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MC-10-2138
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 153895 Permit Number: MC -12 -10 -2138 Scheduled Inspection Date: February 02, 2011 Inspector: Perez, JanPierre Owner: SWISHER, LESLIE Job Address: 530 NE 96 Street Miami Shores, FL 33138 Project: <NONE> Contractor: SERVICE AMERICA ENTERPRISE INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number - Parcel Parcel Number 1132060140691 Phone: (954)979 -1100 Building Department Comments NC CHANGE OUT 2 UNITS TRANE PLEASE DO NOT SCHEDULE ANY INSPECTIONS UNITL NOC IS IN FILE 12/3/10 Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 01, 2011 For Inspections please call: (305)762 -4949 Page 11of17 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, 11orida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 DECO2201O BY: .N.7:-.7.7.77,77 Master Permit No. Permit Type: MECHANICAL`` ,, M i OWNER: Name (Fee Simple Titleholder):, /An In On-k O Phone ) R dad} E Address:530 IUD q lQ S4 City: 11/1,i C4erl i 61110 r 3 State: fl (r c.4 &. Zip: -3(3k Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 530 FuE gip 3 -' City: Mia mi Shores County: Miami Dade Zip: 3 Folio/Parcel#: J G-3 ably - OLO CI 1 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Address: 13A-MU �- —) Lk) 3 City: Qualifier Name: State Certificatio Contact Phone# Phone#: 6sLoQ 1 l -4j00 ext-tialkid '_I -li(30 I (iS( Phone istration #: 19C. O M 1 "i Certificate of Competency #: 4 9 - (too zX q 2!(4Email Address: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: OAddres� //�� sl DAlteration Description of Work:" IC, Ono 3-ty`! CO.��e.r�. /ow ill l� TC5 aao & 0,1v: (4T1"lZ5O3loE tocO/r ONew ►.I" epair/Replace Dun - rQ(Q. 31/2_ I Lc) f.o_uz Iolit_u (H: JTEE3C.04 A-Iono A- CrIv .' ifi150!ya E /ono A- ODemolition * ******* ************000******* *******F *+k******** k+k *+R*******M********* ***** h***** Submittal Fee $ 50- CO Permit Fee $ "6 5 i 1')C CF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ a3� 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 FT,RCTRICAL 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 .immencement must be posted at the job site for the first inspection which occurs seven (7) days after the building pe ' 't is sued ' In the absence of such posted notice, the inspection will not ' ' ' i proved and a re e will be charged. Signa Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 30 The foregoing instrument was acknowl , ged fore me this 2- day of au , 20 /a, by '1;'et P4oeMle , day of � _ . 20 V , by who is personally known to me or who has produced DL.- w + o. pe y kno R' me or who has produced w., As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print My Commission Expires: HAMMANG • State et Ronda c *Comm. • << res Mar 26, 2014 Gommisslon ! 00 984138 NOTARY P Sign: Print: LIC: My Commission Expire + N*aR *Ni*iB+b ****** �kKaIaiaR�R �k ,,.r <. .stir *+REDP+fl�** **�k *�@�bd��kar� *** lye KELLY M. ROTKOWITZ MY COMMISSION # DD 974505 "5 EXPIRES: March 24, 2014 ' ^ Bonded ?hru Notary Public Underwriters Structural Review Clerk (Revised 07 /10/e7)(Revised 06/10/2009)(Revised 3/15/09) Record and Return To: Sunbelt Title Agency 809 S. Orlando Avenue, Ste K-O Winter Park, FL 32789 FILE NUMBER: 7938101486 LOAN # 0034451864 SPECIAL WARRANTY DEED Made this 17th day of November, 2010, by J.P. MORGAN MORTGAGE ACQUISITION CORPORATION a Corporation existing under the laws of the State of DE whose address is: 2001 Bishops Gate Blvd., Mount Laurel, NJ 08054 hereinafter called Grantor, and to: JUAN B. MONTERO, A SINGLE MAN and whose mailing address is: 530 NORTHEAST 96TH STREET, MIAMI SHORES, FL 33138, hereinafter called the Grantee. Grantor, in consideration of TEN DOLLARS ($10.00) AND OTHER GOOD AND VALUABLE CONSIDERATION paid by Grantee, grants and conveys to Grantee that property located in the County of Miami Dade, State of Florida, described more particularly as follows: Lot 9, Block 54, Miami Shores Section Two, according to the Plat thereof as recorded in Plat Book 10, Page 37 of the Public Records of Miami -Dade County, Florida PARCEL ID #: 11- 3206 -014 -0691 AKA: 530 NorthEast 96th Street, Miami Shores, FL 33138 Subject to easements and restrictions of record. Subject to the lien of the General Taxes for the year 2010 and thereafter. Grantor covenants as follows: 1. That the premises are free from all encumbrances made by Grantor; and 2. That Grantor will warrant and defend the property hereby conveyed against the lawful claims and demands of persons claiming by, through, or under him, but against none other. SWDREO.DOT 11/05/09 AC II AKA: 530 NorthEast 96th Street, Miami Shores, FL 33138 IN WITNESS WHEREOF, the said party of the first part has caused these presents to be signed in its name by its proper officers, and its corporate seal to be affixed, attested by its secretary, the day apd year above written. Sig ed, Sealed and lel ered In t ' = Presence of: Printed e: t —r4,Q1 010g Printed Name: STATE OF: NEW JERSEY COUNTY OF: BURLINGTON J.P. Morgan Mortgage Co BY: PRINT NAME: Q2x J,. Otri, i�(,l e TITLE: 1%e(g. ltG.- scol#1i F. ge A ition Corporation, by PHH Atto ey Fact REBY ERTI that o this date %b day of November, 2010, before me personally appeared , i v.) (PRINT NAME),Aesistant Vice President of PHH MORTGAGE CORPORATION, AS ATTORNEY IN FACT FOR J.P. MORGAN MORTGAGE ACQUISITION CORPORATION, a corporation under the laws of the State of DE, to me personally known and who signed the foregoing instrument as such officers for the uses and purposes therein mentioned and that they affixed thereto the official seal of said corporation, and that the said instrument is the act and deed of said Corporation. WITNESS my signature and official seal on day of November, 2010, in the County of Burlington and the State of New Jersey. ARY PUBU signat Print Name: f late nI; _ /e St ColSeal: o xpi � Stamp /Seal: ,13 Q Prepared by: Brandy Cooper Sunbelt Title Agency 3689 Tampa Road, Suite 330 Oldsmar, FL 34677 FILE NUMBER: 7938101486 LOAN # 0034451864 SWDREO.DOT 11/05/09 AC Danielle E. Reeve Notary Public State of New Jersey 315tIS Miami Shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): S U 1 qio 2 City: Miami Shores Village County: Miami Dade Zip Code: 3 3I (38 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ARHI Sheet Attached: YES (r, NO ❑ Contract Attached: YES UNIT BEING REPLACED DATA NEW UNIT el asss1 MANUFACTURER �^ / - art/ -b5 Li AHU or PKG. UNIT MODEL # 1nE awry( COND. UNIT MODEL # 14 1712-S. 3.Q Fes) WO= /® je.i_t KW HEAT IO ,R NOM TONS 3 AHU CU /1' PKG 1) M.C.A AHU(1CU 19 PKG AHU (p(CU3O PKG 2) M.O.P AHU( ,7CU3% PKG AHU U PKG 3) VOLTS AHU 4 s U „'`'' G PKG UNIT / / PKG UNIT / / if EER/SEER I LO t$ o p. YES N REPLACING DUCTS YES O4% NO AYES REPLACING THERMOSTAT NO (SID - NEW 4 "CONCRETE SLAB YES , YES c '7 NEW ROOF STAND YES (Pie YES NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (Wire Size): 4 141. f;(j Nu; u ; 0 2. Maximum Overcurrent Protection (Fuse /Breaker Size): OP CJU l' 0 3. Voltage of Circuit (208/240/480): 000 4. Size Disconnecting Means: (3((M . 30 Nu, (o Contractor's Company Name: U3 Lf „ t.... Y��.R Cam_.. Phlo�n 9 " 1(0 D l State Certificate or Registration N. Certificate of Competency N. P0_010 /9 Signature Date: (Qualifier's signature only) 3sISFLIg Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 530 QS C11045+ City: Miami Shores Village County: Miami Dade Zip Code: 33) B? ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT '2 Uri 1,1 (��1� ,,, MANUFACTURER (j 7 t 1 n► AHU or PKG. UNIT MODEL # e , b () U 14 Copp,- �� COND. IT MODEL # LiT119- ItO®1 $ HEAT Q lGl� NOM TONS S i/ AHU CU PKG 1) M.C.A AHU ( ccu 00 PKG AHU CU PKG 2) M.O.P AHU (CCU CM PKG AHU CU PKG 3) VOLTS AHU 3CU EKG PKG UNIT / / PKG lANIT / EERISEER 1 YES "Zie REPLACING DUCTS YES AEs? NO REPLACING THERMOSTAT NO YES r NEW 4 °CONCRETE SLAB S ' 0 YES [e NEW ROOF STAND YES '• YES ,' ! NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity (ire Size): vl D • 0-41) !°� f • �Y 2. Maximum Overcurrent Protection (Fuse/Breaker Size): • Li ® Pdif:Le0 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: d U- LJ D A Iii: (P 0 Contractor's Company Name: 3/2,Ay L) lJ? Phone: /� State Certificate or Registration N. Certificate of Competency N. (A (5 b/C) Signature Date: (Qualifiers signature only) This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2010. CertiIc- .Product t gs AHRI Certified Reference Number: 3470859 Date: 12/1/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTR5036E1 Indoor Unit Model Number: 4TEE3C05A1 Manufacturer: TRANE Trade /Brand name: XR15 Manufacturer responsible for the rating of this system combination is TRANE Rated as follows in accordance with AHRI Standard 210/240 -2006 for Unitary Air- Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party testing: Cooling Capacity (Btuh): EER Rating (Cooling): SEER Rating (Cooling): 36000 13.00 16.00 * Ratings followed by an asterisk () Indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridireciory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents (Otitis Certificate may not In whole or in part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" Zink and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which is listed below. ©2010 Air - Conditioning, Heating, and Refrigeration Institute ® ®Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129356985471766173 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2010. Ce to of Product tine AHRI Certified Reference Number: 3470859 Date: 12/1/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTR5036E1 Indoor Unit Model Number: 4TEE3C05A1 Manufacturer: TRANE Trade /Brand name: XR15 Manufacturer responsible for the rating of this system combination is TRANE Rated as follows in accordance with AHRI Standard 210/240 -2006 for Unitary Air - Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party testing: Cooling Capacity (Btuh): EER Rating (Cooling): SEER Rating (Cooling): .` 36000 13.00 16.00 Ratings followed by an asterisk (*) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an Involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on `Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which is listed below. ©2010 Air - Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129356985471766173 Air - Conditioning, Heating, NISI ® and Refrigeration Institute Certificate of r This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2010. duct firgs AHRI Certified Reference Number: 3435462 Date: 12/1/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTR5042E1 Indoor Unit Model Number: 4TEE3C04A1 Manufacturer: TRANE Trade /Brand name: XR15 Manufacturer responsible for the rating of this system combination is TRANE Rated as follows in accordance with AHRI Standard 210/240 -2006 for Unitary Air - Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party testing: Cooling Capacity (Btuh): EER Rating (Cooling): SEER Rating (Cooling): 40000 * Ratings followed by an asterisk (1 indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaim all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.anddirectoryorg. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for Individual, personal and confidential reference purposes. The contents of this Certificate may not, In whole or in part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified atwww.ahridirectory.org, click on `Verify Gertitkate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which Is listed below. ©2010 Air - Conditioning, Heating, and Refrigeration Institute Alr- Condltioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129356985752240308 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2010. Ce.HLcte of oduct Rati s AHRI Certified Reference Number: 3435462 Date: 12/1/2010 Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 4TTR5042E1 Indoor Unit Model Number: 4TEE3C04A1 Manufacturer: TRANE Trade /Brand name: XR15 Manufacturer responsible for the rating of this system combination is TRANE Rated as follows in accordance with AHRI Standard 210/240 -2006 for Unitary Air - Conditioning and Air - Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI - sponsored, independent, third party testing: Cooling Capacity (Btuh): EER Rating (Cooling): SEER Rating (Cooling): 40000 13.00 16.00 *Ratings followed by an asterisk (`) indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed In the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, In whole or In part, be reproduced; copied; disseminated; entered Into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The Information for the model cited on this certificate can be verified atwww.ahridirectory.org, Air- Conditioning, Heating, click on "Verify Certificate" Ilnk and enter the AHRI Certified Reference Number and the date on IN and Refrigeration Institute which the certificate was issued, which Is fisted above, and the Certificate No.. which Is listed below. ©2010 Air- Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129356985752240308 STATE OF FLORIDA DEPARTMENT OF BUSYNESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0793 LEVINSOT, RICHARD MARC SERVICE AMERICA ENTERPRISE INC 2755 NW 53RD: COURT FORT LAUDERDALE FL 33309 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 bush ess.in order to serve you better For information about our services, please log, onto www myflorldalioen~ e.co n. There you can find mote information about our divisions and the regulationsthtt impact you, subscribe to department newsletters and learn 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, and congratulations Oh your new license DETACH HERE ACT 51 ;;ice ,.ff., *�.� 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301 -1895 — 954-831 -4000 VALID OCTOBER '1, 2010 THROUGH SEPTEMBER 30, 2011 DBA: Business Name: ER CE AMERICA ENTERPRISE IN Owner Name: RICHARD 'MARC LEVINSON Business 'Location: 2755, NW 63 CT HOLLYWOOD' Business Phone: 954 - 929 -6600 Rooms Seats Eriptoyees. 15 Receipt #: 19 3 -1417 Business Type: CASs AA . /COCO N C Business Opened: ti e./ 01 /199 StatetCoumy /CertfRsg :CAC014 619 Exemption Cade :MNEXEMPT. Machines Prafessipnals For Vending Business On'. Number of Machines: Vending Tyne Tax Amount Transfer Fee NSF Fee Penalty Prior Years Cone ction Cost TvtaIPaid 54.00 0.00 0.00 0.00. 0 0,00 54.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY. IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED This tax is levied for the privilege of doing business within Simard County and is non - regulatory in nature. You must meet all County and /or Municipality planning and zoning requirements. This Busines§ Tax' Receipt most be transferred when the business is sold, business name has changed tit* 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; SERVICE AMERICA ENTERPRISE INC 2755 NW 63 CT FT LAUDERDALE, FL 33309 Receipt #05A-09-0002602g Paid 07/27/2010 54.00 2010 2011 ACG D CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/23/2010 PRODUCER 1- 305 -592 -6080 Arthur J. Gallagher Risk Management Services, Inc. 8200 N.W. 41st Street Suite 200 Miami, FL 33166 THIS CERTIFICATE IS ISSUED AS A ONLY AND CONFERS NO RIGHTS HOLDER. THIS CERTIFICATE DOES ALTER THE COVERAGE AFFORDED MATTER OF INFORMATION UPON THE CERTIFICATE NOT AMEND, EXTEND OR BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Service America Enterprise, Inc. 2755 NW 63rd Court Fort Lauderdale, FL 33309 INSURER ZURICH AMERICAN INS CO 16535 INSURER B: AMERICAN GUAR & LIAB INS 26247 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DDIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 0L065555467 -01 10/25/10 10/25/11 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 1, 000, 000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10 , 0 00 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L 7 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JET LOC A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS BAP6555466 -01 10/25/10 10/25/11 LIMfT (Ea accident) $ 1,000,000 X X X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGO $ B EXCESS X /UMBRELLA LIABILITY ABC 6555463 -01 10/25/10 10/25/11 EACH OCCURRENCE $ 5,000,000 OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ Nil $ $ X $ WORKERS AND EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (Mandatory If yes, describe SPECIAL COMPENSATION LIABILITY Y / N WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ in NH) under PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Evidence of Coverage CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE Second Ave. Miami Shores, FL 33138 USA 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE \�k 4bS ACORD 25 (2009 /01) mrutyun j ayamia 18018549 © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 This Certificate of Insurance 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 (2009/01) A i CERTIFICATE OF LIABILITY INSURANCE DATE 2;;20°;0 ' 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, the policy(les) must be endorsed. 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). PRODUCER Commercial Lines - (610) 251 -8010 Wells Fargo Insurance Services USA, Inc. 1018 West 9th Avenue, Suite 100 King of Prussia, PA 19406 NAME NAME: PHONE FAX (A/C o Ext): (A/C. No): POLICY EXP (MM/DD/YYYY) E -MAIL ADDRESS: PRODUCER 65077 CUSTOMER ID # INSURER(S) AFFORDING COVERAGE NAIC # INSURED Service America Enterprise, Inc. 2755 NW 63rd Court Fort Lauderdale, FL 33309 INSURER A: PA Manufacturers Association Ins. Co.. 12262 INSURER B INSURER C : EACH OCCURRENCE INSURER D : INSURER E : $ INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: 1927862 REVISION NUMBER: See below 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 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. INSR L TR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MDD/YYYY) M/ POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE $ PR S (RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GE 'L AGGREGATE LIMIT APPLIES PER: LOC PRODUCTS - COMP /OP AGG $ POLICY PRO- JECT JECT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A 201075 7650856 10/25/10 10/25/11 x TORY LIMITS O I- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE Second Ave. Miami Shores, FL 33138 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 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 530 NE 96 Street Miami Shores, FL 33138 1132060140691 Block: 54 Lot: 9 LESLIE SWISHER Owner information Address 70 NW 105 Street MIAMI SHORES FL 33150 -1242 Phone Cell Contractor(s) Phone Cell Phone SERVICE AMERICA ENTERPRISE INC (954)979 -1100 Tons: 31/2 & 3 Additional Info: A/H & COND UNIT SPLIT SYSTEMS Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: MECHANICAL Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $6.60 $5.34 $5.34 $2.20 $355.43 $3.00 $8.80 $386.71 Pay Date Pay Type Amt Paid Amt Due Invoice # MC -12 -10 -39558 12/02/2010 Check #: 9377 $ 50.00 $ 336.71 12/03/2010 Check #: 9391 $ 336.71 $ 0.00 Available Inspections: Inspection Type: Final 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 I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 03, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy December 03, 2010 1 12/02/2010 13:41 9549773591 / AR VICE AIR CONDITIONING Mei. eel y°• etle• SERVICE AMERICA Corporate Office 2755 NW 6Srd Court • Ft. Lauderdale, FL 33309 www.serviaearnerica.com Oa 6/4'd fritery PROPOSA 3673;99 q PAGE 01/01 10Db:1Z dt I61►31g !�- z4'la Date: % Homo phone: Pod'K r �f6 r •r f.DDVi other phone- dir 41/2 Emad1 Address: .T 3 C7 Installation Address: System Type: milt 0 Package Condenser Location: round 0 Roof ❑ Grano Needed JOB SPECiFICATIONS DRAIN LINE & REFRIGERANT PIPING Bldg: Q Water Source s.o.a S.O.ff Admin. Fee: Apt: .... Y. reight Cool R Heat Pump ,# of Stories Air Handier Location: 0 Garage 0 Attie a cr .set z =•are CONTROLS & ELECTRIC Wiring: 0 Thermostat 0 Disconnect Sox 0 Smoke Detector Replace Circuit Breaker= 0 Air Handler: Size Type 0 Condenser: Size __Type _ Type - — 0 Heater: Size Condensate Drain Hook -up: tafflirriary 0 New Condensate Pump 0 Slaob=antai drain pan 0 A.syxxillary drain pan tiuxilary float safety switch 0 Refrigerant copper liquid line size: 0 Refrigerant copper suction line size: D Gas pipe from •• 0 Refrigerant line cover l 1.-410A Plus • I Ilati� Y f3 9d e ' mativn :r ' •'' - 1 _ All work performed in accordance with existing cedea.and ramovlal of old nqpermits 1pment�r work Performed by us. Mounting hardware for 1 nstakletlL+n, Weather resistant vibration /isolation pads, hurricane strapping n .ems Make T!'�M- e Tons 3 SEER __L. BTU 3‘r • KWH /,te2 Model A/H 1-17ff Co,f»l' OP' Model Cond 24 7't" f2• O-Sd'ia-leM Price Option 2 Make 1 'Ci t'1 e Tons X I /'2_ SEER /te //—.3 Option 3 sru K at ao KWH /d oriel A/H CEE3COAl4 /,A7 ode% Cenci �" !.` - a J© Price 45/30 • System Investment Vim.^ Install Kit/Crane gekated redits S' Utility FT t. -' Service AmericaCpc. •- MOO - g00 Other Reggr inencl si Insulation Duct Cleaning UV Light Other ' erviee America Parts & Labor Warranty A/H ' 1 Years lel[ Service America Parts :& Labor Warranty Cond. __,1 —. Years d//Mawaitewers• Warranty on Compressor _ i a Eli Years car anufacturer's Warranty on Outdoor Coil JO. L 0 Years • Manufacturer's Warranty on Indoor Goal 0 L 0 ,Years 0 Manufacturers Warranty Parts rnntitJ► .0-"°C—IMS` ity Administrative Fee 4' 1X _ „I pmn-ra>4mdatwq�► 3 Total investment3 i2. ! 3 Auth Down Payment ! Expiration Date Ralanee D.'+ Method of Payment: 0 Cash ❑Check ii;efedit Card 6t4 1390 [] Financing Credit, Card Type ❑ Visa 0 MC IAMEX 0 Discover Credit Card It 37t7 Of6Z(i Signature• I installation Date: r► /` 2 .&7 7,245._...1 ' � 1 Financing Company :..w _ El . _---� � ®pprtlesd:aealt ad. kis agreed an mnderstoed by Terms t accept this propose/ and the spa s/mil one and become fiat r s above. of e r auaata ed to perfe arc laced un paymer t in full is received. Buyers right to e n urn the which is avid pursuant onrd ahaii net l y or o ligationo at any Part it the real wham they P • Pesowilo a aloe to /molders In run capon completion pletfon of fnatntlaHQa. This proposer r v for 30 day unless otherwise altnrthe the date of this transaction b�' P+oP My signature acknowledges acceptance of the terns above. i have read and understand all Informatiois on %.- -,- ".'" % '~ t udder rar{ut Imp' 'j --. '•• • Inspection Date: o�• r- vealaw copy - CurU.ter * Sok Copy -mews. -Casa Copy -Pee 6oi the front and back of t tits pro I. Customer Signature: Comfort Consultant: Date: Z • -1 t'J 1 i Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 530 NE 96 Street Miami Shores, FL 33138 1132060140691 Block: 54 Lot: 9 ANTHONY LIMA Owner Information Address Phone Cell ANTHONY LIMA 969 NE 92 Street MIAMI SHORES FL 33138- U -- 969 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone SERVICE AMERICA ENTERPRISE INC (954)979 -1100 Type of Work: ELECTRICAL Additional Info: A/C HOOK UP Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount 00.80 $2.00 $2.00 $0.20 $100.00 03.00 $0.80 $108.60 Pay Date Pay Type Invoice # EL -1 -11 -39773 03/07/2011 Check #: 10043 01/06/2011 Check #: 9618 Amt Paid Amt Due $ 58.60 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. J Applicant Copy For Inspections, Call (305) 762 -4949 or Log on at https: // bldg .miamishoresvillage.comlcap /. Requests must be received by 3 pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT the public records of this county. DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. March 07, 2011 2 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 530 NE 96 Street Miami Shores, FL 33138 1132060140691 Block: 54 Lot: 9 ANTHONY LIMA Owner Information Address Phone Cell ANTHONY LIMA 969 NE 92 Street MIAMI SHORES FL 33138- 969 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone CeII Phone SERVICE AMERICA ENTERPRISE INC (954)979 -1100 Valuation: Total Sq Feet: $ 1,000.00 0 1 Type of Work: ELECTRICAL Additional Info: NC HOOK UP Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 Pay Date Pay Type Invoice # EL -1 -11 -39773 03/07/2011 Check #: 10043 01/06/2011 Check #: 9618 Amt Paid Amt Due $ 58.60 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. 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 I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. March 07, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date March 07, 2011 1 35161(19 1 1 Fq k \\7,‘V Kij BUILDING 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 Permit No. l l 1 11 L — 91 PERMIT APPLICATION FBC 20 :p31 c ggw3i1 r� 691011 NJ BY: Master Permit No. Permit Type: Electrical (�/� art a° OWNER: Name (Fee Simple Titleholder): JuQft / o a l j i 3 Phone O5>) 0 d "X01 Address: SRO k±,- q U Si- City: DI Co N, 5 %LDt Jo State: c10 r (A0_ zip: 33 ( &8 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 53 L. q iv St City: Miami Shores County: r Miami Dade FolioIParcel#: I ! - 3a-t)l.Q -01(-1 -0 `0 c Zip: 3313k Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: SQL cL Phone#: 1 "g -1 / 0ck C /Z,`F Address: a4SS YO L° (Q city: FV C J-. eU.c to t o state: nor-41- 30 � 9 Qualifier Name: Et CvWA, la) '4C&Y Phon Ms3 H0 ) State Certificatioyr Registration #: (P C 011-11121 1 1 Certificate of Competency #: ' O) u cp 1'9 Contact Phone#: -1-1- I /eO Witunail. Address: DESIGNER: Architect/Engineer: Phone# Value of Work for this Permit: $ 1 TO. == Square/Linear Footage of Work: Type of Work: OAddress O O Alteration New ORepair/Replace ODemolition Description of Work: lam�/ - U p J �. op 0 Submittal Fee $ Permit Fee $ /Co 69,00 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL ME NOW DUE $ �� 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 reinsp tion fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this . � day of %) i , 20 j, by 3..v el !b'Dirt f en, who is personally known to me or who has produced CL. As identification and who did take an oath. NOTARY PUBLIC: Contractor The foregoing instrument was acknowledgqdiefire me this, I day of I _ 0� (),by -Tata f (i1(TJtJ1«°'.. to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Structural Review (Revised 07 /10/07)(Revised 06 /IO/2009XRevised 3/15/09) T ATE OF "LORIDA • m# DD9350 Expires 10/21/2013 *********** * * **** *** *** * * *** *** * * * * * * * * * ** Zoning Clerk 01/19/2011 10:24 9549773591 STATE OF FLORIDA SERVICE AMERICA PAGE 02/02 (L-27 DEPARTMENT OF BUSINESS AND PROFESSIONAL ItEaLTLATICON ELECTRICAL CONTRACTORS LICENSING BOARD ($5.0) 487 - 1395 1940 NORTH MONROE STREET T.ALLA% ,SSEE FL 32399 -0783 PERLMTJTTER, TODD SERVICE AMERICA ENTERPRISE INC PORT LAUDERDALE PL 33309 Congratulations!. WO this license you become one of :the nearly one million Florldi Ins 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 services, please log onto www,myfiaridsdtcense.Com, There you con•f'ined more inform tion about our division's and the regulations' that impact you, sub'sorlbe to 'department newsletters and learn more about the Department's initiatives. Our mi'sslort 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 congretuiations.on your new license! . DETACH HERE L �l.�uiI WC4F.r: :L l!i3 G1.i,�, 1.7 ,�•�j':' °'• fitd4t�q'/ y' j' iyy+;.aCATOR �.— •�'•.�',� L6WV, 1��•.4i't'i: Vi.I.il i�iv.U'' .4' •4' • . • �. Lf'e ;1.7# 46'. • k twj-:e: prssv'S1:'�3 t;i 's' of:: : 'f- ? rat ',i*:. d'&t =e:: C2O12 4, ,- ..S• fZV.'•r' CE AM.�` RzcA ' 'NSTE•R; r . *•. ,.4 •'F"ORR'.' LAt'I SERbA ;N• ' 5}_ Di,SPLiAAS Ri= .Q't1 {R< _ '''. �.a "sIS;L;G�ug: 1 t, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1) 10/21/2010 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 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, the policy(Ies) must be endorsed. 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). PRODUCER Commercial Lines - (610) 251 -8010 Wells Fargo Insurance Services USA, Inc. 1018 West 9th Avenue, Suite 100 King of Prussia, PA 19406 CONTACT NAME: PHONE FAX Ext): (A/C. No): EL ADDRESS: PRODUCER 655077 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Service America Enterprise, Inc. 2755 NW 63rd Court Fort Lauderdale, FL 33309 INSURER A : PA Manufacturers Association Ins. Co.. 12262 INSURER B : INSURER C : INSURER D : $ INSURER E : DAMAGE TO RENTED PREMISES Ea occurrence) INSURER F : • 192786 REVISION NUMBER: See below 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 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 INSR TYPE OF INSURANCE AINSR SwVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence) $ CLAIMS -MADE MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ —1 POLICY PET LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LUAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N/A 201075 7650856 10/25/10 10/25/11 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Evidence of Coverage V L1\ I I I IV.-a I L 1 IV I∎Y`... Miami Shores Village 10050 NE Second Ave. Miami Shores, FL 33138 - - - - - -- - - - - -- 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 f/}} ACORD 25 (2009/09) - . . The ACORD name and logo are registered marks of ACORD ACO CP CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/23/2010 PRODUCER 1- 305 - 592 -6080 Arthur J. Gallagher Risk Management Services, Inc. 8200 N.W. 41st Street Suite 200 Miami, FL 33166 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 Service America Enterprise, Inc. 2755 NW 63rd Court Fort Lauderdale, FL 33309 INSURER A: ZURICH AMERICAN INS CO 16535 INSURER B: AMERICAN GUAR & LIAB INS 26247 INSURER C: INSURER 0: INSURER E: COVERAGES THE POLICIES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR INSRD ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDIYYYY) POLICY EXPIRATION DATE (MM/DDIYYYY) LIMITS A GENERALLIABILITY COMMERCIAL GENERAL LIABILITY GL065555467 -01 10/25/10 10/25/11 EACH OCCURRENCE $ 1,000,000 X TO RENTED PREMISES ( occurrence) $ 1,000,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JF T LOC A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BAP6555466 -01 10/25/10 10/25/11 COMBINEDSINGLEUMIT (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: AGO $ B EXCESS /UMBRELLALIABILITY AUC 6555463 -01 10/25/10 10/25/11 EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ Nil $ $ X $ WORKERS AND EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (Mandatory If yes, describe SPECIAL COMPENSATION LIABILITY Y / N WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ in NH) under PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Evidence of Coverage CERTIFICATE HOLDER CANCELL Miami Shores Village 10050 NE Second Ave. 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 'USA ACORD 25 (2009 /01) mrutyunjayamia 18018549 © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LIOENEING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 PERLMTJTTER, TODD SERVICE AMERICA ENTERPRISE INC 2755 NW 63 CT FORT LAUDERDALE FL 33309 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.rnyfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, -subscribe to department newsletters and learn more about the Department% 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 ken (850) 487-1395 DETACH HERE BATCH NUMBER -1C41ktira 5 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 -- 954-831-4000 VALID OCTOBER 1,2010 THROUGH SEPTEMBER 30,2011 fk Receipt #:181-3103 Busille" TYPe'iE(14ELEscrerRxicALicALIALARcoNTRAmslccroto Business Opened:io/o 3 /2005 StateCountyieert/Reg:Ec0002822 Exemption code:NONEXEMPT DBA: Business Name: SERVICE AMERICA ENTERPRISE INC Owner Name: TODD PERLMUTTER Business Location: 2755 NW 63 CT FT LAUDERDALE Business Phone: 954 -979 -1100 • Rooms Seats Employees 300 Machines Professionals For Vending. Business Only flt lULrhtflSt' ' Vendinq T e: Tax Amount ■•■14•11"."01-11 1..., ,...,.... Transfer Fee ,,,,,,,,,, NSF Fee Penalty .,.. ._ Prior Years Collection Cost Total 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 within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements, Thit 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 riot indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: TODD PERLMUTTER 2755 NW 63 CT PORT LAUDERDALE, FL 33309 Receipt #01A-09-00025483 Paid 07/30/2010 150.00 2010 - 2011 mad*Armin&ga,-,, 0,4 5