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MC-11-1851Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 165314 Permit Number: MC -10 -11 -1851 Scheduled Inspection Date: October 01, 2012 Inspector: Perez, JanPierre Owner: Job Address: 216 NE 98 Street Miami Shores, FL 33138 -0000 Project <NONE> Contractor: ALAN PLUMBER Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060134210 -216 Phone: (954)815 -7380 Building Department Comments EXTEND DUCT TRUNK LIVE FROM PACKAGE UNIT. LB ` Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 28, 2012 For Inspections please call: (305)762 -4949 Page 1 of 36 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 tt SEP 2 3 Z5 i2 J Y: Permit No. MCA— — I 51 Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): 7g00 ii E 2 1'tv C Phone#: 3o5 16 (ctL '41 I a) Li el She + I a Address: / _ City: /h u Lect,ii >> State: ��.. T Zip: 3 3 0 / 2- Tenant/Lessee Name: 1' Id (C-4p R L'74-4 , ov I t 1 d= e l j,.r®i A Phone#: Email: JOB ADDRESS: ? / 6 & C q 5 City: Miami Shores County: Miami Dade Zip: c 3:,13e Folio/Parcel #: p 13 2.o e ®/ 3t/ 2 IT Is the Building Historically Designated: Yes NO Flood Zone: Phone #: 991- e 15 -9330 CONTRACTOR: Company Name: ) 7%'4 *? /' ,I %fc) Address: «/0 c5A) Cl2 4ve City: iavcrfoieda /e State: Zip: Qualifier Name: �^► Phone #: State Certification or Registration #: C„ 2 03q6 1411 Certificate of Competency #: "/ Contact Phone #: 5Y 8/5 -93r0 Email Address: DESIGNER: Architect/Engineer: Phone*: Value of Work for this Permit: $ `7%0.0 0 Type of Work: °Address °Alteration Description of Work: Square/Linear Footage of Work: °New Lace °Demolition +x****** * **** **a *** *,x****+s******** *** * **F ** **** * **** * **** * **** *** ** **** **** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO /CC $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 193-a-) 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 .F,CTRICA L 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 /� °; " 't/ Signature er or Agent The foregoing instrument was acknowledged before me this day of -'ee /e n1i 2012. 1, by L P a 114 E t1 e--, de z s personally known o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: 27 Sign: . . Pri rN fib My Commission Expires: I�MZEO * MY COMMISSION # EE 830779 EXPIRES: September 27, 2016 Bonded Thu Budget Notary Services *** * * * * * *** * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Contractor The foregoing instrument was ackno edged bef day of ��PA� , 20 12, by > ��ddl�it l i� ! _ ' who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My C J e °s '• Notary Public State o1 Ya° orii 15 •i 9j'�� CP. •�� i pin,`, =My om • pireommission # EE 128810 Bonded Through Natio rai (Votary Assn. ****************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ans Examiner Structural Review (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk Jan 12 07 04:58p James Q. Fisher 213 - 341 -1344 p.4 CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT o ^ ^• ^ w � w ^ w w w .tia w w^.^ "�:Xkw w.=,C -'%r^tw•-°}'•`F� ^.�1 ^'^4` 't^ .C`:` �r'�.�,n r'%.v ±St"'C��x : "a`'.`:�'rr. Lit 'CJ.*t'�.P•�.Gt"z.'�.s>Sd�.:! :1A� cit':•:^�e�i�.`r':•;'• -�„iv •:fir }. /.+''Cvy -. rrf,,.`}:�. 'tr: hr:.. r..tS�::'.u.::'.•.' v..! -r ti�.��:•st_.:it..�..r.:%v.1b::. '• 3 s State of California County of + f� i !r� AJ ?7 7- Pn 1r On�j{� �.t-v� r D�� before me, i��! 1 � Name anc Title Odic leis.. Jane Doe. ioike) personally appeared ' F- I tmae s�sgnertel ersonally known to me 0 proved to me on the basis of satisfactory evidence K. SAVAGE ' Commission *1550160 ' = a Notary Public - California Los Comity tJ / MyComm. Ensiles Seib 5. to be the person (j' whose name are subscribed to the within instrument and acknowledged to me at it tshetthey executed the same In er/their uthorized capacity and that by er /their signature(9}•'on the instrument the person or the entity upon behalf of which the person,(sr acted, executed the instrument. WITNESS m nd and ;.�fti ,� sal. OPTIONAL 'Though the Information below is not recurred by taw, It may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document: Description of Attached Document �- T IA/V:& � Title or Type of Document: 1kmt 4 fflhii6tz4T1A. P J.f r t o 1 mil• 1 " ' l"& tat. Document Date:., :DWI 1A2t.V'' 1 $k T D--7 - Number of Pages: Signer(s) Other Than Named Above: 11.D14-e-- Capacity(ies) Claimed by Signer Signer's Name: G Individual O Corporate Officer — Title(s): O Partner — 0 Limited L.1 General • Attorney -in -Fact • Trustee O Guardian or Conservator U Other. Signer Is Representing: RIGHT THUMBPRINT OF SIGNER /•K.�•�✓' �.l'`� .�/C.••t��t `!��^ �J:�✓'`f'F'`i ♦�'+.:r�` �'v«F�'�CF�\. �/l�, •r :r. v Ai v"�(v �r v ti��Srt!'v. v�Ci �'G'v'.�•i V J V V "CrS_^W -� J "�V"� V J -1 t J V ����v s; 1909 National Notary Aasocia1on • 9350 De Soto Mts. P.O. Boo 2402 • Chatsworth. CA 913134402 • ronrxnalt nalnatary.arg Prod No. 5007 Rehear. Cal Th1I -Free 1- 810.878.6327 areari Pt ue v- r.v`4$ uc►i ►too a.a. 1-101rol •AGENT MAY HANDLE ALL MATTERS REGARDING CITY OF MIAMI LICENSES, ETC. AND MIAMI- -DAVE COUNTY, BUILDING PE1 WITS, FILES, 1 -i a ©A , 1 4� I �fs�A��s Lot, A4, Am! sii°R'C%''�'L�% Av t_t1 � 1 P! 6 n�� 1•F �r [- a �`�' ltd pl o t) C yr V� f v D tz_m4 1 M/ UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY' IS i~FFL CTIVE IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED. Title power of attorney will cOntillOS to be'offecave even though 1 bacon Inoapee hated. STRIKE THE* PRECi ING SBITBNCE IP YOU DO NOT WANT TEAS POWER OF ATTORNEY TO CONTINUE W TOO BECOME INCAPACITATED. t.XERCISE OF POWER QF ATTORNEY WHERE MORE THAN ONE AGENT DESIGNATED If I have designed more Than ons agent, the %gents are to act IF YOU APPOINT MORE THAN ONE AGENT AND YOU WANT SACK AGENT TO SE ABLE TO ACT ALONE WITHOUT THE OTHER AGENT JO NiNG, WRITE THE WORD "SEPARATELY" IN THE MANX YOUE If YOU O NOT N OR ANY WORD IN THE BLANK SE's, OR W YOU INSERT THE WORD "J0 $TLY", THEN ALL OF TOG ETHER. 1 a g r e e t h a t a n y t h k d p a r t y w h o receives a c o p y of t h i s dracUment nun a c c t under It Revoc on Of the Power of attorney Is rot effective as io a third party urd1( the third party has actual km/ledge of the revocation. i agree to ihdem, nify the third party for any c1nlrnS that erica against the thI d party because of reliance on this power of attorney. Signed this 1.2th . of etxlus.xyr 2007 GER ( OU toXIALSOMIRITV Mang State of CALIFORNIA County of LOS ANGELES BY ACCEPTING DR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES QF AN AGENT. pc JC.nie (Rev. 44101/30011L Wok timealissetifie Fame UNIFORM STA TORY FORNI POWER OF ATTORNEY RO.R. .pfx„* th ut Wt.UJtl +Jt#lIAA* 14. rlkiff�71 41..1•uvi• I. t044 p.G UNIFORM STATUTORY FORM POWER OF ATTORNEY (CaUfonda Probate Code Section 4401) NOTICE: THE POWERS GRANTED EY THIS DOCUMENT ARE BROAD AND SWEEPING. THEY ARE EXPLAINED IN THE UNIFORM STATUTORY FORM POWER OF ATTORNEY ACT (CAL.IFORNIA PROBATE CODE SECTIONS 44004464 IF YOU HAVE ANY QUESTIONS ABOUT THESE POWERS, Of 'AJN COMPETENT LEGAL ADVICE. nu DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL. AND OTHER HEALTH •ARE DECISIONS FOR YOU. YOU MAY REVOKE THIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SD. t 35 NW 54 ST LC 330 NW 71 ST LC 668 NW 62 ST LC 7 4 6 i W 62 ST LC 12 955 NW 7 AVE LC 1744 NW 36 ST LC 6145 NW 7 AVE LC 1201 NW 54 ST LC 7800 NE 2 AVE LC 7155 NW 2 CT LC 1536 NW 36 ST LC DOLPHIN PEA LC mutt NNOANDADflRS6i appoint LIZA E. D Z tNAMAND ACCEIESS 4F THE PERON APFOINTEb.C*CF EACH PERSON APPOlNTED EMU VOW flri OESIGHATI & THWO OW as my agent (attorney-le-fact) to eat for me In any lawful way with re spect!o the talldaring Initialed sweats; TO GRAI4T ALL OF THE FOLLOWING mass, MIITIAL THE UNE IN FRONT OF NAND IGNORE THE LINES IN FRONT OF THE OTHER POWERS. TO GRANT ONE OR MORE, OUT FEWER THAN AL I, OF THE FOLLOWING POWERS, NIk7IAL. THE LINE Phi FRONT OF EACH POWER YOU ARE GRANTING. TO WITHHOLD A POWER, Do NOT MUM, THE LINE 114 FRONT CF IT. YOU MAY, BUT NEED NOT, CRASS OUT EACH POWER WITHHELD. Real property transaction Tangible personal property irarisedione. Stock and bond transactions. Commodity and option transactions. Banking and other financial InstttutIan trensacdiot<s. Coolness operating transactions. Insurance and annuity transactions, Estate, trust, and other bena1tilary transactions. Claims and Ogaden. Perascnsi and foray makstenanee. Benefits from scout serenity. medicare, medicaid, or other gorernn ental programs, or civfi or teitltary service. Retirement Alen transatns. Tax matters. ALL OF THE POWERS LISTED ABOVE. YOU NEED NOT INITIAL ANY OTHER LINES W YOU iNMAt. UNE (1). SPECIAL. INSTRUCTIONS: ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS MUTING OR EXTENDING THE POWERS GRANTED TO YOUR AGENT. NONJC 19 (Raw E4t01?2O SL UNIFORM STATUTORY FORM POWER OP ATTORNEY Motel Dept lessen* 1 RjR BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Business Name: Owner Name: Business Location: Business Phone: Rooms PLUMBER ALAN PLUMBER ALAN 910 SW 42 AVE FT LAUDERDALE 954 - 357 -4392 Seats Employees 1 Receipt #:HEATING /AIRCONDITION CONTR Business Type: (HEATING /A /C CONTRACTOR) Business Opened:12/17/1987 State /County /Cert/Reg:CACO 3 9 617 Exemption Code: 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 and zoning requirements. his Business Tax Receipt must be transferred when the business is sold, buginess 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. WHEN VALIDATED Mailing Address: PLUMBER ALAN P 0 BOX 5582 LIGHTHOUSE POINT, FL 33060 2012 - 2013 Receipt #035 -11- 00008585 Paid 09/27/2012 27.00 - - - BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Business Name: Owner Name: Business Location: Business Phone: Rooms PLUMBER ALAN PLUMBER ALAN 910 SW 42 AVE FT LAUDERDALE 954- 357 -4392 Seats Employees 1 CTR Receipt #: 183-1878 Business Type:HEATING /AIRCONDITION CONTRACTR (HEATING /A /C CONTRACTOR) Business Opened:12 /17/1987 State /County /Curt /Reg: CAC039617 Exemptio1 Code: Machines Professionals Signature Number of Machines: For Vending Business Only Vendinn Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Ye Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 Receipt #035 -11- 00008585 raid 09/27/2012 27.00 STATE OF FLORIDA DEPARTMENT OF BUSINES CONSTRUCTION INDUSTRY 1940 NORTH MONROE TALLAHASSEE PLUMBER, ALAN INDIVIDUAL 211 NE 14TH AVENUE POMPANO BEACH AND PROFESSIONAL REGULATION ICENEING BOARD (850) 487 -1395 32399 -0783 F-1 3 Congratulations! With this license you become one of Floridians licensed by the Department of Business and Our professionals and businesses range from architects boxers to barbeque restaurants, and they keep Flora la's Every day we work to improve the way we do business For information about our services, please log onto www There you can find more information about our divisions impact you, subscribe to department newsletters and lea Department's initiatives. Our mission at the Department is: License Efficiently, R constantly strive to serve you better so that you can sery Thank you for doing business in Florida, and congratul 060 i nearly one million Regulation. yacht brokers, from Homy strong. order to serve you better oridancense.com. d the regulations that more about the Fairly. We your customers. on your new license! DETACH HERE FLORIDA Ot, , AC E 2' 2 ®.3 O TMENT OF BUS IN B . SIONAL REGULLT1' Y U 07/20/12 128013''62 IR COND Ct N' CAC039617 fch.4J9as, 2000659 T IC 3 TITRfl lEM J sz A # 6220300 STATE OF FLORIDA DEPARTOF BUSINESS AND PROFES CONSTRUCTION INDUSTRY LIC GU'ATION SEt# L12072000659 07 10i' 2 128011962 :• cA£039617 fj T7ze °:CLASS A ASR CONDITIONING C3NTRACTOR Nam d Sae loW ;1S CE F rider, .the . , . provie�.on.s o f Chapter 489 FS. Expiration date: =0,31, 2014 LU1�8R :... 211 NE 14TH °AVENUE PANG BEACH. FL, 33060 KEN LAWSON SECRETARY 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 BUII, ING PERMIT APPLICATION Fsc zo Permit No. MCA (®' %''S 1 Master Permit No... Permit Type: MECHANICAL /" f OWNER: Name (Fee Simple Titleholder): ' ®0 /�t'4X�Phone #: COS v 56 7 .629 Address: � 'r 45. /% 6 City: / GZ' ie9, "! State: f2 LC1 x.2.95. Phone#: Email: Tenant/Lessee Name: JOB ADDRESS: 0?/6 sve- 9745/ City: Miami Shores / County: Miami Dade Folio/Parcel#: .//(3.20 6C/. (354�/0 Is the Building Historically Designated: Yes NO Flood Zone: Zip: O3/36" Phone #: �,�f /5 73870 p Zip: 3 30W CONTRACTOR: Company Name: Address: Po 6 ©x City: 1 i k1 h6a5e State: FG Qualifier Name: State Certification or Registration #: (4C l3 Contact Phone #: Email Address: Phone #: Certific%e of Competency #: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ AV Square/Linear Footage of Work: Type of Work: DAddress DAlteration DNew DRepair/Replace / F/4,.r4 Description of Work: iO dcfc-7 DDemolition 'AC kef je e(4) /1-- o Submittal Fee $ t % Permit Fee Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ itit* ***** * * ** * * * * * * * * * * * * * * * *** * * ** * * * ** CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE$ (1'9 -101 �b`�\ Q-0 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 t do the work and instal lions as indicated. I certify that no work or installation s PP Y P 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 AP'r''DAVIT 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 al condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith tha!' a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject 10 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 he approved and a reinspection fee will be charged. Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 34) The foregoing instrument wa acknowledged before me this day of ! , 20 11 , by /12.4_ E e -� �e - , day of � , 20 , by .( who is rsonall known o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 772 A- 2eo My Commission Expires: * * * * * * * * * * * * * * * * * * * *.r * ** APPROVED BY ��t�,5Y P% JOHANNA MAZZEO MY COMMISSION I DD80989a IRES. mbet27,2012 edThru Wee (Revised 07 /10 /07)(Revised 06 /1I0/2009)(Revised 3/15/09) who is personally known to me or who has produced / as identification and who ditakei oath. NOTARY PUBLIC: .(IP Si _ � 1' ��, ..--- ': c • Print: O • • �Cr `0 S erg of _ VDA My Commission Expires: /11111, iti%«����`��e\\ ****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Tans Examiner Zoning Structural Review Clerk A"-508,3303 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY BOARD omoifF L1008100092.4 DATE BATCH NUMBER LICENSE NBR 08/10/2010 108030888 CAC039617 The CLASS A AIR CONDITIONING CONTRAC'iOlt Named below IS CERTIFIED Under the provisions of Chapter 489 FSL-e Expiration date: AUG 31, 2012 rH PLUMBER, ALAN. INDIVIDUAL,. 211 NE 14TH AVENUE POMPANO BEACH CHARLIE CRIST GOVERNOR FL 33060 DISPLAY AS REQUIRED BY LAW CHARLIE LIES, SECRETARY CTR 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: PLUMBER ALAN #:183 -1878 Business Receipt Type :HEATING /AIRCONDITION CON (HEATING /A /C CONTRACTOR) Owner Name: PLUMBER ALAN Business Opened:12/17/1987 Business Location: 910 SW 42 AVE State /County /Cert/Reg:CAC039617 FT LAUDERDALE Exemption 9ode:NONEXEMPT Business Phone: 954-357-4392 Rooms Seats Employees 1 Machines Professionals For Vending Business Only Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 2.70 0.00 0.00 29.70 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: PLUMBER ALAN P 0 BOX 5582 LIGHTHOUSE POINT, FL 33060 2011 - 2012 Receipt #01C -11- 00000153 Paid 10/04/2011 29.70 '�c:"q°® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/D11 PRODUCER Florida 1st Insurance &Tax Svc. I 1503 S. Cypress Rd. Pompano Beach, FL 33060 Phone (954)942 -7888 Fax (954)942 -6699 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED ALAN PLUMBER 211 NE 14 Ave POMPANO BCH, FL 33060 1954 357 4392 INSURER Pc. TAPCO UNDERWRITERS INC 206 -4593 INSURER B: INSURER C: INSURER D: INSURER E: RAMSGATE INS 206 -7790 COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 POUCY NUMBER POUCY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A ❑ GENERAL LIABILITY 206 -4593 01/12/11 01/12/12 EACH OCCURRENCE 300,000 V COMMERCIAL GENERAL LIABILITY PREMISES SES (EaEoccurence) fire 50,000 ❑ ❑ CLAIMS MADE d OCCUR MED EXP (Any one person) 5,000 ❑ PERSONAL & ADV INJURY 300,000 ❑ GENERAL AGGREGATE 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP/OP AGG 300,00 B ❑ 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) ❑ C ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG D ❑ EXCESS/UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 206 -3456 01/12/11 01/12/12 V WC STATU- ❑ OTH- TORY LIMITS ER E.L. EACH ACCIDENT 100,000 E.L. DISEASE - EA EMPLOYEE 100,000 E.L. DISEASE - POLICY LIMIT 100,000 F OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION MIAMI SHORES BUILDING DEPT 10050 NE 2 AVENUE MIAMI SHORES, FLORIDA 33138 Armen ee I nnA men nor 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 INSURE -% 11•• AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTA ©ACORD CORPORATION 1988