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DEMO-14-2678Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-225461 Permit Number: DEMO -12-14-2768 Scheduled Inspection Date: January 08, 2015 Permit Type: Demolition Inspector: Devaney, Michael Inspection Type: Final Owner: GOLDENBERG, PAUL Work Classification: Electric Job Address: 905 NE 92 Street Miami Shores, FL 33138- . Phone Number Parcel Number Project: <NONE> 1132060050010 Contractor: U S HEATING AND AIR CONDITIONING INC Phone: (954)581-8333 Building Department Comments DEMOLITION Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. INSPECTOR COMMENTS False Inspector Comments January 07, 2015 For Inspections please call: (305)762-4949 Page 20 of 34 BUILDING PERMIT APP CATION ❑BUILDING ELECTRIC Miami Shores Village Building Department DEC 17 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 10 Master Permit Noo?'a iy, o; Sub Permit N414M-,L/421 ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: _ QO5 P�� Q2—rck �' ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: f;3 3�5 Folio/Parcel#:%9C? X,0 -CX2f;� - C>O l C> Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ���t�CI, Phone#: Address: gcr5 Nu- g2`yk -->t- City: T"c (�►Q -i� � S State: -'i - eA f->� Zip: t Tenant/Lessee Name: Email: Phone#: CONTRACTOR: Company Name: U3 -%klv' Phone#:O � Address: c>n 2-1 3 V4 qM •,pCV`� �o� City: C >'kVi Q State: _1�tZef��a Zip: Qualifier Name: State Certification or Registration #: U2�i Certificate of Competency #: DESIGNER: Architect/Engineer: y t_�r %roce Phone#: U r Address: %® C� (S ` -' City: K .... i SL -re s State: _E_ Zip: Value of Work for this Permit: $ (0oo Square/Linear Footage of Work: )- q �� Type of Work: E-1Addition El Alteration E-1New[:jRepair/Replace , demolition Description of Work: r.1y.0 L Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $'" Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) ceys after the building permit is issued. In the absence of such posted notice, the be approved and a ER or fee will be charged. The foregoing instrume t was acknowledged before me this day of 20 / , by ZZ4 {r (,t 4�1 who is personally k own to me or w as prod�e/`� identification and who did take an oath. Sign:_ Print: r 41*&� jg��X4 Signature CONTRACTOR The foregoing instrument was acknowledged before me this day�ofIG/C* �i1► v � 20, by lei- who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: naw enn I� n ���i c Print: Ay �' I!`,�'W r' , 4-A t 1 ► i J Seal: s My Comm. Expires Nov 8, 2016 Seal: ��"�••"°°4o AVRAHAMKALMIS ?, Commission # EE 217642 MY COMMISSION 4 FF 122440 Bonded Through National Notary Assn.# * EXPIRES: May 12, 2018 �'+r "..11:°P Boked Thru Budget Notary WOW APPROVED BY( /�- Z Plans Examiner Structural Review (Revised02/24/2014) Zoning Clerk Miami shores Village Building Department CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. '� COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C.COPY OF LIABILITY INSURANCE* D. V COPY OF WORKERS COMPENSATION INSURANCE* 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E, COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: U S BUSINESS ADDRESS:322/ nw !!1-7 5zCITY C'Ir'L 1tp,r_ STATE _ZIP�� BUSINESS PHONE: (`rozzz c) �8I'$.333 FAX NUMBER (C�—% )� g CELL PHONE ( ) QUALIFIER'S NAME:_ QUALIFIER'S LIC NUMBER: 115 S. Andrews Ave., Rm, A- 00, Ft, Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER , 2014 THROUGH SEPTEMBER 30, 2015 DBA: Business Name: US HEATING & AIRS ONDITIONING INC Receipt #:181-3443 1 TL/ALARMS/CONTE Business Type: (ELECTRICAL /CONTRACTOR) Owner Name: ROBERT HICKEY Business Opened:lo/31/2008 x Business Location: 3721 SW 47 AVE 43 5 DAVIE i State/County/Cert/Reg:Eco 0 0 0624 Business Phone: 954-581-8333 Exemption Code: Rooms Seats Employees 10 For Vending Busin Number of Machines: Tax Amount Transfer Fes NSF Fee Penalty 27.00 0.00 0100 0 Machines Professionals ass Only Vending Type: Prior Years Collection Cost Total Paid 00 0.00 0.00 27,00 1I THIS RECEIPT MUST BE POST D CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This t' x 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 zgning requirements, This Business Tax Receipt must be transferred when the b'1 siness is sold, business name has changed or you have moved the busin,'ss location. This receipt does not indicate that the business is legal or that t is in with State or local laws and regulations. Mailing Address: US HEATING & AIR CONDITIONING IN 3721 SW 47 AVE 4305 DAVIE, FL 33314 2014 2015 Receipt #52A-13-00001710 Paid 09/29/2014 27.00 R 1:_ The Un( RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CQ�TRACTORS LICENSING BOARD 41 TRICAL CONTRACTOR + ow — -- — kr_� provisions cif -Chapter 489 FS. date: AUG 31, 2016' 1� HICKEY ROBERT US HEATINGAND.A _Q 624 DCUGLX�A ALTAM0N'TE_ ISSUED: 0811012014DISPLAY AS d4gF ir NiK REQUIRED BY • # L1408100003088 (D CD n m cD 0 cD 1 a ACC?RO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 12/15/2014 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 BB Insurance Marketing Inc 10167 W Sunrise Blvd, 3rd Floor Plantation FL 33322 ICIAME: T CT Lindse Gainey Ext. 311 PHONE FAX t IN 88B-728-0817AIC No : -4 -0450 E-MAIL AD.REss:lindsi@bbimi.com INSURERS AFFORDING COVERAGE NAIC # 10/11/2014 INSURERA:Ohio Security In 74 EACH OCCURRENCE $1,000,000__ INSURED USHAC-1 INSURER B:�4074 INSURER C:Zenith Insurance Company 113269 USHAC of South Florida LLC INSURER D: DBA US Heating and Air Conditioning 3721 SW 47th Ave #305 PRODUCTS - COMP/OP AGG $2,000,000_ _ Davie FL 33314 INSURER E: AUTOMOBILE X X LIABILITYBAS55666863 ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS INSURER F: COVERAGES r:FRTIFIr:ATF NI IMRFR• REVISION NUMbLK: 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF /Y MM/DDYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR BKS55666863 10/11/2014 0/11/2015 EACH OCCURRENCE $1,000,000__ DAMAGE TO RENTED PREMISES Ea occurrence $300,000 MED EXP (Any one person) $15,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYX PRO- LOC PRODUCTS - COMP/OP AGG $2,000,000_ _ $ A AUTOMOBILE X X LIABILITYBAS55666863 ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 10/11/2014 0/11/2015 Ea accident 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ — PROPERTY ac TY DAMAGE $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE US055656863 10/11/2014 0/11/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / A NZ126821301 10/11/2014 0/11/2015 X 1 WC" OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE -POLICY LIMIT 1 $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) HVAC, Plumbing and Electrcial Contractor located at 3721 SW 47th Ave #305, Davie, FL 33314. Uninsured Motorist $20,000. PIP $10,000 w/ $0 Deductible. Comprehensive / Collision Deductible $500/$500. Certificate Holder is included as an Additional Insured on the policy with respect to General Liability, only as required by written contract. Waiver of Subrogation Applies. General Liability policy is primary and non contributory. rFRTIFIf`ATF Hnl r1FR rANr`FI I ATInN ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2 Avenue AUTHORIZED REPRESENTATIVE Miami Shores Village FL 33138 ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD