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MC-15-1277 PSA`n�>� ��-'I 5-127x' Miami Shores Village ftW TOw M£ChaffiCill:-Re$ Cttit) 10050 N.E.2nd Avenue NE �1 1 �Gatl*Ad6��on1A1*ratiOn Miami Shores,FL 33138 0000 � � .. hfi � Phone: (305)795-2204 r Ae�t lAI 'AI *�EP� [ORtDp' Pots:6 Expiration: 12123/2015 Project Address Parcel Number Applicant 640 NE 101 Street 1132060172090 j LOIS WEISMANTLE Miami Shores, FL 33138-2468 Block: Lot: 9 Owner Information Address Phone Cell LOIS WEISMANTLE 640 NE 101 Street (305)467-5342 MIAMI SHORES FL 33138- 640 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone $ 700.00 Valuation: AIR PLUS CORPORATION (954)591-1231 Total Sq Feet: 00 ' i Tons: Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work: Underground Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.80 Invoice# MC-5-15-55739 DBPR Fee $2.25 05/27/2015 Credit Card $50.00 $115.10 DCA Fee $2.25 Education Surcharge $0.20 06/26/2015 Check#:1989 $ 115.10 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $165.10 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL, DOWS,DOORS,R O NG and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify t t a the foregoing i orm on i accurate a d th all work will be done in compliance with all applicable laws regulating construction and zoning. Futherm re,I uthorize the ab ve-n ed ontractor to o th work stated. June 26, 2015 Authorized Signature: wner / Applica / Contractor / n Date Building Department Copy June 26,2015 1 f Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235545 Permit Number: MC-5-15-1277 Scheduled Inspection Date: September 21, 2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: WEISMANTLE, LOIS Work Classification: Addition/Alteration Job Address:640 NE 101 Street Miami Shores, FL 33138-2468 Phone Number (305)467-5342 Parcel Number 1132060172090 Project: <NONE> Contractor: AIR PLUS CORPORATION Phone: (954)591-1231 Building Department Comments RE INSTALL EXISITNG UNITS 2 MINI SPLIT Infractio Passed Comments INSPECTOR COMMENTS False l Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 18,2015 For Inspections please call: (305)762-4949 Page 11 of 34 Miami Shores Village Building Department MAY 2 2 015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. (�f—" i S— I PERMIT APPLICATION Sub Permit NoAC.� Z4-- %2?- ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP p CONTRACTOR DRAWINGS ! `�0 IV JOB ADDRESS: •� - 101 sT S? City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: L C-,-i&-dhau.se-va- �li we sv,,"41e Phone#: 3a5"-"7S! --a-,7Ua- OWNER:Name(Fee Simple Titleholder):�o n Address: (e 1�O A), C . 10 ( sf• City: AA i,a- ✓h,I S k 0 v e S State: EL- Zip: 3 3 /3 Y Tenant/Lessee Name: /(/�71 Phone#: Email: 9 CONTRACTOR:Company Name: .0 I k_ f(,AS &&'UP Phone#: Address: 0150il- �.AJrj'�r'f%C/ %„/'Y City: !2,Q)fVV1rrQ 1 fhof.*Uk State: F'1.o1Dot Zip: Qualifier Name: 60"546" -rot ra'sbcA Phone#: !asAy� lA , State Certification or Registration#: C/A 6,10S..J"17\ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ® Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: s e Specify color of color thru tile: Submittal Fee$ Permit Fee$ t CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ t TOTAL FEE NOW DUE$ 1 (RevisedOZ/24/2014) 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 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. Signature/ � �✓L _ Signature C��/ri OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _� day of M.4y 20 IS by %e day of r✓LA`/ 120 J� by e_iLS�, 'T�uho is personally known to cnvy -h MFsbg�A ,who is personally known o me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign- ^A- Sign: _ 4� Print: .... s+► Print: Seal: ,�,.. .. . MY COMMISSION SFF054895 Seal: ` `i MY COMMISSION#FF0541I88 X61 ''�f• ' EXpIRgB September 17,2017 •.,,� �,oP.•• EXPIRES September 17,2017 409)398.0163 016M4NOWNService.com 407 318.0163 FWk1allotar~1w.oem APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) DOOR Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel. (305)795.2204 CONIRTACTORM' REG Fax: (305)756.8972 �ISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A.--±✓—COPY OF QUALIFIER'S STATE LICENCES B. %/ COPY OF LOCAL BUSINESS TAX RECEIPT C.___.V- COPY OF LIABILITY INSURANCE* D.—%J COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI MADE 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 form and Contractor Affidavit) *YOUR 114SURANCE COMPANY MUST ISSUE A CERTIFICATE AS CerUfIcate 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:AZ P1,vS BUSINESS ADDRESS: q Sl 2- ^AA4S '-r - (�-�'A CITY-&t19d4&A-WTATE 'SL, ZIP_,jjh,%+ BUSINESS PHONE: FAX NUMBER( CELL PHONE(... QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850}487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MESBAH, MOHSEN AIR PLUS CORPORATION 9592 MAJESTIC WAY BOYNTON BEACH FL 33437-3327 Congratulations! With this license you become one of thi nearly _ one million Floridians licensed by the Department of Business and - Professional Regulation. Our professionals and businesses range STA'L'E OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEP/RTM OF BUSINESS AND and they keep Florida's economy strong. PROF ULATION Every day we work to improve the way we do business in order to CAC05343 t = 7122/2014 serve you better. For information about our services,please log onto www.myfloridalicense-cm. There you can find more information about our divisions and the regulations that impact you,subscribe s C'ERTtFlEt3 to department newsletters and learn more about the Department's lE ;` AIR PLUS initiatives CO Our mission at the Department is:License Efftciently,Regulate Fairly. rtn --Vste:�x3rtstarh#yst •to serve you bettsr`em'tt'rafyou can serve your ,} customers. Thank Th$r�ys�ll'i'iC3rdtilrig business in Florida, I3 GER1"iftEi3 uridsr4rre prG+v^:- fsions Of Gh. 89 F$. and congratulations on your new license! rtar ,eats Alt 6.3� zasis-= +tr DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF f LOPJDA OIF-INMWESS AND PROFE-SSIONAL REGULATION ' 1Af SM UCENS The CLASS'A R C. - DITIONiNG CC}N_TFIAGT U: e .. "taste C r: FS. E tton'daW,'A R 3Tw1d16• AV#R J6 kSSUEo: 07v22M14 DISPLAY AS REQUIRED BY LAW SECS L1407220001081 A N N£_M. G A N'N 0 N P.O.Box 3353,West Palm Beach,FL 33402-3353 � t_OCATED AT` CONSTITUTIONAL TAX COLLECTOR warw.pbctax.com Tel:(563)355-2264 seming Palm Bwch Cooney 9592 MAJESTIC WAY Servingyou. BOYNTON BEACH, FL 33437-3327 TYPE OF BUSINESS OMER CERTIFICATION Ri RECEIPT#10ATE PAID AA#T t',1D BILI4 23 0948 AIR CONDITIONING CONTR AdES$AH Mfi#iSEN CAC1953i331 s14,1371783.0M, '14 84C72333A This document is valid only when receipted by the Tax Collector's office. STATE OF FLORIDA 'ALM BEACH COUNTY 81-309 2094/2095 LOCAL BUSINESS TAX RECEIPT AIR PLUS CORPORATION LBTR Number: 200519303 AIR PLUS CORPORATION 9592 MAJESTIC WAY EXPIRES: SEPTEMBER 30, 2015 3OYNTON BEACH,FL 33437-3327 This receipt grans the privilege of engaging an or tt 1,,11111191<I8i111I/iiIs!1tdYiiDtiY1 111III managing any business profession oromupation within Its jurisdic-don 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. FROM (WED)MAY 27 2016 16:00/ST. 14:68/No.7626033823 P 1 ACt�7RL,�° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDmrYv) 05/27/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS E CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIS 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 pol)cy(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 cer locate does not confer rights to the certificate holder In lieu of such endomement(s). PRODUCER pR�T Ancona Insurance Agency,Inc. lip NE FAX 605 S.E. 10 Street E- L , (954)420-5998 c.Nob (954)420-5985 Deertield Beach, FL 33441 felipe®ancorainsuranos.com msu s AFFORDING COVERAGE NAIL s Phone (954)420-5998 Fax (954)420-5985 INSURERA: LLOYD'S OF LONDON INSURED INSURER B: AIR PLUS CORP. INSURERC: 9592 MAJESTIC WAY INSURERD: BOYNTON BEACH,FL-33437 (954)591-6722 INSURER E: COVERAGESINSURER F 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. INSLTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER EFF PCUCY F� LIMITS GENERAL LIABILITY EACH OCCURRENCE S 100 000.00 ® COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED A F-1❑ ❑ CLAIMSMADE ® .000 OCCUR N N 09/23/2014 09/23/2015 CIBFLOO10030 MED EXP An arson)one $ 5,00000 ❑ PERSONAL a ADV INJURY $ 100,000.00 GENERAL AGGREGATE $ 200 000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOP AGG $ 200,000.00 POLICY ❑ PRO ❑ LPC AUTOMOBILE LIABILITY OMBINE�DdSINGLE LIMIT ❑ ANY AUTO ALL BODILY INJURY(Per person) $ ❑ AUTOS ❑OWNEDSCHEDULED ❑ NON-OWNED INJURY(Per accident $ HIRED AUTOS ❑ ❑ AUTOS YOPER GE $ ❑ UMIBRELLA LIAB ❑ $ OCCUR ❑ EXCESS UAB ❑CLAIMS-MADE EACH OCCURRENCE $ 11 AGGREGATE $ DED ❑ TEN710N WORKERS COMPENSATION $ AND EMPLOYERS•LIAMUTy !N WC STA - ❑OTH- ANYPROPRIETORIPARTNERlEXECUTIVE IR OMF�ER/MEMBER EXCLUDED? N f A E.L.EACH ACCIDENT $ Ifyss !%b; 'orY In d- E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schsdule,h mora space Is required) AIR CONDITIONING AND HEATING SERVICES AND INSTALLATION CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS, 10050 NE 2ND AVENUE MIAMI SHORES-FL-33138 AUTHORIZED REPRESENTATIVE y FAX:305 756 8972 ACORD 25(2010105)QF ®1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation few. EFFECTIVE DATE: 10/9/2013 EXPIRATION DATE: 101912015 PERSON: MESBAH MOHSEN FEIN: 650316368 BUSINESS NAME AND ADDRESS: AIR PLUS CORPORATION 9592 MAJESTIC WAY BOYNTON BEACH FL 33437 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-GOND pursuant to ChWer440,05(14),r-s-an officarofa corporation who elects exemption from this chapter by fling a catecate ofeledtori under this section may not recover benefits or ewnpensabon under this chapter.Pursuant to Chapter 440.06(12),F.S.,Ce0cates of election to be exempt.-apply only y4thin the scope of the business or trade listed on the notice of election to to eXampt.Pursuant to Chapter 440,05(13).F S,,Notices of election to be exempt and certificates of elactionlobeexempt 9W W subject torevotefion if,at any time after the filing of the notice or the issuance ofthe cerfific0te,the person named on the notice or ceffoate no longer meats the requitamemts of this section for issuance of a certificate.The department shall revoke a ceddicate at any time for failure of the person"mod on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS7(850)413-1609 ... o,.. Miami shores Village %7wV' Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-rime employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. �XaSignature . Owner State of Florida County of Miami-Dade rn The for going was acknowledge before me this i day of ' 1 ' ,20 S. By W� VIAr 0 _ who is personally known to me or has produced I` Io as identi .��`Pr vti''o Notary: ;20 e`�, DOUGLAS:MARIANONotary Public- of FloridaMy Comm.Expirg 27,2017SEAL: Commission 046776 C �^ Air Plus Corp. 9592 Majestic way,Boynton Beach,FL 33437 (954)591-1231 05/21/2015 State of Florida County of Miami-Dade Before me this day personally appeared Mohsen Mesbah who is being duly sworn,deposes and says: That he will be the only person working on the project located at Sworn to and subscribed before me this 21't day of may 2015,by Mohsen Mesbah Personally known ROBERTO L ROCHA MY COMMISSION#FF054M September 17.2017 AUM Print,Type or Stamp name of Notary