MC-15-2305 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-246352 Permit Number: MC-9-15-2305
Scheduled Inspection Date: October 26, 2015 Permit Type: Mechanical - Residential
Inspector: Perez,JanPierre
Inspection Type: Final
Owner: RUARK,JOHN Work Classification: Addition/Alteration
Job Address:9909 NE 4 Avenue Road
Miami Shores, FL Phone Number (410)610-2148
Parcel Number 1132060171310
Project: <NONE>
Contractor: SANSONE AIR CONDITIONING Phone: (954)428-8919
Building Department Comments
HVAC PER PLAN 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.
October 23,2015 For Inspections please call: (305)762-4949 Page 25 of 39
may° Miami Shores Village 'tt� 11 (
10050 N.E.2nd Avenue NE {)Ijrp)[tjjt@00C)1
Miami Shores, FL 33138-0000
N c� Phone: (305)795-2204 i , 3
i
fes.
. .
lssu813ate 9/1512E�15 Expiration: 03/13/2016
Project Address Parcel Number Applicant
9909 NE 4 Avenue Road � 1132060171310
Miami Shores, FL, Block: Lot: JOHN RUARK
Owner Information Address Phone Cell
JOHN RUARK 9909 NE 4 Avenue Road (410)610-2148
MIAMI SHORES FL 33138-
9909 NE 4 Avenue Road
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 8,800.00
SANSONE AIR CONDITIONING (954)428-8919
_.... ........._ ... _, _ _.. _. _ Total Sq Feet: 2800
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: HVAC PER PLAN Underground
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $5.40
Invoice# MC-9-15-57037
DBPR Fee $4.62 09/10/2015 Credit Card $ 50.00 $290.64
DCA Fee $4.62
Education Surcharge $1.80 09/15/2015 Check#:2099 $290.64 $0.00
Permit Fee $308.00
Scanning Fee $9.00
Technology Fee $7.20
Total: $340.64
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,PLUMBIN ECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFF ID VIT: I c rtify th all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and z n g. e, I uthori ov -named contractor to do the work stated.
September 15, 2015
Authorize Signatur n / Applicant / Contractor / Agent Date
Building Department Copy
September 15,2015 1
Miami Shores Village
g -
� g 2015
Building Department SEP 0
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'
BUILDING Master Permit No. C Z
PERMIT APPLICATION Sub Permit No. /AC
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑F-IPLUMBING ❑E MECHANICAL PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9909 NE 4 AVE RD
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3206-017-1310 Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: MECH Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): JOHN W RUARK SERGIO B PAPA Phone#:
Address:9909 NE 4 AVENUE RD
City: MIAMI SHORES State: FLORIDA Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: SANSONE A/C Phone#: 954-428-8919
Address: 590 GOOLSBY BLVD
City: DEERFIELD BEACH State: FLORIDA Zip: 33442
Qualifier Name: SCOTT SANSONE Phone#: 954-428-8919
State Certification or Registration#: CMC1249260 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$8,800 Square/Linear Footage of Work: $�t�
Type of Work: Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: HVAC PER PLAN
Specify color of color thru tile: ,c
Submittal Fee$ S ) Permit Fee$ d ACF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ t"!
(Revised02/24/2014)
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 b ilding permit with an estimated val exceeding$2500, the applicant must
promise in good faith that a copy of the notice of co m ncement and construction lien law chure will be delivered to the person
whose property is subject to attachment. Also, a ce fiedicopy of the recorded notice of com cement must be posted at the job site
for the first inspection which occurs seven (7) ,day aft r the building-permit is issued. In he absence of such posted notice, the
inspection will not be approved and a reinspection e e ch ed.
,.w
Signature Signature
OWNE r AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 120, 20 (,6- by 9 day of SEPT 20 15 by
Gt who is personally known to SCOTT SANSONE who is personally known to
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 PU IC:
t"
Sign: Sign:
Print: LtL%-yt^ ��h.,.��� Prin SH EY DZ A89LEYA. DZIEWIT
Seal: � �° My COMMISSION#FF iM27 7107
* * Seal:EXPIRES:Match 16,2019
!� 07 �yg
�
Bonded Tt,Budget Notary Services
APPROVED BY _ v �Iansxaminer Zoning
Structural Review Clerk
(Revised02/24/2014)
09/10/2015 09:20 9544281405 SANSONE PAGE 01104
IFER
"' 1 rl iami shores
V
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel, (305) 795,2204
CONTRACTORS' REGISTRATIQN Fax: (305) 756.8972
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. x COPY OF QUALIFIER'S STATE LICENCES
B.X COPY OF LOCAL BUSINESS TAX RECEIPT
C. X COPY OF LIABILITY INSURANCE*
D. X COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADS 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 INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORE=S,FL 33138
Certificate must specify the description of operations or contractor license number.
■rRRrrrrrr*RRrrrrrrRRrrrrrrRRRfrrrrr RRirrrrrrrRRrrrrrrRRrrrrrrRRrhrrrrRrRR RrrrrrRRfRrrrrrrR
BUSINESS NAME: SANSONE A1C
BUSINESS ADDRESS: 590 GOOLSBY BLVD DEERFIELD BEACH
CITY STATE FL ZIP 33442
BUSINESS PHONE: 9I 54 ) 428-8919 FAX NUMBER( 54_) 42$-1405 —
CELL PHONE( ) QUALIFIER'S NAME: SCOTT SANSONE
QUALIFIER'S LIC NUMBER: CMC 1249260
0911012015 09:20 9544281405 SANSONE PAGE 02/04
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CQNSTRUG-TION-1;II)U•ST-RY...-LICENS-ING-BOARD............ . ............................_. _.„
• ..... .. (850)..A'87.-1.395....:............................_
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
SANSONE, SCOTTJOHN
SANSONEAIR CONDITIONING
4570 GLENWOOD DRIVE
COCONUT CREEK FL 33066
Congratulations! Wrth this license you become one of the nearly
one million Floridians licensed by the Deparlment of Business and
r
Professional Regulation. Our professionals and businesses range -..
from architects to yacht brokers,
and the Y from boxers#o barbeque restaurants,
y keep Florida's economy strong_
dew r... IC,,Ij "rl- LArT]C3N`
lY y e work to improve the way we do bustness in order to
Eve ^� �»
serve you better. For information about our services lease i onto
www.mytioridallcOnsO.com. There you can find more information .-
about our divisions and the re ulations that impact you,subscribed -IFIE `
to department newsletters and learn more about thDepart
initiatives, ment's
Our mission at the De "��"�'"�"�'; .--- �•������
partment is:License Effciantly,Regulate Fairly. �✓" �'"=." ,r ., ^�,°��'n-�
We constant!y strive to serveou better so that you can serve your
Customers, Thank you for doing business in Florida,
and congratulations on your new ricensel16
�
r'"' .•w�.,,b.,.•�.r...."..-w.., ...ems
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DETACH HERE
RICK SCOTT,GOVERNORKEN
77—
SECRETARY
SON
b.EPARTII EN�`,1DFBUS�t
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lssui:o: 07,o312014
l7ISPLAYAS REQ#JIRED BY LAW SFQe 1.+4070300011e7
09/10/2015 09:20 9544281405 SANSONE PAGE 03/04
BROINARD cook rY LOCAL BU9IN SSyTAX
115 S.Andrews Ave., Rm. A-100, Ft. Lauderdale FL 33301-1896—
VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 D00
DBA:SANSONE AIR CONDITTONING Receipt#:J83-1348
Business Name: Hustnef3s Type' TING/AIRCONDITION CONT
(MECHANICAL CONTRACTOR)
Owner Name:SCOTT J S,ANSONE/QUAL Business Opened:12/11/2003
Buslneas!_OCatlon:590 GOOLSBY BLVD 8t2te/C0unty/C9rUR09:CMC1249260
DEERFIELD BEACH FXempttOn Code;
Business PhOne:954-428,8919 I
Room* feasts Employees Machines Professionals
75
For Vortding Busruose only
Number o1'Maehinee u Venelrn T
Tax Amount Tramfer Fee 8 �
NSF Fee Penalty Prior Years C0119emn Cost TO�15
id
150.00 0.00 0.00 0.00 0.00 0.00 .00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS f
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business willhin sroward County and is i
I
nen-regulatory in nature.You must meet all County and/or Municipality pinning J
WHEN VALIDATED and zoning requirements.This Business Tax Receipt must be ttzn*bnred when
the business is sold, business name has changed or you have moved the
business location,This moslpt does not indicate that ft business is legal or that
It is in compliance with State or loyal lawn and regulations,
Mailing Address:
590 GOOJ SANSOA.T.
59RcmiPis 110IA-14-00008937
0 LSRX BLItt)LVb
D r.RFIELI7 BEACII, FL 33442 Paid 08/06/2015 ]50.90
2015 . 2016'
09/10/2015 09: 20 9544281405 SANSONE PAGE 04/04
` sCiPR 4
CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDMVY�
=REPRESENTATIVE
IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATI: HOLDERyTHIS
S NOT AFFIRMATIVELY OR NEGATIVELY AMENb, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES
RTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
OR PRODUCER,AND THE CERTIFICATE HOLDER.ttermsanf the cartions cats polder is an ADDITIONAL INSURED,tlla Pollcypes)must be endorsed. 1(3u$ROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement pn leis certifecat®does not confer rights to the
E1'.',Lcs)jB
older in lieu of such endorsements-
Frankk*usman NTAC
i Tnc. PHONE
Atlant-,c Blvd. f95�1943-5050 F
E•MAFL .(9591942-63.10
1927
each FL 33061 INavRM AFPOTINGCOVERAGE
ED INSURRRAXational 1'Y ug t; Ina Co NAICN
Sansone LLC dba Sat►s022e Air Conditioniag 10178
INSURERB:FCCI IngUranCp Co 20141
590 Goolsby Blvd. INSURERC$rid afield Em 1d erg Ins Co
1 7 1
INSURER D;
Deerfield Beach FL 33442 Ill URE-
COVERAGE;$ IN 1URFR F-
CERTtFICATENt1MBER;2015-16 N O/Zndto
THIS IS TO CERTIFY THAT THE POLICIES O IREME ANCE LISTED BELOW NAV@ BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY date
REVIgIONNUMI3ER:�c Po>;# update
ICERTIFICATE MAY BE NDfCATED, NOTWITHSTANDING ANY REC1U1_REAAENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
EXCLUS NS AND CONDITIONS OF SUCH POLICIES.LHMIT$SUANCE IOWN MAY E eEE�EDUCED BY PAID CLAI►Ng,
wS POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
TYPE F INSURANCE
GENERAL LIADILITY LICY tUM111125R POLI FF CY E
LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRf;NCE $ 11000,000
A CLAIMS-MADE M OCCUR0016162 2 2/1/2024 2/2/1015 $ 1001000
MED EXP Anyone rsm) $ 5,000
PERSONAL&AOVINJURY $ 11000,000
GRN'LAGGREGATELIMIT APPLIES PER; GENERALAGGREGATP, a r000,OQQ
POLICY X PRO PRODUCTS-COMP/pPAGG S 2,000,000
LOC
AUTOMOBILE LIABFLrry
A x ANY AfJtp GO'
n1JWED St LE LI
ALL OSCHEOULED BODILYINJURY(For p"on) $ 1 000 000
AUTO& A0027402 5 2/;/2024 2/1/1015
X HIREt)qI rt0a XTNON-OWNED ROOILY INJURY(Por accident) $
PROP Pa ed
DA MA 9 $
X VAMRELIA LIAR OCCUR $
B EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE
$ 3,000,000
DED X R NT N 10,00OD11T25 5 Z/1/2DAGGREGATE $ 3,000,000
C WORKERS COMPENSATION 1� 2/1/2015
AND EMPLOYERS'LIABILITY $
ANY PROPRIETORIPARTNER�E><ECUTTVE YIN X WC STAT U. DTH_
OFMCERIMEMBER EkCLUDED? N f A .OBY lIM
if SIEatFdarory In NH) E30 und59159 EL EACFIACCIDENr $ '0001000
OE$CRIPTION FOPERATIONSbelow /1/2015 /2
F.L.DISEARE-EA EMPLOYE S 1 000 000 �
E.L."EASE.POLICY LIMIT $ 1 000 002
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ANach ACORD 101,AddlUoMal Remprke SahaDule,If more&DACA Fs M4W1r
a13
)
RE. KZQXMqi0A,L CONTRACTOR LXCENSE # MC124926a
CERTIFICATE HOLDER
CANCELLATIQN
SHOULD ANY OF TFIE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
MIAMI SHORES VILLAGE BLDG DEPT
ACCORhANCE WITH THE POLICY PROVISIONS.
10050 NE 2� AV$
MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE
Dir$ DeJon3/RD . ...ems.� �,
ACORO 25(2010105) ®.1988-2010 ACQRD CO
RPO nn,nnc,m Thr,d rnlan n�r„ti. RPORATION. All rights reserved,
Anrl Innn are renie*arx rl mar4e of Af;fspn