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MC-15-440 Miami Shores Village ~ Building�ng Department FEB 2 7 LJ 15 � 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 � FBBC 201() BUILDING Master Permit No. it— PERMIT APPLICATION Sub Permit No.-MC "I P�-U4144 (� ❑BUILDING ❑ ELE C ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 21 6"2 City: Miami Shores Coun : Miami Dade zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): :Z LZ C Phone#: Address: City tate: Tenani/Lessee Name: Phone#: r:f6 Email: CONTRACTOR:•Company Name: `0 U Phone#: RSA Q("L Address: J Y. City: s, 1 m14 ` State: Zip: '3 3 0 Z_ Qualifier Name: % �--,� Phone#:_3 0Y—"3,4_Z State Certification or Registration#: 6f& e_ + ' (�� Certific Competency M DESIGNER:Architect/Engineer: Phone#: Address: rll� �.. Zip: Value of Work for this Permit:$ Square/Linear Foota f Work: Type of Work: ElAddi • El Alteration ❑ N w Repair/Rept ce ❑ Demolition Description of Work: 4U ® "A Specify color of color thru rile: Submittal Fee$ Permit Fee$ V CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ — •2 (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 a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. o,.q m Signature-2 Signature OWNER or AGENT ) d CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of W rr 20- by '5 day of PC 20 l5 by IAC 2-en, ,4 is personally known to argv"ie. aka UM who i ersonal y k wn to me or who has produced _as me or who has produced as identification and who ditake an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: d Sign: Sign:_ Print: �tf; VAUrl-Ve cL Print: Q.,_ Seal: Kofie M. Wynter Seal: _ {� ��� COM # Ffl74236 �= Kofie M wy�ter EXPIRES:Nnft k 2M$ �yp� f fF1T423g I ►WIRONNOURY.colf APPROVED BY l Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) _ STATE OF FLORIDA _ TSir, F_d DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ���(�� CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 " w 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HYLTON, GERVAISE W KOOL FLOW INC 5889 SW 21 ST BLDG F WEST PARK FL 33023 Congratulations! With this license you become oneofthe-nearly - ---- one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range " tee. STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. w PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CAG1816347 ISSUED: 08/03/2014 serve you better. For information about our services,please log onto WWW.myfloridalicense.com. There you can find more information CERTIFIED Al R,COND CONTR about our divisions and the regulations that impact you,subscribe HYLTON,GERVi4ISE W to department newsletters and learn more about the Department's initiatives. KOOL FLOW INC Our mission at the Department is:License Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED-under the provisions of Ch.489 FS, and congratulations on your new license! Expiration d%la'-:AUG 31 2016 L1408030002752 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY X STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC1816347 The CLASS AAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 HYLTON,GERVAISE W KOOL FLOW INC: 5889 SW 21 ST BLDG F WEST PARK FL 33023 e ISSUED: 08ro3n014 DISPLAY AS REQUIRED BY LAW SEQ# L1408030002752 .._....................... 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954.-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 DBA: Business Name:KOOL FLOW INC Receipt#:H A3-228AIRCONDITTON CONTRACT. Business Type:(AIR CONDITIONING CTR) Owner Name:GERVAISE W HYLTON Business Opened:10/26/2009 Business Location. 5889 SW 21 ST BLDG F WEST PARK State/County/Cef'it/Reg:CAC1816347 Business Phone: Exemption Code: Rooms Seats Employees Machines Professionals 1 Number of machines: For Vending Business Only Tax Amount Transfer Fee Vending Type: 27.00 NSF Fee Penalty Prior Years Collection Cost Total Paid r7.0p 0.0a c.7t7 0.00 0.00 29.7C 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 tritest meet all County and/or Municipality planning WHEN VAUDATED and zoning requirements, This Business Tax Receipt roust 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 it is in compliance with State or local laws and regulations. Mailing Address: GERVAISE W HYLTON 5889 SW 21 ST BLDG F Receipt 52A-15-00000025 WEST PARK, FL 33023 Paid 10/01/2015 29.70 - 2016 AC�0 712/22/2015 (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE TI't.4 CERTIFICATE IS ISSUED ASA 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 CONTACT NAME: David Reiter Sierra Insurance PHONENo, 954-788-1005 a No):954-346-4801 4613 N University Dr.#481 ADDRESS:Idavid@sierracoversyou.com Coral Springs, FL 33067 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Atlantic Casualty INSURED INSURER B:Normandy Harbor Kool Flow, Inc INSURER C:Ascendant Insurance 5889 SW 21 St St. INSURER D: Building F INSURER E: West Park FL 33023 INSURER F: COVERAGES 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. INSRTYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD A X COMMERCIAL GENERAL LIABILITY X X CBC20000806000 09/22/15 09/22/16 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE ❑X OCCUR DAMAGETO occurrence)RENTED 100,000 PREMISESS $ MED EXP(Any one person) $ 5000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ C AUTOMOBILE LIABILITY ASC6395252 10/01/15 10/01/16 CEaOMBINccidenEDtSINGLELIMIT $ 1,000,000 a ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION NHFL639423 09/20/15 09/20/16 PER OH- EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes, scribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) License CAC 1816347 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 N.E. 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE n ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Y Certificate of Product Ratinqs AHRI Certified Reference Number: 4260512 Date: 9/20/2011 Product: Split System:Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: VSX130361A* Indoor Unit Model Number:AR*F363616C* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade/Brand name: GOODMAN,JANITROL,AMANA DISTINCTIONS, EVERREST, ONE HOUR AIR CONDITIONING AND HEATING, ENERGI AIR Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP. Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent,third party testing: Cooling Capacity (Btuh): 34400 EER Rating (Cooling): 11.00 SEER Rating (Cooling): 13.00 'Ratings followed by an asterisk(')indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes. The contents of this Certificate may not,In whole or In part,be reproduced;copied;disseminated;entered Into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual,personal and confidential reference. CERTIFICATE VERIFICATION The information forthe model cited on this certificate can be verified atwww.ahridirectory.org, VDI Air-Conditioning,Heating, click on"Verify Certificate"link and enter the AHRI Certified Reference Number and the date on ■o `/ and Refrigeration Institute which the certificate was issued,which Is listed above,and the Certificate No.,which Is listed below. 02011 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 129610224796257117 • Proposal and Contract SOVRIN REFRIGERATION AND 1667 McNab Road AIR CONDITIONING INC. Pompano Beach, Florida 33069 Phone 954.783.9294 Fax 954.783.9293 License: State of Florida No. CAC 057102 NNNSTON PORDE S54-868-0720 Comer's Name: Phone: ?4rg-- Date : e/= R 4 r s I". ice C. FAX V- 7 Street Job Nance: C— . I City,State and Zip._ R 3�/,5---� Job Location_ �, II �LCA �. I (2) � � ArchitecVEngineer: Date of Plans li I� PROJECT NO. I SHEET NO. SOVRIN Refrigeration and Air Conditioning, Inc. ("Contractor") proposes to furnish equipment and materials for the below described Work pursuant to the attached Terms and Conditions. EQUIPMENTIFABRICATION-MATERIALS ARE.5-6 WEEKS LEAD TIME, AND ANY REQUEST FOR FASTER SERVICE WILL INCUR SURCHARGES. LIST SPECIFICATION SECTIONS AND/OR WORK TO BE PERFORMED.. 2:?di jit ----=� -�''',� 2---,-=-=' -`' --- 'Q_'•vo/ -��- ----. -----D-`�- ---�,v c�� C ac��g�_--1N s �� c o �x/r d u e 1--99^a 3-JAI- i a - ---Ccr.�s i _r4 j� % s c�L _ i�c !�! 4 ----------------------------------------------_--_________----------------__ -__-------------------------- A DEPOSIT OF $35% DOWN UPON SIGNING OF THE CONTRACT. CONTRACT PRICE: 1=0 ALL WORK WILL BE PERFORMED IN COMPLIANCE WITH STATE OF FLORIDA CODES. NO CUTTING,PATCHING,PAINTING,ROOF REPAIR,PERMITS OR ELECTRIC CL ANY ADDITI NICAL WORK DONE OR REQUIRED WILL 1NCU I N C R II Cor�raa�or- Customer: i' Date of Proposal: Date of Acceptance: This Proposal shall be effective for a period of sixty (60) days.