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MC-13-621 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-228552 Permit Number: MC-3-13-621 Scheduled Inspection Date: February 23, 2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: ACOSTA,JUAN CARLOS Work Classification: A/C Replacement Job Address: 128 NE 99 Street Miami Shores, FL 33138- Phone Number Project: <NONE> Parcel Number 1132060132270 Contractor: SANSONE CORPORATION Phone: 954-428-8919 Building Department Comments HVAC PER PLAN WITH DUCTWORK NEW 2 TON UNIT Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. February 20,2015 For Inspections please call: (305)762-4949 Page 18 of 28 Miami Shores Village Building . . D� Department I10050 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 No. � —�21 PERM APPLICATION Master Permit No. ELL - 5(09 FBC 20 � Permit Type: MECHANICAL-� • - AWSk- 1AA �77OWNER:Name(Fee Simple Titleholder):�L�ZQY) COdOS Phone, 05�1'10- 40 Address: f nn City: i S'1-of Q s i CL e- State L Zip: Tenant/Lessee Name: Phone#: Email• JyOY1CA l 0 S Q�J C110 CO Yr) JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: C33 4 3(� Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company N m : / n /� �G">'1 e �� O f 01; c�'Y�/ Phone#: Address: �o G.d ]?�IV4 . City: L<' ly eCACState: Zip: Qualifier Name: ylso n 'L Phone#:C6 +9-9-o 'l 16F State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Addressp_s lK'JU A®SQnf:00 --a .rn'2,) _ DESIGNER: Architect/Engineer: Phone#: —T Value of Work for this Permit:$ LA Square/Linear Footage of Work: Type of Work: OAddress ❑Alter((aa�tion Q� VNew ORepair/Replace ODemolition -Description of Work: ******** **************************Fee ******************************************** Subntittal Fee$ Permit Fee$ f t CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ It I 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 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 alue exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien l brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of c nntencement 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 Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20_,by day of ((kA— ,20\?2,by- G: � 5SAS004 . who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: �J Print: Print: My Commission Expires: My Commissis,1111, Wy COMMISSION#EE167107 EXPIRES February 07,2016 998-0161 FMridsN .00m ############################################## ############################################################# q� i APPROVED BY v �0Ps Examiner Zoning NIT Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 1iE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 �. 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 SANSONE, SCOTT JOHN SANSONE AIR CONDITIONING 4570 GLENWOOD DRIVE COCONUT CREEK FL 33066 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business andof STATE OF FLORIDA Professional Regulation. Our professionals and businesses range $ DEPARTMENT OF BUSINESS AND from architects to yacht brokers,from boxers to barbeque restaurants, PROFESSIONAL REGULATION and they keep Florida's economy strong. CMC12492e'0 ISSUEQ 07/30/2013 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 CERTIFIED.MECHAN-ICAL CONTRACTOR www.myfloridalicense.com. There you can find more information SANSONE _Sb&*J0.H • about our divisions and the regulations that impact you, subscribe SAN50NE AlR CONDITfONkNG 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 is cERTrFIED un d, pronasions of Ch 4;89 FS customers. Thank you for doing business in Florida, expiratron date ,thio 31,2014 L13073000013Z3. and congratulations on your new license! The Department of State is leading the commemoration of Florida's 500th anniversary in 2013. For more information, please go to www.VivaFlorida.org. VIVA ILIIRIOAY?% DETACH HERE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION %e - 4670 CONSTRUCTION INDUSTRY LICENSING BOARDCMC1249260..The MECHANICAL CONTRACTOR Named below iS GERTIFLEDUnder the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 SANSONE, SCOTTJOHN SANSONE AIR CONDITIONING GLENWOO,D DRIVE...._ COCONUT CREEK FL:33066 VIfi RORIOASa{.. RICK SCOTT ISSUED: 07/30/2013 SEQ# L1307300001373 KEN LAW, SON GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT i 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2013 THROUGH SEPTEMBER 30,2014 i D : R / Business Name:SANSONE AIR CONDITIONING Business Type:HEATINGAIRCONDITION CON CTR (MECHANICAL CONTRACTOR) Owner Name:SCOTT J SANSONE/QUAL Business Opened:12/11/2003 j Business Location:590 GOOLSBY BLVD State/County/Cert/Reg:CMC1249260 DEERFIELD BEACH Exemption Code: Business Phone: 954-428-8919 4 � Rooms Seats Employees Machines Professionals 75 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior YearsCollection Cost Total Paid 150.00 15.00 0.00; O.00 0>00 0.00 165.00 I THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PL'A'CE OF BUSINESS j 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 t j 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 j it is in compliance with State or local laws and regulations. Mailing Address: I SCOTT J SANSONE/QUAL Receipt #04B-12-00000360 I 590 GOOLSBY BLVD Paid 08/21./2013 165.00 DEERFIELD BEACH, FL 33442 ; E I � 2013 . 2014 lisle oil -- A� CERTIFICATE OF LIABILITY INSURANCE DATE,M>�DDmYY> F11/21/2013 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 Au A Franc H. Furman, Inc. PHONE (954)943-5050 F°X (954)942-6310 1314 East Atlantic Blvd. L P. 0. BOX 1927 INSURERS AFFORDING COVERAGE NAIC q Pompano Beach FL 33061 1NSuRERANational Trust Ins Co INSURED INSURERB;FCCI Commercial Insurance Co. Sansone, LLC dba Sansone Air Conditioning INSURERCFCCI 'Insurance Company____ 590 Goolsby Blvd. INSURER D: INSURER E beerfeld :Beach FL 33442 INSURER F: COVERAGES CERTIFICATE'NUMBER:Kaster cert w/o form 4 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 R€OUIREMENT, 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, ILTRNR TYPE OF INSURANCE POLICY EFF POLICY EXP POLICY NUMBER IYYY MM/D LIMITS GENERAL LIABILITY j EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY 11 PA iS�gS a�u�' $ 50,000 A CLAIMS-MADE I A f OCCUR 3LOO16162 2/1/2013 2/1/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,006 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY FXI PRO LOC $ AUTOMOBILE LIABILITY E COMBINED tSINGL LIMI $ 1,000,000 A X ANY AUTO 1 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 0017402 2/1/2013 2/1/2014 BODILY INJURY(Per $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident) $ PIP-Coverage by Workers $ 10,000 X :UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,Z00,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED X RETENTION 10,fl0 0011725 2/1/2013 12/1/2014 $ C WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I NLIM _ORANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT r 5 1 OFF1MatdaMory In NH)EMBER EXCWDED9 N/A 13AO2128 /.1/2013 1/1/2014 ,000 000 .It.es,describe.trnder E.L.DISEASE-EA EMPLOYE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 3.1000f000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MILL BE DELIVERED IN Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Dirk DeJong/AM � ° �—� ACORD 25(2010/05) ©1888-2010 ACORD CORPORATION. All rights reserved. INS11125 onirmsi m Thu Ai'r%D l name anA Innn ara raniatarnri m=rka of ArnOn 01/61/2002 00:31 9544281405 SANSONE PAGE 61/01 ACQRU� DA (MNIm0[n-M CERTIFICATE OF LIABILITY INSURANCEF127/30/2013 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 13Y 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 thla certificate does not confer rights to the certificate holder In lieu of such endoraemen a. PRODUCER CONTACT E: Frank R. Fu=ktn, Inc. PHONE (954)943-5050 FAx ivs4)942-6310 1314 East Atlantic Blvd. -MAIL P. O. Sox 1927 INSURER S APPOROW0 COVERAGE NAIC M Pompano Beach FL 33061 INSURERA-National Trust: Ins Cc INauRERe:FCCI Commercial Insurance Co. Sansone LLC dba Sansone Air Conditioning wsuRrRc.Guarantee Insurance Cc 590 Goolsby alvd. INSURER 0z OIAURER E: Deerfield Beach FL 33442 MSURERP: COVERAGES CERTIFICATE NUMBERINaetor w/o form # 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 AUDL WON TR TYPE OP INSURANCE POLICY Numben P4 Y POLICY LINETS GENERAL LIABILITY M � COMMERCIAL GENERAL LIABILITY EACH cCCURtmHCE $ 1,000,000 A CLAIMS.MADQ ®OCCUR 3LOO16162 2/1/2018 2/1/Z014 MEm S 50,000 A one S 5,000 PFRSONALAAAWIWURY S 1,000,0DO GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 POLICY W PRO. LOC S AUTDIaOetLELIA81LlTlr COMBINED t_ A g ANY AUTO . dent 11000,000 BODILY INJURY(Par Pelson) s ALL OS AUTOSCHEDULED D77e02 2/1/2013 2/1/2014 AUTOS AUTOS BODILY INJURY(Par aeGdenl) S X HIRED AUTOS X AUTOS NON-OWNED PROPER V aeeidem PIP.Co - woemm S 10 000 UMBRELLAA OCCUR EACH OCCURRENCE S 3,000,000 B ExOE89LIAB CLAIMS-MADE OM011725 2/1/2013 2/1/2014 AGGREGATE $ DED RETENTIONS 20,00 (Over GL A Auto only) S (,' WORKERS COMPENSATION wC 9TATU- OTH- ANDEMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER(EXECUTNE YJN OFMCERIMEMBER EXCLUDED? N f A E.L.EACH ACCIDQNT S ] 0 00 000 (ManEatory In NH) NCP100436501GIC /1/2014 /1/2015 n �e,dewfte order E.L.DISEASE-EA EMPLOYEE $ 1 000 000 5CRIPMON OF OPERATIONS below EL.DISEASE.POLICY LIMIT I S 1 OOO OOO DESCRIPTION OF OPERATIONG 1 LOCATIONS I VENrCEAg iAtMO ACORD 101,Addl6enal Remarks 3abodule.N morn a mN raRmwgd) Co CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TNtERIROF, NOTICE WRL BE DELIVERED IN Village Of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORREDREPREWNTATIVE Dirk Dejong/ALK •� � ACORD 25(2010105) ®1988,2010 ACORD CORPORATION. All rights reserved. INR1125rxwnnal M Thn Af`A1011 nem.nnrl hnnn am r+anla4�rarf rnerlre of AtInian