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DEMO-14-2767'T Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-225460 Permit Number: DEMO -12-14-2767 Scheduled Inspection Date: January 08, 2015 Permit Type: Demolition Inspector: Diaz, Osvaldo Inspection Type: Final Owner: GOLDENBERG, PAUL Work Classification: Plumbing Job Address: 905 NE 92 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060050010 Project: <NONE> Contractor: U S HEATING AND AIR CONDITIONING INC Phone: (954)581-8333 5miaing Department comments DEMOLITION OF ALL FIXTURES INSPECTOR COMMENTS False Inspector Comments Passed Failed C). a Correction d Needed r Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. January 07, 2015 For Inspections please call: (305)762-4949 Page 19 of 34 BUILDING PERMIT APPLICATION ❑ B ILDING PLUMBING ❑ ELECTRIC 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: (30S) 762-4949 DEC 17 2014 BC 20 00 Master Permit No o=4 Sub Permit NoQc� = El -2.3564- [:] ' 3564- ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 10B ADDRESS: qy� �Ei qz City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I I Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): AV�Q CxO�� Phone#: Address: QQ�� ,1� Q2.x--;( City: �C' il4 iSli affix E_-5 State: CJ�Zip: Tenant/Lessee Name: Email CONTRACTOR: Company Naame,� /L: _ V�—r4 � pc Phone#:CI Y Address: �- c 7 'C' ' L 4_y� j ,1 City: FL�1 State: Zip: `,- 3 Qualifier Name: «NCS `?�y'�S Phone#: State Certification or Registration #: CSG ©nrD� (�1 Certificate of Competency #: DESIGNER: Arch itect-/1Engineer: t, C4,r- `sr0r-tt Phone#: cess: !j 10 l 5-- City: ,v state: Zip: :3 'Work for this Permit: $ 1000 Square/Linear Footage of Work: �z (g s- ) FA ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace [��emolition A: v tile: 'mit Fee $- y CCF $_ DBPR $ .,n Fee $ Training/Education Fee $ CO/C44 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 Zip City State Zi 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) 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. OWNER or The foregoing instrument was acknowledged before me this /day of �),f�i' CY--~ 20 by f,�w o duis personally known to me or whoAs proced /2 rv,-�-,) ez,-e identification and who did take an oath. NOTARY Print: —( A--� Signature CONTRACTOR The foregoing instrument was acknowledged before me this V!►Ot day of D6f& 20 � by cijenn who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: y P"%, DENISE CHURBA Seal: ?ot► Y ."," AVRAHAM KALMIS fi= Notary Public - State of Florida * MY COMMISSION If FF 172440 •= My Comm. Expires Nov 8, 2016 , EXPIRES: May 12, 2018 Commission # EE 217642 r+e,,01`a' BordedThruBudget Notary Services ******** **�k':s�en'**4'Mre�R#tatibtl'dFltldkiRtji�if. APPROVED BY Plans Examiner Structural Review (Revised02/24/2014) as Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. v COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C.✓ PY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE (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: S, J4.Q .(f' - BUSINESS ADDRESS:3-d/ 4-1 Q=iLm5 CITY s _ STATE_ZIP,� BUSINESS PHONE: ('7-57 6'8o$� FAX NUMBER 0291 )C7 o- I g3 CELL PHONE ( ) QUALIFIER'S NAME: l-_-.;(e-A r1 &44:5 QUALIFIER'S LIC NUMBER: - - •••••. wv 1 nRiG t, n ►CIr I IN 115 S. Andrews Ave,, Rm. Ai 100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: Business Name: US HEATING & AIRj CONDITIONING INC Receipt#:182- IN82 SPRNKL/CONT Business Type: (PLUMBING/CONTRACTOR) Owner Name: GLENN C BUTTSBusiness Opened:iO/31/2008 Business Location: 3721 SW 47 AVE #�05 DAVIE State/County/Cert/Reg:CFC057167 Business Phone: 954-581-8333 Exemption Code: Rooms i Seats Employees Machines Professionals 10 For vending Business Only Number of Machines: ETax Amount Transfer Fee Vending Type: NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0:00 -0.00 0.00 0.00 27.00 i i 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 3 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: US HEATING & AIR CONDITIONING INC 3721 SW 47 AVE #305 Receipt #52A-13-00001710 DAVIE, FL 33314 Paid 09/29/2014 27.00 s' 2014 -2015 " STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 w� 1940 NORTH MONR'OE STREET TALLAHASSEE FL. 32399-0783 BUTTS, GLENN C U S HEAPING AND AIR CONDITIONING INC 624 DOUGLAS AVE SUITE 1402 ALTAMONTE SPRINGS FL 32714 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 team more about the Department's initiatives, Our mission at the Department is: License Efficiently, Regulate Fairly, We constantlyy 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! DETACH HERE a c a: U m L RICK SCOTT. GOVERNOR KEN LAWSON. SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC057167 -he PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter Ogg FS. Expiration date'. AUG 31, 2016 BUTTS. GLENN C U S HEATING AND AIR CONDITIONING INC 624 DOUGLAS AVE SUITE 1402 ALTAMONTE SPRINGS FL 32714 ISSUED: 06%11120! c DISPLAY AS REQUIRED BY LAW SEO x L1406110000857 u `o 0 CL cl• m c+� c� U m N 70 N C _3 E� U U m N CL i , 0 .� _C CERTIFICATE OF LIABILITY INSURANCE DATE (MMIpD/YYYY) F12/15/2014 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(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 BB Insurance Marketing Inc W Sunrise Blvd, 3rd Floor Plantation FL 33322 NTAC NAME:Undsi Gainey Ext. 311 PHONE FAX - A/c,No : - AIC,10167 E-MAILN. ADDRESS:I INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:OhiO ecurity Insurance Co 24 4 BKS55666863 INSURED USHAC-1 INSURER B:OhiO Casualty Insurance Co 24074 INSURER C:Zeoith Insurance Company 13269 USHAC of South Florida LLC INSURER D: --_- DBA US Heating and Air Conditioning 3721 SW 47th Ave #305 Davie FL 33314 INSURER E: To "AMA RENTED PREMISES Ea occurrence)$300,000 INSURER F: CAVFRAGFR CFRTIFICATF NUMRFR- 1)n1)o'1-7n1)zD 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY BKS55666863 10/11/2014 0/11/2015 EACH OCCURRENCE $1,000,000 MERCIAL GENERAL LIABILITY To "AMA RENTED PREMISES Ea occurrence)$300,000 MED EXP (Any one person) $15,000 __ !17i CLAIMS -MADE K OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 $ POLICY X PRO- LOC A AUTOMOBILE LIABILI7YINGLE BAS55666863 10/11/2014 0/11/20. LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AU OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE $ Per accident) B X UMBRELLA LIAB X OCCUR US055666863 10/11/2014 0/11/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $$ C WORKERS COMPENSATION 2126821301 10/11/2014 0/11/2015 X WC STATU- OTH- I TORY LIMITS AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE a — E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E.L. DISEASE -POLICY LIMIT $1,000,000 If ESCyes, describe under DRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I 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. f+0O"r101^ATC L1^1 neo r`Aklr`CI I ATinkl ACORD 25 (2010/05) U 1988-2010 AGUKU GUKNUKA I IVIV. AU ngnis reserves. 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 Miami Shores Village FL 33138 AUTHORIZED REPRESENTATIVE , , ,-•~-' ACORD 25 (2010/05) U 1988-2010 AGUKU GUKNUKA I IVIV. AU ngnis reserves. The ACORD name and logo are registered marks of ACORD