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EL-10-1818 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL `0 I r _ Phone: (305)795-2204 Fax. (305)766-8972 l v I �( Inspection Number: INSP-157979 Permit Number: EL-10-10-1818 Inspection Date:April 05,2011 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: BUTLER,JACQUELINE Work Classification: Addition/Alteration Job Address:1460 NE 102 Street Phone Number Parcel Number 1132050240140 Project: <NONE> Contractor: ABLE ELECTRIC OF SO FLORIDA INC Phone: 3051266-6602 Bullding Department Comments DEMOLISH THE ENTIRE ELECTRICAL EXISTING SERVICE FOR THE HOUSE Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-152301. Neds temp. for Eaconstruction pole. Failed E:1 Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 April 05,2011 Page 1 of 1 JJ a 3 } Miami Shores Village ^F, 10050 N.E.2nd Avenue NE ' h Miami Shores,FL 33138-0000 Phone. (305)795-2204 .I=Y M '€!{n4 Expiration: 04123/2011 Project Address Parcel Number Applicant 1460 NE 102 Street 1132050240140 JACQUELINE BUTLER Block: Lot: Owner Information Address Phone Cell JACQUELINE BUTLER 1461 NE 102 Street MIAMI SHORES FL 33138-2621 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 ABLE ELECTRIC OF SO FLORIDA INC 305/266-6602 Total Sq Feet: 0 Type of Work:ELECTIRCAL Available Inspections: Additional Info:DEMOLITION Inspection Type: Classification:Residential Final Scanning:1 Meter Box Alteration Relocation Fire Alarm Service Change Underground W.W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-1040-39158 DBPR Fee $2.25 10/26/2010 Check#:3483 $159.10 $0.00 DCA Fee $2.25 Education Surcharge $0.20 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated. October 26,2010 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 26,2010 1 CERTIFICATE OF hIASILITY INSURANCE DATE(U'DD"'') 1WWI0 PROW= Tammy Insumme Agency THAs CERTIFICATE IS IMUED ASA MATTER OF INFORMATION 9821 S.W.40th Stmt ONLY ANG CONFERS NO RItiHT$UPON THE CEWMATE Nliami,FL 33165 HOLDER.TM CERTIRICATE DOES NOT AMEW,EXTEND OR NaM THE COVER E ED BY UO E Phone(305)485-MFax (305)485.3gg4 INSURERS AFFOROM COVERAGE MAIC# INSURL?D Able Electric of South Florida Inc INSURER A: AtIontiocasuafty Insurance Compan INSURER ' 2010 SW B, 83 St Miami, FL 33155- INSURER a: (306)608-32T8 JNSURERD INSURER E- COVERAGES THE POLIOII"a8 OF INSURANCE DOTED r{11VC DM ISSUED TO THE INSURED NAMW ABOVE FOR THE POLICY PERIOD INDICATED. NO7 VItIl'HSTANDINfB ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WrrH RESPECT TO V6110K THIS CERTIFICATE MAYBE rSSUEv OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE S DESCRIBED HEREIN G SUBJECT TO ALL THE TERMS,OCCLUSIONS AND CONDITIONS!SSU D SUCH POLICIES.AGGREGATE Y VE BEEN REOUOFn KY PAID CLARM. JJAIN0 A Now TYPE OF INSURANCE POLICY NUMBER ® EXPM GI L DATE fm NYRCIALGENEALABLrrY N EACH OCCURRENCE � 1,000,000 L040001319 9?J0812009 12/08/2090 PREMISES i„�o urren 100,000 A ❑® CLAM MA1DE ® OCCUR MED EKP(Any one person) 6,wo ❑ ❑ BOO DED PERSONAL.3 ADV INJURY 1,000,000 ❑ 5W DED GENERAL AGGREGATE 1,000,000 OWL AGGREGATE U Wr APPLIES pER: PRODUCTS.COMP/OP AM 1,000,000 ❑ POLICY ❑PROJECT U LOO AUTOWBILB LIABILnY ❑ ANY AUTO COMM=SINGLE LOMAT ❑ ALL OWNED AUTOS ❑ ❑ SCtWULED AUTOS BODLY(NJURY ❑ HIRIM AUTOS ft pervan) ❑ NON OWNED AUTOS BODILY CRY ❑ ftacald" E GARAGE LIABIL.n'Y ft aoowent) ❑ ANY AUTO AUTO ONLY-LLA ACCIDENT❑ ❑ OTMR THAN CA AW AUTO ONLY: AGO EXCESS/UMBRELLALIABILRY EACH OCCURRENCE a EDOGGUR E3 CX.AIMCi MAL7E AGGREOATB ❑ DEDUCTMW ❑ RETENTION S EMPLOYERS'LIABILrry AND U WC g� ❑ pTy, ANY PROPRMETOR I PART NIR I WmcLTIVE YEN ER (OFFICER/MEMBER EXCLWED? E.L.EACH ACCIDENT IM In ft deter- � S� PR E.L.DISEASE-EA EMPLOYEE OTHER AL E.L.DISRUS-POLICY LIMIT DESCRIPTION OF OPERATIONS I DATIONS I VENCLES 104WLUSIVNS ADGwD 13Y ENb0r4sCI4BNT/.9PEGIAL►ROYISIONS CERTIFICATE mou)ER CAWE"TION SHOULD ANY OF THE ABOVE DESC HMM PoWES BB C"OELLED Bt?FORE THE EXPIRATION DATE TH mw THE Mmma$LgUpm WILL BNOBAvvR To MNL MIAMI SHORES VILLAGES 30 DAYS WRITTEN NOT=To THE CgRTWIGATE HOLDER NAMED To 10050 NE 2 AVE TAT,BUT FAILURE TO Do 80 SHALL IMPOSE No OBUGATION OR Lu18um MIAMI SHORES FI-331 as OF ANY X=UPON THE INSURER,kT5 AGENTS CIR RWRIWWATWW. 305-768-8972 AUTHOR=TENTATIVE 305436.0252 Jessica Hechw ania ACORD pemoi)QF Qv 1988 CORD CD � reserved. The A and I o are °g registered nwHls of ACO . RG Miami Shores Village TMETWT91 Building Department ! OCT 14 2010 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ' Tel:(305)795.2204 Fax:(305)756.8972 �� INSPECTION'S PHONE NUMBER:(305).762.4949 BUILDING Permit No. 10—IM PERMIT APPLICATION Master Permit No. LQ FBC 20 Permit Type: ELECTRICAL Owner's Name(Fee Simple Titleholder) JITC OWE LI A,-, WVEK, Phone# Owner's Address 1+61 NC- ►0-17' City. 5,4 Stated. zip 3kt2J$ Tenant/Lessee Name Phone# Email Job Address(where the work is being done) t 4(af *�E 1 d'L.v*- City Miami Shores Villaee County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Flood Zone Contractor's Company Name 61i'i�i 7 IL tt B d R Phone#( SOS) a X70--6 Z,Zelp Contractor's Address d /10 �DP, City AA'. .4&-4- State �L.d Qualifier Name_�=•0% i.A Phone#(3 O 5) 7 7s''- art. 2ffi State Certificate or Registration No. Certificate of Competency No. D ZA• D D D At 3 G Contact Phone_ �J d�J ?��--� Z 2.c f E-mail Architect/Engineer's Name(if applicable) _r546*AAA tabc,"IE Phone# V Terni $ Square i Linear Footage Of Work: T'yp'e of Work`i' ,❑Addition1 ❑Alteration ❑New ❑ Repair/Replace molition Describe ork• CL ig D Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Notary$ Training/Education Fee$ Technology Fee$ Scanning$ Radon$ DPBR$ Bond$ Double Fee$ Violation date: Structural Review.$ Total Fee Now Due$ See Reverse side-> 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 WOM 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 honing. "WARNING TO OWNER: YOUR FAILURE 'TO RECORD A NOTICE OF COMAIENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR 'LEND)ER 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 app4ant 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 re-inspection fee will be charged Sigaature - Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was.acknowledged before me this ly day of . $20 by day of. &Waer, ,201k,by is AA 14 , who is personally known to me or who has produced who is personally known�t �0RTErA1 As identification and who did take an oath. ��Ve/ iG as id = 6•"�'��aqd�r� ` dl CS�t� l orida 27,2012 NOTARY PUBLIC: NOTARY PUB t tHy Commission dF Comm.EonC. # sep DD 819 19458 6 ...Its Bonded Through National Notary Assn. Sign: Sigm: Larr Print: Print: h My Commission Expires: My Commission Expires: ��p .1 4f no/;: APPROVED BY y'�L f0®",-/lans Examiner Zoning Engineer Clerk checked (Revised 07/10/07XRevised 06/102009) MIAMI-DADE COUNTY 2010 MUNICIPAL CONTRACTOR'S 2011 FIRST-CLASS TAX COLLECTOR TAX RECEIPT U.S.POSTAGE 140 W.FLAGLER ST. MIAMI-DADE COUNTY-STATE OF FLORIDA r PAID 1st FLOOR PURSUANT TO COUNTY CODE SEC.10-24 MIAMI,FL MIAMI,FL 33130 EXPIRES SEPT.30,2011 PERMIT NO.231 THIS IS NOT A BILL-DO NOT PAY - RECEIPT NO. 30-3340965 CC NO: 02E000436 BUSINESS NAME/LOCATION RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR ABLE ELECTRIC OF SO FLORIDA INC AS SPECIFIED HEREON. 2010 SW 83 CT OWNER :ABLE ELECTRIC OF SO FLORIDA INC SEE BACK OF RECEIPT FOR ELECTRICAL CONTRACTOR A LIST OF NON-PARTICIPATING MUNICIPALITIES Receipt holder must DO NOT FORWARD register In the city where work is to be ABLE ELECTRIC OF SO FLORIDA INC done.. ABLE RAMIREZ 2010 SW 83 CT MIAMI FL 33155 PAYMENT RECEIVED MIM-DADE COUNTY TAX 2g 2010 x 022'1A067002 000200'.00 111111+11111111111111+1+1111111'++11111+1111111+I11111++1111111 4M 0MIAMI-DADE COUNTY 2010 LOCAL BUSINESS TAX RECEIPT 2011 v FIRST-CLASS TAX COLLECTOR MIAMI-DADE COUNTY-STATE OF FLORIDA U.S.POSTAGE 140 W.FLAGLER ST. EXPIRES SEPT.30,2011 PAID 1 st FLOOR MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI,FL MIAMI,FL 33130 PURSUANT TO COUNTY CODE CHAPTER 8A-ART.9&10 PERMIT NO.231 THIS IS NOT A BILL—DO NOT PAY 320694-3 RENEWAL BUSINESS NAME/LOCATION RECEIPT NO. 334096-5 ABLE ELECTRIC OF SO FLORIDA INC CC B 02E000436 2010 SW 83 CT 33155 UNIN DADE COUNTY OWNER ABLE ELECTRIC OF SO FLORIDA INC Sec.Type of Business WORKER/S THIS Is &X6A &KCTRICAL CONTRACTOR 2 BUSINESS TAX RECEIPT.IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTINOR G LAWS DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDERFROMANY OTHER PERMIT OR LICENSE % noTAcnON F ABLE ELECTRIC OF SO FLORIDA INC THE `DE"S°"A"F'o" ABLE RAMIREZ 2010 SW 83 CT ` PAYMENT RECEIVED MIAMI FL 33155 2 M1DADE COUNTY TAX 09/29/2010 nnnn7 S6inn01 1111111tilt is+111111+1111sit111111111+1117►1717++111111+111911 07-22-2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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 law. EFFECTIVE DATE: 07/22/2010 EXPIRATION DATE: 07/21/2012 PERSON: AYALA LUIS FEIN: 650502962 BUSINESS NAME AND ADDRESS: ABLE ELECTRIC OF SOUTH FLORIDA INC 2010 SW 83RD CT MIAMI FL 33155 SCOPES OF BUSINESS OR TRADE: 1- REGISTERED ELECTRICAL CONTRACT IMPORTANT: Pursuant to Chapter 440 . 051141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.051131, F.S., Notices of election to be exempt and certificates of election to be exempt shalt be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shell revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 s PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE ; STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION O Pursuant to Chapter 440.05(141, F.S., an officer of a corporation who CONSTRUCTION INDUSTRY elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW D chapter. EFFECTIVE: 07/22/2010 EXPIRATION DATE: 07/21/2012H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be PERSON: LUIS AYALA exempt... apply only within the scope of the business or trade listed on FEIN: 650502962 R the notice of election to be exempt BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05031, F.S., Notices of election to be exempt ABLE ELECTRIC OF SOUTH FLORIDA INC and certificates of election to be exempt shall be subject to revocation 2010 SW 83RD CT if, at any time after the filing of the notice or the issuance of the MIAMI, FL 33155 certificate, the person named an the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this 1- REGISTERED ELECTRICAL CONTRACT section. QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 4 QUALIFYING TRADE(S--- —____— 0001 ELECTRICAL HenniNo Gonzalez P,E. Secretary al Ue Board Miarry-pose cony M�t/� CTQB Y relaara as ara0erlY dpaa herein, w«w _ .n*amidade.VOWbypyrnacode !r Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY y4; 02E000436 ,A. ABLE ELECTRIC OF SOUTH FLORIDA INC D.B.A.: L AYALA LUIS Is certified under the provisions of Chapter 10 of Miami-Dadeti6rity -- t Miami Shores Village 10050 N.E.2nd Avenue u Miami Shores,FL 33138-0000 rry {En aid E itl i ' E� Ss s< r( ° r Y3iitY Ef iir. Phone: (305)795-2204 r �E �'Y tY 1 �Ef'��Y YS s"� Y��yJ', 1 �y �� , ' Expiration: 0412=011 Project Address Parcel Number Applicant 1132050240140 JACQUELINE BUTLER Block: Lot: Owner Information Address Phone Cell JACQUELINE BUTLER 1461 NE 102 Street MIAMI SHORES FL 33138-2621 Contractor(s) Phone Cell Phone $ 1,000.00 Valuation: AIRSOUTH MECHANICAL INC (305)828-9400 Total Sq Feet: 0 Tons: Available Inspections: Additional Info:DEMOLITION Inspection Type: Classification:Residential Ventilation Approved:In Review PP Final Comments: Date Approved::In Review Hood Date Denied: Type of Work:MECHANICAL Rough Duct Scanning:1 Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# MC-10-10-39091 DBPR Fee $2.00 10/26/2010 Check#:3483 $108.60 $0.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated October 26,2010 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 26,2010 1 `• Miami Shores Village ,VT)T Building Department OCT 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No.mc, i o -i 1-n PERMIT APPLICATION Master Permit No. b -I t UO FBC 20 Permit Type:MECHANICAL OWNER:Name(Fee Simple Titleholder):_Z �Ik.fk_ tZ _ Phone#: Address: 14 U I �A_ 1 g --'k S-t" City: r Anm S10cLC�, State: PL-- Zip:z g 17-,9' Tenant/Lessee Name: Phone#: Email: S JOB ADDRESS: 1 4 I D I �jr, City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1 t �;Ld_S — Or2-q ON 6 Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name:'', Y-rJcu" Oman/t?Q I-7n C Phone#: .50 J5-d Z F-9 q-00/ Address: ) . h ct 19 la o it- City: 4hal ea h State: E/ Zip: 33c a- Qualifier Name: 1--j-0h V l B®me f Phone#: State Certification or Registration#: C �,�� '� _ Certificate of Competency#: Contact Phone#:%6C6--SZ b c-7 400 Email Address:Jah n 6?01 YS 4)u 411 mer-hd n :e-aj DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ L 9 9 V`9 y Square/Linear Footage of Work: Type of Work: OAddress DAlteration ONew ORepair/Replace Aemolition Description of Work: ��t .`r`if- 300k,� DK.,t&,"t'1�cc. - r4-Nks s wit90 Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$,l to 1 [9 l $ •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 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 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 ,20 1 G ,by J �xyg%mlwjet tg who is personally known to me or who has produced who is onally known t me or who has produce\\ ' Cl.Q4 vos0000° P� As identification and who did take an oath. as identification and who did�\ �°i ` �p�• oe o �� pef 3,?Oj9Fse e*d NOTARY PUBLIC: NOTARY PUBLIC: ,Q�kff o°min o� •<Ca Sign: Sign: "Aik #Opsi9�5� �p. . < ,9• roy ••gyp\va Print: Print: I�I�Q Q 1� ae y�.°°'''°�P�O\\®\ 3 2c/)it 61011111t4t��`® My Commission Expires: My Commission Expires:!�� sx�xxx�xxxx�xxxm�xxxxx��x��x��xxxxx��mxx�xxxxx�xx�xxxa APPROVED BY Nit �VPlans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) i mec anica _ M. Miami Shores Village Building Dept 10050 NE 2nd Ave. Miami Shores,F133138 Authorization for Permit Pick-up Date: September 16, 2010 I, John Bomar, as qualifier for Airsouth Mechanical Inc., located at 1650 -1652 W. 32nd Place, Hialeah, FI 33012, hereby designate the following person to submit, pick up and pay for permits on my behalf: Print name of designated person Signature of designated person Print name of designated person Signature of designated person Print Name of Qualifier Si ature of Qualifier State of Florida County of Dade Print Name of Notary Public Signatu ® lick WSS/0'v. ®� �o Q�gmber3 hc� My commission expires: Sept. 3, 2011 z, . o� #DD 679757 O1Z*d141 thN �Qa` sd�®s%/ IC STAIS��`�� 1650— 1652 W. 32nd Place Hialeah,F133012 305-828-060109 305-828-9897 License CAC 1813715 City of Hialeah FSC 2014 11 ycBBF6.... Mixed Sources Business Tax Receipt ' PRINTED WISH conmacctacso.ms -RSEMLY�GREM NUUMAWKSu`^ " Mayor Julio RObaina No: 238220-114 (OLD-1711-882) Amount: $ 150.00 The person,firm or corp.listed here has paid the business tax required to engage in or operate the business specified subject to the regulations and restrictions of the City of Hialeah,Florida Owner:JOHN DAVID BOMAR Type of Business:Plumbing, Heating, and Air—Conditioning Contractors AIRSOUTH MECHANICAL INC. 1650-52 W 32 PL Business Location: HIALEAH, FL 33012 1650 W 32 PL Validating No.: 0000 Expires September 30, 2011 THIS IS NOTA BILL STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET .��VWX6 TALLAHASSEE FL 32399-0783 BOMAR, JOHN DAVID AIRSOUTH MECHANICAL INC 2920 GARDEN DRIVE COOPER CITY FL 33026 5. 419 a 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.comCFRTIFI � C. 1-9 There you can find more information about our divisions and the regulations that SR, tAt3 ou impact ,subscribe to department newsletters and learn more about the 'wr P Y P Departments initiatives. 4`r Our mission at the Department is:License Efficiently, Regulate Fairly.We : constantly strive to serve you better so that you can serve your customers. rs -CERAxwx provisions of t4$9. Fs_ Thank you for doing business in Florida,and congratulations on your new license} o-rzsoT us astrr.,3.on. t"e=9, UC '. .�a. DETACH HERE �- �� C� �� .t01�:.��ar• � (:-,/��,4 ropy- ..�ice. yf W, CENSE --NB 70 ""- i IS. _NWIR-94M .: .. ..m r -'7`E '. .. . ' _r � ..r� �^•cx^ _ 3 a:,� as y. z Sxpiratioas slate- ASG 31 . 2flI2 €:; r -.a Yy � 4 _ • r - C��£E�R�L . *' �.r- q- =�' �i'- �. "��,h ; - ' - r 'I�P.+tR:Li•1 S �t.ET�`.Y tC;�.11lRECY LAW; - - MIAMI-DADE COUNTY 2010 LOCAL BUSINESS TAX RECEIPT 2011 FIRST-CLASS TAX COLLECTOR MIAMI-DADE COUNTY-STATE OF FLORIDA U.S.POSTAGE 140 W FLAGS ST. EXPIRES SEPT.30,2011 PAID lot FLOOR MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI,FL MIAMI,FL 33130 PURSUANT TO COUNTY CODE CHAPTER 8A-ART.8&10 PERMIT NO.231 THIS IS NOT A BILL—DO NOT PAY 568588-9 RENEWAL BUSINESS NAME/LOCATION RECEIPT NO. 593044-2 AIRSOUTH MECHANICAL INC STATE* CAC1813715 1650 W 32 PL 33012 HIALEAH OWNER AIRSOUTH MECHANICAL INC Sec.Type of Business WORKER/S THIs 18 120A MERAL MECHANICAL CONTRACTOR 12 EUSINM TAX RECEIPT.IT DOES NOT PEFWT THE HOLDER TO VIOLATE ANY E)aSTZNG LAWS SOFE THE ZONINGDO NOT FORWARD COUNTY OR CRIES. NOR DOES IT EXMZFr THE "PEEOLDER IUM PROR ANY OTHER AIRSOUTH MECHANICAL INC REQUIRED BY LAW.THIS I8 JOHN BOMAR PRES NOT A CERiTIRCATION OF THE HOLDERS oUALOc^- 1650-52 W 32 PLACE mom HIALEAH FL 33012 PAYAIENT RECEIVED ODAMI-DADE COUNTY TAX COLLECTOR. 07/07/2010 60050000385lal y}t7 }y 000051.00 {:. z:zsz,iz........ . : : SEE OTHER SIDE _ AeoRra CERTIFICATE OF LIABILITY INSURANCE GATE20/2D/l`YYY) a5/ a/281 a PRODUCER Phone (ZS')825 8580 Fax ;3C5}825858+ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SHARP INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6175 N W 153RD STREET,SUITE 304 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR MIAMI LAKES FL 33014 ALTER THE 4j G£ AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A, Travelers Indemnity Company AIR SOUTH MECHANICAL,INC. INSURER 8: 1650-1652 WEST 32 PLACE HIALEAH FL 33012 INSURERC INSURER 0 WSURER E' COVERAGES 'THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCYPERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT.TERM OR CON04TION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THS CERTIFICATE MAY BE iSSUEO OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR tNsm TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE WA(0 DATE M GENERAL LIABILITY C00551P354 49/23/09 89/23/10 EACH OCCURRENCE $ 1,044,840 X COMMERCIAL GENERAL 4"ILITY ,�'�"tv MAGe R aDnce) S 300,000 CLAIMS MADE o OCCUR MED EXP(Any one person) S 5,000 A E PERSONAL 8 AOV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S 2,000,000 O POLICY LOC 11 $ AUTOMOBILE LIABILITY BA05SIP364 09/23/09 09/23/14 X ANY AUTO COMBINED SINGLE LIMIT (Eeacadenl) s 1,000,000 RI.A OWNEDAU70S BODILY INJURY SCHEDULED AUTOS A ;Per person) S HIRED AUTOS BODILY INJURY NON •OWNED AUTOS tOer awdent) S PROPERTY DAMAGE (Par a=sent} $ GARAGE LIABILITY AUTO ONLY.EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY AGG S EXCESS i UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR r CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE S RETENTION 5 S WORKERS COMPENSATION AND INC YIN STATU• orHER EMPLOYERS'LIABILITY TORY LIMITS ANYPROPME=PARTN0Mr.42CUTnM a E.L.EACH ACCIDENT $ MandERMEMBER EXCWOEO? Mandatory ow E.L DISEASE-EA EMPLOYEE S MAL ,xxlgr SPECIAL PROVISIONS bB"w E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Regarding Jab:500 NE 102 Street Miami Shores Village,FL 33138 CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 8EFORE THE Building Department EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOT?CE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 10050 NE 2 Ave. DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS Miami Shores,FL 33138 AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE IL Attention: Fax:305-828-9897 _49;K'41 ACORD 25(2009l01) Certificate# 106910 1988-2009 ACORO C RPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .q ...rv.rvav ay...v Ltvtt 4AAJUA U11vG "V14 111aV1%A11'-L %,VMI..iUll—full ..1VU1.11 1nCt.11Q211VQ1, lulu,. 1/1 CERTIFICATE OF LIABILITY INSURANCEata 5/20/2010 Producer: Lion Insurance Company This Certificate Is Issued as a matter of Information only and confers no rights 2739 U.S. Highway 19 N. upon the Certificate Holder. This Certificate does not amend,extend or alter Holiday, FL 34691 the coverage afforded by the policies below. Insurers Affording Coverage NAIC Insured: South East Personnel Leasing, Inc. Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer c: Insurer D: Insurer E: Coverages IN pokoes of insurance listed below have been issued to the insured named above Ire policy period n-4Cated.NoNuithstanbng any reWrement,term or Conditon or any Contractor Omer documeamth Mpett to wftch this certificate may be issued or may pertain.the insurance afforded bv,the prihr�rs descMed herHn:s paid Claim.4_ s 2*1t to en the terms.eZu'SiOVS.and condib,ns of such policies.Aggregate limits shown may he*to.en reduced by NISR AWL I Policy Effective Policy Expiration Date LTR nvsRD Type of Insurance Policy Number Dole Limits (MM/DD/YY) (MM/DD/YY) ENERAL LWBILITY Each Occurrence Commercial General Liability Damage to rented premises(EA Claims Made Occur occurrence} Med Ev General aggregate limit applies per: Personal Adv Injury Policy 0 Protea ❑ Loc Cenral Aggregate Products-Comp/Op Ag9 AUTOMOBILE LIABILITY Combined Single Limit Am,Ate, (EA ACcideM All Owned Autos Bocfi y lhfury Scheduled Autos 'Per Person) Hired Autos Sod h�lniwy Non.Camed Autos (Per Accident) Property Darrege (PerAr-cidem) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/012010 01!012011 x We statu- OTH- Employers'Liabllty I to ER Any Propristor/Partner/executiveofficer/member E.L.Each Accident S?.000.twO excluded? E.L.Disease-Ea Employee $1,000.000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits $1,000.000 Other Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/LocationsiVehieles/Exclusions added by EndotsementtSpecial Provisions: Client ID: 29.65-454 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.that are leased to the following"Client Company": Air South Mechanical,Inc. Coverage only applies to injuries inarred by South East Personnel Leasing,Inc.active employee(s) ,while working in Florida. Coverage does not apply to statutory employee(s)or independent contractor(s)of the Client Company or any other entity. A list of the active empioyee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: 500 NE 102 STREET,MIAMI SHORES VILLAGE,FL FAX:305-828-9897/ISSUE 05-20-10(SD) CERTIFlCATE HOLDER CANCELLATmN Benin Date:1/20.12010 MIAMI SHORES VILLAGE Should airy o:me atxwe descnbed policies be cancelled before me woravon date thereof,Cue issuing insurer win BUILDING DEPARTMENT endeam to mail 30 days written notice to me certificate holder named to rhe left.but failure to do so shell impose no 10050 NE 2ND AVE obligation or haNuly of any land upon the insurer,its agents or representatives. MIAMI SHORES, FL 33138 t '•IP.. _£NSE CLASS E r*fi10-464-69-102-'V i ac = . 292G c,,wRDEN DR w ++ -00--=—q C7 Y,FL 33fl26-360S -i✓o w-c 1Sb'� 5�X.rt. ac�eao> c•>a Ii v S�OtOtOp:tlx �' 1l � 5 I w IY ,ISIC, '39N 'wa�ay V6u dN0 3WVN 210 SS32100V jo SAVO slOL NIH ,(u>do,d 11¢wleya,epuolj yo ayeyS ayl lUr1 03211RO321 3SN3,11 1N3W3J V1d321 na Ru¢>o'sal l00'aZ ueNl 5"l 21MA9 a u"ala!4an I¢u awwoTuou.tuy-3:SSVIo :S.LN3W3SNOON3 --!_ casual anina.uo}b:SN01101a1S3LJ