel Number 1121360010160 -22 Phone: (954)962 -8843 Building Department Comments CLEAN & REPAIR DUCT WORK 3 l4,l�z, Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 02, 2012 For Inspections please call: (305)762 -4949 Page 29 of 30 Miami Shores Village Building Department 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 Permit No. Master Permit No. C Owner's Name (Fee yySimple Titleholder) RAO ( iN Nenr Phone # Owner's Address b) 'OC NIC AVCc.1 City IA) NI siJOris State Zip 33 112 1 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) WILY MI lVb Ps try City Miami Shores Villa a County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone ® GA(N6O- 4 4t Contractor's Company Name 1 /A) ® is 1 � 1 d`JQ S / Contractor's Address 1/( 3 i9 S City J'lr'f r, " ` i `. State Phone # //// rFN../ Zip 0 l� Qualifier Name r.,Ri(/ £ /A-2) Phone # State Certificate or Re istration No. v�", C/ ( 3j ertificate of Com etenc No. g P Y Contact Phone gs Architect/Engineer's Name (if applicable) E -mail Phone # k'Value of Work For this Permit $ , Z0 Type of Work: ❑Addition Describe Work: ,/ �,q� (/(/is ��'�, `� �✓'J mil►` ` % tO I ! ` r1(0) ❑Alteration Square / Linear Footage Of Work: ❑New ❑ Repair/Replace ❑ Demolition Submittal Fee $ Permit Fee $ Notary $ Scanning $ Radon $ Double Fee $ lees CCF $ CO /CC $ Training/Education Fee $ DPBR $ Violation date: Structural Review. $ Technology Fee $ Bond $ Total Fee Now Due $ See Reverse side -+ llonding,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 nspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this l 1' day of WU 'j, 20 17,, by who is personall kno a or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: All My Commission Ex APPROVED BY Contractor The foregoing instrument was acknowledged before me this 2. day of , 20 V1--,by &i f`l (3N..3 S �d- t who is personally known to me or who has produ e 1 O as identification *Ma l 'i'ditai5e an oath. `‘..„,..co . Ny ® w4.• :03 — f• C' ° 0 E NOTARY PUBLIC: Sign: Print: My Commission Expires: /Ifllllll����11\\ ********************************* * * * * * * * * * * * * ** * * * * * * ** * * * * * * * ** Plans Examiner Engineer (Revised 07 /10 /07XRevised 06/10/2009) Zoning Clerk checked Jan.12. 2012 2:43PM Accounting & Tax Service No.4481 P. 1 A CCoRL1e DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 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 ADDr11oNAL INSURED, the poiicy(Ics) must be endorsed. If SUBROGATION IS WAIVED, subject to • the terms and conditions of the policy, certaln policies may require an endorsemclik, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement$), PRODUCER C8NTA0T — —' ALL ABOUT INSURANCE NAME:, _,_,_ GAIL SANOIR _ Pte, ,.E,-t : (954) 284 -8282 7962 Miramar Parkway ) Vic, soh A. BESS: info.ellaboutins@gmail.COm Miramar, FL 33023 • — — •— ._—.. • Phone (954).284-8282 IN PU SUR7(S) AFFORDING covERAGE INSURED __ I INSURERA: KOOL FLOW INC i INSURER B : INSURER C : • 7021 SW 30 STREET ; INSURER D: MIRAMAR, FL 33023 954 e45URER E : —COVERAGES — INSURER F : CERTIFICATE NUMBER: _REVI$ION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE IADDLSUBRI `. POLICY EFF POLICY EXP • ARM I wUA, P LILY NumeeR _ (piroDryYYYt j (MM/DD/YYYY) LIMITS 1 Fax - (954)965 -2325 A FCB&IFUND (954) 965 -2325 NAILS •, GENERAL LIABILITY COMMERCIAL, GENERAL LIABILITY I .. ! 1 I CLANS-MADE r OCCUR Ir GI N'l. AGGREG_AI E LIMIT APPLIES PER• ' POLICY _ ; f 0 LOC • AUTOMOBILE UABILITY j ANYAUTO .1 . �OWNED YI SCHEDULED iJ HIRED AUTOS i J AUTOS WNED j 1 i t UM$REL LESS LIAR I CLAIMS -NJDE J DED I , RETENTION$_ WORKERS cOMPENSAT10N 1 AND EMPLOYERS' UAalLnY ANY PROPRIGT R/PARTNEWEXECUTiVE / N OFFICER1MEMI ;R EXCLUDED? If yea_ Eestribc under L..Y • OE5_tRIPTION OF OPERATIONS below I IU LA LIAa I OCCUR 1 a j ! • (Mandatory in NH) • ijNIA; I I _ _ DESCRIPTION OF OPERATIONS r LOCATIONS / VEHICLES (Attach ACORD 106 -48116 CERTIFICATE HOLDER CITY OF MIAMI SHORES VILLAGE 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 FAX # 305- 756 -8972 ACORD 25 (2010/05) CIF t EACI�9CCURRENCE $ DAMAGE TO RENT—FD r- PREM,5S (Es 000urrenee) ' $ MED EXP (Any cute person) ;$ PtRSONAI. & ADV INJURY $ GENERAL AGGREGATE . s PRODUCTS - COMP /Op AGG 5 S OMde BINED SINGLE LIMIT $ Ls aoci n*) - . 'BODILY INJURY (Per pe rso _ )) g BODILY INJURY (Per sodden*) $ 1"KOPERTY DAMAGE L (Ne(rceiden() EACH OCCURRENCE AGGREGATE :$ `S -- f .5 _ I $ • _$ • ' WC STATU. OTH- ` _TORY_ J5Jf$. -. ER ' t'L' EACH ACCIDENT $ 500,000.00 • 10/29/2011 10/29/2012 I ! El. DISEASE - EA EMPLOYE4 $ 500,000.00 E.L. DISEASE - POLICY LIMIT; $ 500,000.00 I - lea. Additional Remarks Sane— dule. if more space is required) CANCELLATION — I 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 © 1088-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET (850) 487 -1395 TALLAHASSEE FL 32399 -0783 HYLTON, GERVAISE WASHINGTON 7021 SW 030THHCSTREET FL 33023 Congratulations! 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 barbeque 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.myfloridaiicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam more about the Departments 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, and congratulations on your new license! STATE OF FLORIDA -A ' = f Si DEPARTMENT OF . BUSINESS AND -PROFESSIONAL, RNGII.LATION cC1816347 06/30/• 0 0970616.62 TIFIED AIR :COND`. CONTR TON, OERVAIS- WASHINGTON L.' =FLOi : 'INC STATE OF FLORIDA: *ENT DF BUSINESS AND PROFS. PN I AL . RE o T ON • CONSTRUCTION INDUSTRY LICE ING. - BOARD SE(#L1 :0063011;0' 0'4,: LICENSE NBR. t r`e CERTIFIED under the provisions of 02.489 Ft Ep*ratjon date: AUG 31, X220¢,`2 '-1;100630.00504: DATE - BATCH NUMBER �, 30/2f 0 t}9 =,—..i 66391 CAC181.63.47 _ ,W,!--4, n4 ffi8 � A CONDIrIONI G CONTRACTOR v.. ek b dW .1 . E RTI - l l:r ' der t fpro g ona DChapter 48:9 FS Bxp xat1dn date: ;AUG 41, 2012' BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Business Name: KOOL FLOW INC Owner Name: GERVAISE Business Location: 7021 SW MIRAMAR Business Phone: Rooms W HYLTON 30 ST Seats Receipt #:183-228626 Business Type: HEATING /AIRCONDITION CONT (AIR CONDITIONING CTR) Business Opened:10/26/2009 State /County /Cert/Reg :CAC18163 4 7 Exemption Code:NONEXEMPT Employees Machines Professionals 1 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty 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 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: GERVAISE W HYLTON 7021 SW 30 ST MIRAMAR, FL 33023 Receipt #05A -10- 00011106 Paid 09/12/203.1 27.00 2011 - 2012 SHOULD ANY OF THE Aeove DESCRi5ED POLICIES BE CANCELLED BEFORE 1 FIE EXPIRATION DATE 1114 tEOF OTICE WILL BE DELIVERED IN ACCORDA E WITH THE ' • . Y - - + IONS. ®1988 -2010 ACO -•17 CORPORATION. All rights reserved. ACORD ® 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. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDMYYYY) 01/12/2011 IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS VIIAIVED, subject to the terms end 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). David Reiter _ �m. aa� 954 -788 -1005 ML B MApvii,dem davld@$ierracovereyou.com nwRURElusl AFFORDING coveansa PRODUCER Sierra Insurance 4613 N University Dr. #481 Coral Springs, FL 33057 tXlc, No 954 -346 -4801 NAIL INSURER A : Western Heritage INSURED Kool Flow, Inc 7021 SW 30th Street Miramar FL 33023 INSURER B INSURER Cs INSURER 5: INSURER E t INSURER F COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER 1 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEI EXCLUSIONS AND CONDmONS OF SUCH POLICIES, UMrrS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. t+ TYPE OF INSURANCE ml wrra POUC( NUMBER LM DIYY�YVI IM�M1uDDlYTYYYI A GENERAL uAB1u•ITY SCP0813504 09/22/11 09/22/12 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GSN'L AGGREGATE Limn' APPLIES PER: -I POLICY n ITelt L00 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS WIRED AUTOS SCHEDULED NON -OV*I$D AUTOS UMBRELLA LIAR EXC$$S UAB OCCUR CLAIMS•MADE DED 1 I RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' UABLITY ANY PROPRIErORiPARTNERIEXECUTIVE (MOdeto OFFICER/MEMBER ) EXCLUDED? Ityaa, donee under DESCRIPTION OF OPERATIONS betOn NIA DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarha $flMdale, If nor@ APelle IF required) ;D NAMED ABOVE FOR THE POLICY PERIOD )OCUMENT WITH RESPECT TO WHICH THIS HEREIN 1S SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE $ _ 1,000,000 DAMAGE TO RENTE6 PREM,LSES tErl oocurASAr03 -1, MED EXP (Any me person) 100,000 $ 5000 PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS •COMPfOPAGO $ 2,000,000 $ COMBI a D $:NGLE OMIT BODILY INJURY (Per per n) $ BODILY INJURY (Per awldmd) 3 PROPERTY DAMAGE acciden $ $ EACH OCCURRENCE 3 _ AGGREGATE $ $ _ I Jam- _, E.L. EACH ACCIDENT S EL DISEASE - EA EMPLOYEE 3 E.L. DISEASE- POLICY LIMIT 3 _ CERTIFICATE HOLDER CANCELLATION City of Miami Shores Village 10050 N.E. 2nd Ave. Miami Shores, FL 33138 fax 1- 305 - 756 -8972 ACORD 25 (2010/05) The ACORD name and Togo are registeisd marks of ACORD