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MC-12-205Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 169667 Permit Number: MC -2 -12 -205 Scheduled Inspection Date: March 19, 2012 Inspector: Perez, JanPierre Owner: SKLAR, ARI & OSCAR Job Address: 9400 NE 2 Avenue 9400 Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: METRO AIR Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)326 -2747 Parcel Number 1132060132780 -00 Building Department Comments MECHANICAL WORK FOR TENANT IMPROVEMENT. NEW SPRINT RETAIL STORE \ \i\-Y‘ Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 16, 2012 For Inspections please call: (305)762 -4949 Page 11 of 19 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 Per' a FEB 0 3 BY: e A_____�_ovoeee____ V: _ 12® Master Permit Nom 111 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): M S) C L L C. Phone #: Q S {3 D-Q Address:. b ft( 1 L■ woo j ,t City: f`O L y (,a G` " ) State: t Zip: a J C Tenant/Lessee Name: S9 (Li t4 Phone #: t 1 (.o (01 S- 5a46 Email: JOB ADDRESS: / ®® Af vre - p City: Miami Shores County: Miami Dade Zip: 33 ) 3 cc Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: M ,e % i z Ant e r ® t l , 0 t n 0 A J W C : „ Phone #: (45'1- y 9 / / o Address: gi:� ® AI O() 5 7 P -( City: State: FL zip: 333o el Phone #: g5'ti - I- l i,120 ^ // State Certification or Registration #: Certificate of Competency #: C4 L a (y 4 6 6 Contact Phone #:9s1 -y9!— % 80 Email Address: Phone #: 137— 939'— 911180 Qualifier Name: r% DESIGNER: Architect/Engineer: D t P _ Fortin') eil ylee-11"n Value of Work for this Permit: $ co l / © , Square/Linear Footage of Work: Type of Work: Address Aklteration )kew ❑Repair/Replace Description of Work: N e 4) t A-A-1 . / t kk by c-T Wo ❑Demolition ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *Fees® ** ***** * * * * *x * * * * * * * * * *** * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $,5 1 b G CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $50 5.50 2/6 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 ' • ' Apr v and a reinspection fee will be charged. Signature The for day of Mr .. Signature "'!Z der or Agent oing instrument was acknowledged before me this 3rq , 20 �, by P.feal ‘ C ' who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commissio"pires: * * * * * * * * * * * * *** * * * * * ** APPROVED BY Contractor The foregoing instrument was acknowledged before me this \`.1' day of'S vusac)41 , 20 \7., by c-q�0 'Sc" GAS, (who is personally crown to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: °y. Print: CemA0.$0 L,• %s.. CNN.oc1.lLikcav -S c_. NOTARY PUBLIC -STATE OF FLORIDA JACKEUNE TORRES My Commission Expires: "%% Mary Lou Morehouse NOTARY PUBLIC :'; i Commission # DD980799 STATE OF P.ORLDA -.,,,,,,,,..$ Expires: APR. 12, 2014 118657 BONDED TIM ATLANTIC BONDING CO., INC. ��t �Y: 11*** k3: 9r: F3e3eaY3e: kk: F: F: YaF************:Y:Y9:** **3: *k Y** **k***Br*:F***k9F**** Yk* Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009XRevised 3/15/09) 7 ?,,sr.x .,*d7.'w_'?c' ,?mL?.d7RSQct.AcS.'""etto..6S; a .` atc i• 'eL`? 4Y47 :3 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 Receipt #:183-818 Business Name: METRO AIR CONDITIONING INC Business T Yp e :HEATING /AIRCONDITION CONT (A/C CONTR) Business Opened:o9/03/1998 State /County /Cert/Reg:CAC 014 6 6 6 Exemption Code:NONEXEMPT DBA: Owner Name: FREDERICK L INGLE Business Location: 830 NW 57 PL FT LAUDERDALE Business Phone: 491-1980 Rooms Seats Employees 10 Machines Professionals 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 VAUDATED 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: FREDERICK L INGLE 830 NW 57 PLACE FT LAUD, FL 33309 -0000 2011 - 2012 Receipt #03A- 10- 00013405 Paid 09/26/2011 27.00 P.lr& , `Rf= Q131,R D Y1 ACCING8 CERTIFICATE OF LIABILITY INSURANCE W TRO-4 OP ID: DAR;) DATE(YYYY) 01/10/12 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 ADDITIONAL INSURED, Wig palicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the term and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate hold.0tin IIeu of such endorsement(s). PRODUCER Abacoa Insurance Grow PBG 4382 Northlake Blvd, Suite 212 Palm Beach Gardens, FL 33410 Don Raudenbush Metro Air Conditioning, Inc. Attn: Fred Ingle 830 NW 57th Place FL Lauderdale, FL 33309 561 -776 -2323 561 -770 -6425 CONTACT NAME: (A/O, No Ext): E-MAIL ADDRESS: FAX No): INSURERS) AFFORDING COVERAGE 1:7sURER A : Accident Insurance Co. INSURER B : Associated Industries Ins. Co. INSURER C: INSURER 0 : INSURER E INSURER F • NAIC 0 +23140 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REOUIREMENT, 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 DESCRISED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR — ADMSUBIC - POUCYEFF-- POUCYEXP LTR TYPE OF INSURANCE I. - ; ,.I. POUCY NUMBER MMUD . MUID . LIMITS GENERAL LIABILITY A X COMMERCIAL GENERAL UABILITV A92250 09107/11 09107/72 CLAIMS -MADE X OCCUR GEM. . AGGREGATB .IMIT AP PLIES PER X POLICY JEST LOC EACH OCCURRENCE $ 1.000.000 0AMAGETORENTEO PREMISES LEa occurrence) s MED EXP (Any one person) $ 100,000 5,000 1,000,000 PERSONAL & ADV INJURY S GENERAL AGGREGATE s - - - - . -- - PRODUCTS • COMP/OP AGG . 5 S 2,000,000 -- _ 1,000,000 AUTOMOBILE LUUDLITY . _ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT SEs =dent) S BODILY INJURY (Per person) S B ODILY INJUR Y (Per S PROPERTY DAMAGE S (Peraoeden:) S UMBRELLAUAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE DED RETENTIONS AGGREGATE S S WORKERS COMPENSATION AND EMPLOYERS' LWBIUTY /N 01101/12 01/01/13 X _TORY UrTII S_- -. °Jr: EL EACH ACCIDENT S 100,000 B ANY PROPRIETOR /PARTNERJEXECUTIVEY OFFICER/MEMBER EXCLUDED? N/A AWC1006258 E L DISEASE - EA EMPLOYEE $ 100,000 500,000 (Mandatory In NH) a yes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT s DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Per Florida Statute, ten (10) days notice of cancellation for non - payment of premium. Miami Shores Village 9 10050 NE 2nd. Ave. Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTNOR¢ED REPRESENTATIVE /-. /l==.1. s ACORD 25 (2010 /05) @ 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD