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DEMO-14-1572Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL U j' Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-216289 Permit Number: DEMO -7-14-1572 Scheduled Inspection Date: August 11, 2014 Permit Type: Demolition Inspector: Perez, JanPierre Inspection Type: Final Owner: , Work Classification: Mechanical Job Address: 9723 NE 2 Avenue Miami Shores, FL 33138 - Phone Number (305)949-9049 Parcel Number 1132060134210 Project: <NONE> Contractor: AIR HANDLERS OF (THE) PALM BEACHES INC Phone: (561)203-2835 tsunaing Department comments DEMOLITION FOR 9717 NE 2 AVE INSPECTOR COMMENTS False August 08, 2014 For Inspections please call: (305)762-4949 Page 7 of 27 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 08, 2014 For Inspections please call: (305)762-4949 Page 7 of 27 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING (DPLUMBING ti; r7PUBLICWORKS JOB ADDRESS:_ FBC 20)® Master Permit 1414"d Sub Permit No q �- ❑ REVISION ❑ EXTENSION C3RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP •T'. T �X. City: Miami Shores County: Miami Dade Zip: Fol to/Parcel#: fl,:.MD(O ® Is the Building Historically Designated: Yes NO A --'— Occupancy Type: Load: Construction Type: G i3 S Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): &Akaw I ZA3 g fg &K4 e 44-c- Phone#: 30C y`t f' %0q Address:/ -,'p r A-)4' 14 3 Sf City:yAt il. I -Val.: J& ee . State: FL Zip: l Po Tenant/Lessee Name: Phone#: Email: CONTRACTOR. Company Name: #1-f I"BKS nr Qqohone#: Q I- cl()5 - a& Address: 5o S. 0`0\ �)ju' P-� *k City: r %kcir ___State: PL Zip: mlss Qualifier Name: eo, l f -w- f Phone#: 4 -36 3d State Certification or Registration #: CAC: 1$l 55-9 Certificate of Competency #: DESIGNER: Architect(Engineer: _ gam• Phone#: �-g Address: `,1 ect, Aaa&dsw•d 13�v City: �4.. �� a®� State: �L Zip: 3331 Z Value of Work for this Permit: $ Square/Unear Footage of Work: e Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition Specify color of color thm tile: Submittal Fee $ 50 nnZI Permit Fee $ W W CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ RR `` TOTAL FEE NOW DUE $ 6 4 , 6 IN • -Mn h, Mw, ,f Bonding company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address a 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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, o certified copy of the recorded notice of commencement must be posted at the job site for the f list 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 e�A— .—�- OWNER or AGENT The forggoing instrument was acknowledged before me this day of 20 IV by wh ersonally n to me or who has produced as identification and who did take an oath. CONTRACTOR The foregoing instrument was acknowledged before me this 16 day of 54AV .20 14 by cyX--y RKeLyw rrN who is rsonally known me or who has produced as Identification and who did take an oath. NOTARY PUBLIC: Sign: Print: I�Cb` V tattPub5cto d FloridaSeal: UyCF 051248410, Expk7 �########•###i######################•##########�#########################kit########################y###### APPROVED BY �Pla s Examiner Zoning Structural Review Clerk 1Rovieaein7»a»mA% 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): City. Miami Shores Village County: Miami Dade Zip Code: 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 AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: i Y I-erS &Z11A-e— L(m _ U&hone: !UA(- aC3 -ZS State Certificate or Registration No._ CA C k%k 5c7 S'� Certificate of Competency No. Signature Date: 1H (QuaRflees signature) (Rev1sed02/24/2014) UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: i Y I-erS &Z11A-e— L(m _ U&hone: !UA(- aC3 -ZS State Certificate or Registration No._ CA C k%k 5c7 S'� Certificate of Competency No. Signature Date: 1H (QuaRflees signature) (Rev1sed02/24/2014) t�ry vvvt t, vv Vu—§tvt♦ LICENSE NUMBER nra� trrraven, �t-vt�t-tratat STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 'FOREMAN, COLIN ROBERT AiR HANDLERS OF (THE) ; LAA BEACHES INC 450 S..OLD f3IXIE,,liW—Yti. it ff# JUPITER FL- 3'458 ISSUED: 06/05/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1406050000796 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 FOREMAN, COLIN ROBERT AIR HANDLERS OF (THE) PALM BEACHES INC 450 S. OLD DIXIE HWY, SUITE # 1 JUPITER FL 33458 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.myfloridalicense.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'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 on your new license! STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFE$BIE�QULATION CAC 1815997 ISSUEV �- 06/05/2014 CERTIFIED AIR:;0dk0 COI— FOREMAN COL' 4-41OI3E4TY AIR HANDLER$,Ofi (,I7.RE}.P- YHES h IS CERTIFIED under the provisions of Ch.489 FS. Expiration date : AUG 31, 2016 L1406050000796 ANNE M. . GA_ NN_ON o CONSTITUTIONAL TAX COLLECTOR seting Palm Beach county Serving you. P.O. Box 3353, West Palm Beach, FL 33402-3353 "LOCATED AT*' www.pbctax.com Tel: (561) 355-2264 209 ELM WAY BOYNTON BEACH, FL 33426 TYPE OF BUSINESS OWNER . 23-1148 AIR CONDITIONNG CONTR FOREMAN COUN its document is valid only when receipted by the Tax Collector's Office. B1 -92 AIR HANDLERS OF THE PALM BEACHES INC AIR HANDLERS OF THE PALM BEACHES INC 209 ELM WAY BOYNTON BEACH, FL 33426-9361 ��Il�nll��l��lnl�l�ll��l�l�n�li��llun�li CERTIFICATION # I RECEIPT *DATE PAID AMT PAID BIL. # CAC1815997 I 813.1474669-08MI3 $27.50 640174632 STATE OF FLORIDA PALM BEACH COUNTY 2013/2014 LOCAL BUSINESS TAX RECEIPT LBTR Number: 200909411 EXPIRES: SEPTEMBER 30, 2014 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public. 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/16/2014 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 Strictly Commercial Insurance 810 Saturn Street Suite 16 Jupiter FL 33477 CONTACT David Laufer PHONE 561 741-7150 F4X 561 741-7125 EMAIL , strictlycomm@bellsouth.net INSURER(S) AFFORDING COVERAGE NAICA INSURER A: James River Insurance Company INSURED Air Handlers of the Palm Beaches, Inc. FBI Construction Services, Inc. 450 S. Old Dixie Hwy., Suite 1 Jupiter, FL 33458 INSURER B INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY 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. ILSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MPOLI pY EFF POLICDY EXP LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $ 50,000 MED EXP (Any one pareon Excluded 000623590 05/19/2014 05/19/2015 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECTF-1 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS None BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAB CLAIMS -MADE None DED I I RETENTION WORKERS COMPENSATION PER I OTH ER� AND EMPLOYERS' UABILI Y Y / N PROPRIETORIPARTNE ICERIMEMBER EXC UDEIDE?XECUT[VE LJ N / A None E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) "yes descdbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) General Contractor - A/C Contractor Certified General Contractor License #CGC1516159 Certified Air Conditioning Contractor License #CAC1815997 CERTIFICATE HOLDER CANCELLATION MIAMI SHORE VILLAGE DEPARTMENT 10050 NE 2 AVE SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE D 5E&L> ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD A`CMV CERTIFICATE OF LIABILITY INSURANCE 071155!2014/2014"'' 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 cerdfidate 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 Neu of such endorsement(s). PRODUCER Jacobs Insurance Inc. S Congress Avenue 48 West PaimBeach FL 33408 Jackie Egerton PIroNe (581 887-8400 P AXNO). (5611967-9088 E4w2135 KESS: JEGERTON JACOBSINSINC.COM INSURER(S) AFFORDING COVERAGE NAIL N wsURERA: Retail First INSURED AIR HANDLERS OF THE P. B. INC 209 ELM WAY BOYNTON BEACH FL 33428 INVURER 8: INSURER C: INSURER D: INSURER E: 1 INSURERF: r'nNFRA[SF/B CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY 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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TYPE OF INSURANCE THE EX TION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE POLICY NUMBER MMN EFF M D LIMITS GENERAL UABW7Y COMMERCIAL GENERAL LIABILITY CLAIMS.MADE � OCCUR EACH OCCURRENCE s P M $ s MED EXP ( sire person) s PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER PRO M LOC PRODUCTS - COMPIOP AGO $ $ AUTOMOBILE LIABILITY ANY ALIO O SULED � OAUTOS HIRED AUTOSAUTON-OWNED EacrlMt L BODILY INJURY (Per perms) S BODILY INJURY (Per wWwt) S PROs d. S s UMBRELLA LIAROCCUR EXCESS LIAR HCLAIMS-MADE EACH OCCURRENCE S AGGREGATE S DED I I RETENTION 11S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPMETOWPARTNERIEXECUTNE OFFICERAdEMBERExdWED7 ( ±M NM Ifyyaass desc�eunder DESCRITRION OF OPERATIONS below NIA 52044337 04/04/14 04104/15 INC STATu- OTH- IIWit E.L. EACH ACCIDENT $ 100000 E.L. DISEASE - EA EMPLOYE $ 100000 E L. DISEASE - POLICY I [MIT $ 500000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attwh ACORD 101, AddManal Remerke Schedule, H more spew le rmwk") CGC 1518159 CAC1815997 AIR CONDITIONING CONTRACTOR CERTIFICATE HOLDER CANCELLATION ACORD Z5 (2010105) CORPRATION. All rights reserved. The ACORD name and logo are re Ste d marks of ACORD 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE DEVELOPMENT THE EX TION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE ACCO AN WITH THE POLICY PROVISIONS. AUT TIVB MIAMI SHORES FL 33138 ACORD Z5 (2010105) CORPRATION. All rights reserved. The ACORD name and logo are re Ste d marks of ACORD 1