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MC-13-389 a r y Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INS P-186410 Permit Number: MC-2-13-389 Inspection Date: October 23, 2013 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: MACPHAIL, GAVIN AND MARCIA Work Classification: Addition/Alteration Job Address:226 NW 93 Street Miami Shores, FL 33150- Phone Number Parcel Number 1131010331080 Project: <NONE> Contractor: SOVRIN REFRIGERATION $AIRCONDITION INC Phone: (954)868-0720 Building Department Comments RE MOUNT EXISTING DROP IN NEW BATH AND DEN Infractio Passed Comments FOR GARAGE CONVERSION INSPECTOR COMMENTS False I . W V Inspector Comments Passed Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 October 23,2013 Page 1 of 1 Miami Shores Village �� eS Building Department �\ 10050 N.E.2nd A \(\ venue,Miami Shores,Florida 33138 v Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No. ll k5'N�\ PERMIT APPLICATION Master Permit No. 1 t- FBC 20 Permit Type:MECHANICAL c OWNER:Name(Fee Simple Titleholder): - P6 Address• V City: !S State: Zip: L 5 TenanVIzssee Name: Phone#: Email: JOB ADDRESS: ' ; City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name:- Q VI'Y/AJ d� s A e/ �CPhone#: Address: 1,667 ✓�'� /; V'J City: AIWA2.1i 0 Stat .1 L. Zip: (0 Qualifier Name: �'J—� Phone#: State Certification or Registration Certificate of Competency#: C�A ®c")7/ Contact Phone#: ?1W ®7 3 Email Address: a i xa, Q? S/@.1.©a ° DESIGNER:Architect/Engineer. Phone#: Value of Work for this Permit:$� o �� Square/Linear F096ge of Work: Type of Work: DAddress DAlteration DNew Repair/Replace DDemolition Description of Work La,ur,4 zv tg-r i Al L b V,6 P .j/ Submittal Submittal Fee$ Permit Fee$_ I V9V CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review.$ TOTAL FEE NOW DUE$ 2h6 W Bonding Company's Name(if applicable) Bonding�ompany's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lendees:Address da _ City -- State zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,.POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Signature /Z- I&c)0A J Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this G� day of ,200a,by �c A . /'l a c, P day of R6 yaY ,20 l3,by (a �aa�e who is personally known to me or who has produced who is personally known to me or who has produced— + l As identification and who did take an oath. �� as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: h r �- Print: ' PPrb►ic.State of Florida Print: misswn#EE 198163 SiLVIg OS My Commission Expires: My Comm.expir8s May 14,2016 My Commiss nXCLNotm' Public S 190 a1 FWW6 ommission#EE 1433016 omm.9)oras Nov.01,2015 �x APPROVED BY ��._ s Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) - 9'15 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33309-1895—954-831-4000 VALID OCTOBER 1.2013 THROUGH SEPTEMBER 30,2014 Cl SOVRIN REFRIGERATION & R @C @ipt#:STING/AIRCONDITION CT Business Name:me:AIRCONDITION INC Business Type.(AIR CONDITIONING CO OR) Owner Name:WINSTON A FOPDE /QUAL Business Opened:11/19/2003 BusineS9 Location:1667 W MCNAa RA StaWC0unty 1Cert1Reg;CAC057102 POMPANO BEACH Exemption Code: Business Phone:954-78 3-92 94 ...•.'.., :iaji't;: .:• .i •.L'.. :.Sys.'.•;. "' •. Rooms `'t Seats 7 ``:i`mpll ya9s;``•;?L, Machin" Professionals ., For B . g usin®ss Only Number of Machines: eridln Vending Type•, Tax Amount Transfer Fee NSF Fee Psr s ty. Prior Year§• Collection Cost Total Paid 27.00 0.0'0`• 0.'00= ;7p 0:`100 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: WTNSfiON ,A FORDE /QUAY Receipt #02R-13-00000506 1667 W MCNAB RD Paid 10/16/2013 29.70 POMPANO BEACH, FL 33069 2013 .- 2014 Oki ` 09-13-2012 JEFF ATWATER STATE OF FLORIDA GRIEF F1NANCAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS, COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW # �e CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 0911312012 EXPIRATION DATE: 09/13/2014 PERSON: FORdE WINSTON FEIN: 650589926 BUSINESS NAME AND ADDRESS: SOVRIN REFRIGERATION 8 AIRCONDITION INC 1687 WEST MCNAB RD POMPANO REACH FL 33069 SCOPES OF BUSINESS OR TRADE: 1- HEATING, VENTILATION, AIR-CONO iMPURTANT. Pursuant to Chaptar 440 . 031141, P.s., an *loner of a corporation who elects exemption from this en¢ section may not recover benefits or compensation Pter DY fllPng a tertificeie of electron under this nsation Hader is chapter. scope of the P M pier. Pursuant to Chapter 440,05tf21, F.S., certificates at elactaon to be exempt... apply a only within the D e husiemp or trade subject t the native of election to be ex¢mp;.pursuant to Chapter 440.051!3), F,S., notices of election to he exempt end certificates aF election to be exempt shall he suhjeee tv revvcatfun If, at any time after the filing of the notice or the issuance of the certificate, the Darwn named on the notice or cortlflcate no longer meats tae requirements of this section for issvencs of a Th te, a department sDSil revoke a certificate at any time for failure of the person named on the certificate to neat the requirements of this section. OWC-252 C1HTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 413-15 PLEASE CUT OUT i U THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES IMPORTANT DIVISION OF WORKERS'COMPENSATION F Pursuant to Chapter 440.05(14), F.S., an officor of a corporation who CER IFICATETFEL INDUSTRY O elects exemption from this chapter b film p OF ELEGTfON P t a 'i4'iBEEX Y g certificate of e EMPT FROM FLORIDA !action WORKERS'COMPENSATION LAW L under this section may not recover benefi Y is or compensation under this D chapter. EFFECTIVE: 09/13/2012 EXPIRATION DATE: 011/13/2014 PERSON: 1V2NSTEIN FORGE Pursuant to Chapter 440.05(1'2), F.S., Certrficates of election to be H exempt.. apply only within the scope of the business or trade listed an FEIN! 850588926 E the notice of election to be exempt BUSINESS NAME ADDRESS ND : R A SOVRIN REF rsuant to RiceRA,Tlat+ & atttcaNOrrl INC i Chapter 440.05{13}, F.$. N ti f aN rvc o ces o election to he exempt 3657 WEST MCNAB RD and certificates of election to be exempt Shall be Subject to revocation POMPANO BEACK FL if, at 33069 any time after the filing of the notice or the issuance of the certificate. the per-Son named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department Shall revoke a certificate at any time for failure of the SCOPE OF SUSINESvS OR TRADE: person named on the certificate to meet the requirements of this i, HEATINO, vENTILATION;AIR-00ND section. QUESTIONS? (850) 4131009 CUT HERE Carry bottom portion on the job, keep upper portion for Your records. f � STATE OF FLORIDA - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET (850 ) 487-1395 TALLAHASSEE 8E FL 32399,x783 FORDS,- WINSTON ANTHONY SOVRIN REFRIGERATION & AIRCONDITION INC 1667 N M RD POMPANO BEACH FL 33069 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 clay we work to improve the way we do business in order to serve you bette For information about our services,please log onto www.myfloridalicense.aom, There you can find more information about our divisions and the regulations that impact you,subscribe to department newsletters and learn more about the Departmerifs 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 far doing business in Florida.and congratulations on your new license! 4 DETACH HERE ,�ijJit.�ii.LS y •''3. :�_ " rr yyy� " 33 {�� t33''1`I ST,�jyL ;1GY►ATION r. nb. :•: �:VO, L N' r. t 1.01 °Y •'r - •s :" SIC $. NB�.,`a�.•<��,�;� a�. l I.K :a " 211 ; , 1 Cbfib ,. Naed:.,•bey aria `:I'S CERtIF•TD`date rat i31, T]rider it:hcr'prav3sicins off' ha t_ ',°':z . .. Y<:n°:•::., Exp cs� : AUt3.. p ✓ ; r= r: °•a•.Y •Y.�u'y.{fy�..I Jl •.�J.rK��•. :.:'t�L:i:.r Y. '. :;;;•,d.,n.;� to ;:�>c•Y.; •�:•"'+;i:;..,::.;:;. mil." „�/sY&i'• 7' .•,'•••imk SOVRI�•''.•#tEI�XiOlkRAATT•'IOW.'Sc'AIR((77((]]:''�7�.',...�:'s , . '+tier;^ •..>:; 1.667 ' {� MCMA$ RD PO4PANO BEACH 0. F+`I+ Oct. 21, 2013 3: 16PM No. 3633 P. 1/1 CERTIFICATE OF LIABILITY INSURANCE DATE 10/21D/YYYY1 10/21!13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVF.I.Y AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIPICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT_ If the cerlllteate holder is an ADDITIONAL INSURED,the policq(ies)!oust be endorsed. If SUBROGATION IS WAIVED,subject to the term9 and eondlllone of the policy,certain policies may require an endorsement A statement on this cardlicals does not confer rights to the certificate holder In lieu of ouch endorsement(s). PRODUCER I CONTACT Marlins Insurance gONL; (954)587-7850 FAX (954)587.7778 850 S.W,40 Ave. ADDROSS, madinsil�aoi.oanr Plantation,FL 33317 INSURER(S)AFFORDING COVERAGE NAIC 8 Phone (954)587-7850 Fax (954)587-7778 I SURER A: Federated Nallonal INSURED INSURER 8; Sovrin Refrig&A/c fRsuRER o 1657 West Mcnab Road INSURER D r POMPANO BEACH,FL 33069- (561)753.5914 INSURER E: INSURER F- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POU0198 OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION Ole ANY CONTRACTOR 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 ADD`gUB ' POLNCY EFF POLicYEXP!N.RR Awn POLICYNUMBER MMID ao LIMITS GENERAL LIABIuTY EACH OCCURRENCE S 1,000 000-00 DAMAGE TO RENTED COMMERCIAL GENERAL LWS1LfIY PREMISES Ea 6ftgrencel Is 100.000.00 A [I El CLAIMS-MA09 ❑ OCCUR GL-0504 01 1 1 513-00 MEDEXP one rson s 5,000.00 09/1112013 09/1112014 PERSONAL BADVINJURY g 1,000,000.00 ❑ CENERALAGGRE%TIC s 2,000,000,00 GEN•LAGGREGATBLIMITAPPUESPER: PRODUCTS-COMP/OPAGO $ 1,000,000.00 ® POLICY ❑ P ° ❑ LOC g AUTOMOBILE LIABILITY OM8INED StNG66 LIMIT ❑ ANY AUTO 800ILY IN.IURY(Per person) s ❑ ALL NEO ❑ AqUTOSULEO BOWLY INJURY(Per ecddenr) s ❑ HIRED AUTOS ❑ A�NOSWNED OPPER DAMAGE s in F1 I S ❑ UMBRELLALIAB E]OCCUR I EACH OCCURRENCE s ❑ EXCESS LIAR ❑CLAIM&MADE I AGGREGATE s OED n RETENTI N s $ WORKERS COMPENSATION TWO STAYU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRK70RIPARTNERtEXECUTIVE, OFFICERIMEMBEREXCLUDED? ❑ NIA R.I.EACHACCIDENT g Mende! I EL DISEASE-EA EMPLOYE s orscR PTrp 0 OPEaanpNg 6dpv E.L DISEASE-POLICY LIMIT $ 1 • I i i DESCRIPTION OF OPERATIONS!LOCATIONS VEHICLES(AllechACORD 101.Addl1.10nal Remarks Schedule,If more space IS required) Air Condition Systems Installation,Services 8 Rpairs 3 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE Aa0VE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village I THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shore,FI 33138 AUTHORIZED REPRE9 Barbara Garcia ACORb 25(2010/05)OF 0 198 -2010 A= CORPORATION. All rights reserved. The ACORD nalrne and logo are registered marks of ACORD