Loading...
MC-11-268 �S Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL ^� Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-156105 Permit Number: MC-2-11-268 Inspection Date: January 20,2016 Permit Type: Mechanical- Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: BUTLER,JACQUELINE Work Classification: New A/C System Job Address:1461 NE 102 Street Miami Shores, FL 33138-2621 Phone Number Parcel Number 1132050240140 Project: <NONE> Contractor: CHANIN MECHANICAL Phone: (305)865-1729 Building Department Comments NEW A/C SYSTEM INSTALLATION change of contractor on hold until contractor provides all licenses updated G/ h Inspector Comments Passed Failed S Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid For Inspections please call: (305)762-4949 January 20,2016 Page 1 of 1 `F MIAMI SHORES POST OFFICE NIANI SHORES, Florida 331539998 1158540118 -0099 03/11/2013 {800}275-8777 03:14:29 PM Sales Receipt Product Sale Unit Final Description Qty Price Price HALLANDALE FL 33009 $0.46 Zone-1 First-Class Letter 0.50 oz. Expected Delivery: Wed 03/13/13 Return Rcpt (Green Card) $2.55 @@ Certified $3.10 Label #: 70121010000084347044 "W7Issue PVI: $6.11 Total: $6.11 Paid by: AMEX $6.11 Account #: XXXXXXXXXXXX1030 Approval #: 548200 Transaction #: 941 23 903520633 4094738069 @@ For tracking or inquiries go to USPS.com or call 1-800-222-1811. Order stamps at usps.com/shop or call 1-800-Stamp24. Go to usps.com/clicknship to print shipping labels with postage. For other information call 1-800-ASK-USPS. Get your mail when and where you want it with a secure Post Office Box. Sign up for a bo;< online at usps.com/poboxes. Bill#: 1000100415933 Clerk: 05 All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER Go to: https://Postalexperience.com/Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION COUNTS Customer Copy Y OFor delivery information visit our website at www.usps.come, H E l' :Q Postage $ ii.4b ;� RES$/ Certified Fee . G (Endorse erd Required) •ec i C3 (EndoraemeMRliv equired) $0.11fl r C3 Total Postage&Fees $ $6.11 (1 nj M --- ---------- —~ - -- —--- -- --- ------ � Street,Apt No.; r or Po Box No. 3 p ,,� =----—------ --- -- --------------------- Cfry State.ZIP+4 �tlati Uz P` 33001 WS Form _„ ALIgUSt 2006 Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your maiiplece ' ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Ipsured or Registered Mail. ■ Foran additional fee,a'tietum Receipt may be requested to provide proof of delivery.To obtain ReturnReceipt service,please complete and attach a Return Receipt(PS Form 3811to the article and add applicable postage to cover the fee:Endorse mailpiece Return Receipt Requested'.To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement'Reshicted De))very° ■ If a postmark on the Certified Mail receipt Is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an Inquiry. PS Form 3800,August 2008(Reverse)PSN 7530.02-000-8047 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY 4 Complete items 1,2,and 3.Also complete A. S117re item 4 tf Restricted Delivery Is desired. �h\+ ��� v print your name and address on the reverse X ��^ ❑Addressee so that we can return the card to you. by( �0 c. of ivery 6 4 ■ Attach this card to the back of the mailpiece, 3 l� or on the front If space permits. 1. Artide Addressed to: D.Is delivery address Meant from item 1? U Yes If YES,order delivery address below: ❑No We 51W6 c� 6y- C IffmNi 3-10. -PrAso-, ON-4. kNb,\*& kA- - 33001 3. seri Cwffmd Mail o EWm Mall /Rem o Retum Rept for Mer"xilse 0 Insured Mab ❑O.O.D. 4. Restricted DeAvery4(Extra Feel ❑Yes Z Article Number 7I}12 10100000 8434 7044 mar ffom Service t j .PS Form 3811,February 2004 Domestic Retum Receipt tam-WrAo UMED STATES PosraL SERVICE First-Class Man PO &Fees Paid USPSP Pemnk No.0-90 •Sender.Please print your name,address,and ZIP+4 In this box 33 t9 1 •�'����1�Jt,J j1#t1ir���J1�,�„�J�J����i�,l���JJ�,s��,t��JJ#,��t STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSIDNG*BOARD (850) 487-1395 1940 NORTH MONROE STREET •�°�w• `• TALLAHASSEE FL 32399-0783 CHANIN, DREW NED CHANIN MECHANICAL LC 6095 NORTH BAY ROAD MIAMI BEACH FL 33140 STATE OF FLORIDA AC# 6 15 3 78 Congratulationsl With this license you become one of the nearly one million DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. PROF.ESSIO> i, .R$GULATION Our professionals and businesses range from architects to yacht brokers,from boxers to be qua restaurants,and they keep Florida's economy strong. CAC056292 0 ],2 110415948 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.mytloridalicense.corm CERTIFIED`: W .6NTR There you can find more information about our divisions and the regulations that ! CHANIN, D , impact you,subscribe to department newsletters and learn more about the CHANIN MIR +, 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 customers. IS CERTIFIED under the provisions of cn.489 of Thank you for doing business in Florida,and congratulations on your new licensel saps:aason aaee: AUG 31, 2014 112060600745 i DETACH HERE DOCUMENT HAS A COLORED II• • •• • PAPER AC# 6153783 STATE OF FLORIDA DEPARIIgNT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L12060600705 �. LICENSE NBR 06 06 2012. 1],0415948 CAC.056292 The CLASS A AIR CONDITIONING CO .` Named below IS CERTIFIED Under the provisions of Chapter, p Expiration date: AUG 31, 2014 CHANIN, DREW NED IF' ,"V F CHANIN MECHANICAL LC x 1 ` 6095 NORTH BAY ROAD MIAMI BEACH FL 33140 RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW CITY OF MIAMI BEACH CERTIFICATE OF USE,ANNUAL FIRE FEE,AND BUSINESS TAX RECEIPT 1700 Convention Center Drive Miami Beach Florida 33139-1819 TRADE NAME: CHANIN MECHANICAL LC AIR CONDITIONING GONTRACTO RECEIPT NUMBER: RL-04003110 IN CARE OF: DREW CHANIN Beginning: 10/01/2012 ADDRESS: 6095 N BAY RD Expires: 09/30/2013 MIAMI BEACH,FL 33140-2038 Parcel No: 0232100020790 A penalty Is Imposed for failure to keep this Business Tax Receipt TRADE ADDRESS: 1963 71ST ST exhibited conspicuously at your place of business. Code Certificate of Use/occupation A certificate of Use/Business Tax Receipt Issued under this article 004603 CONSTRUCTION CONSULTANT does not waive or supersede other City laws,does not constitute City approval of a particular business activity and does not excuse the licensee from all other laws applicable to the licensee's business. This Receipt may be transferred: A.Within 30 days of a bonafide sale,otherwise a complete annual payment Is due. B.To another location within the City N proper approvals and the Receipt are obtained prior to the opening of the now location. Additional Information CERTIFICATE OF USE 400 PREVIOUS BALANCE $0.00 C_U#OF UNITS 1000 Storage Locations Constr Consult FF Y FROM: CITY OF MIAMI BEACH PRESORTED 1700 CONVENTION CENTER DRIVE FIRST CLASS MIAMI BEACH, FL 33139-1819 U.S.POSTAGE PAID MIAMI BEACH,FL PERMIT No 1525 CHANIN MECH LC AIR CONDITIONIN 1963 71 ST ST MIAMI BEACH, FL 33141-4415 6J6nllnnlhlulnrlhlnldnlorll�h6d�d1 ' CHANT-1 OP ID:AS CERTIFICATE OF LIABILITY INSURANCE DATEW THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO FLIGHTS UPON THE CERTIFICATE HOOW=1 THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED T THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER. INSURER(S), qUTHOROW IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy{les)must be endorsed. If SUBROGATION IS WANED,subject the terms and conditions of the poUcy,certain policies may require an endorsement A statement on this certificate dog not confer rights to the Certificate holder in Iteu of such endorsemen s. to PRODUCER International Insurance Center 305-279-5446 INTACT 7990 SW 117 Ave Suite 209 305-279-4045 PHONE Miami,FL 33183-3845 Edward Cahassa Fax ADaRA°Ess: M.N01. INSURERS AFFORDING COVERAGE INSURED Chanin Mechanical LC INSURER A:Mid-Continent GroupNAICD 1965 71st Street INSURER a:Arn I rust Miami Beach,FL 33141 INSURER C: 018533 INSURER 0: INSURER E: COVERAGES CERTIFICATE N MBER: IN F THIS IS TO CERTIFY THAT THE POLICIES UI it LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASO FOR THE POLICY PERIOD REVISION NUMBER: CERTIFICATE NOTWITHSTANDING ANY PERTAIN, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER IS SUBJECT EC ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN INSR TYPE OMAY HAVE BEEN REDUCED BY PAID CLAIMS. F INSURANCE GENERAL LIABILITY POLICY NUMBER M LIMITS A X COMMERCIAL GENERAL LIABILITY 04GL000851995 EACH OCCURRENCE S 1,000,00 CLAIMS-MADE X� 06/24112 06124113 OCCUR PREM►S Ea ae:aarerlce $ 100,0 MED EXP(qny one Person $ exclud PERSONAL 8 ADV INJURY $ 11000,00 X POLICY LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,QO X POLICY PRO AUTOMOBILE UA&UTY OC PRODUCTS-COMPIOP AGO S 1,000,00 L $ ANY AUTO Ea a N L L I Alm I1TOS E0 AOWNSpg CHEDULED DPer(OILY INJURY Person) S HIRED AUTOSAUTOSwNED BODILY INJURY(Per seed" S P UMBRELLA Upper $s OCCUR $ EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE $ WOMM COMPENSATION DEO RETENTION$ AGGREGATE $ ANDEMPILOYERS'LIABILITY X WC STATU TI{ B ANY PEETOR/PARTNER/EXECUTIVEYIN $ AWC1012791 f F ERIMWY In BNH)ER EXCLUDED? N l A 04/28/12 04/28/13 yes E.LEACHACCIDENT $ 1,000,00 OESG�ItId PTTtI OF OPERATIONS below E.L.DISEASE-EA EMPLOYE $ 1,000,00 E.L DISEASE-POLICY LIMIT S 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,K more space Is required) 'ERTIFICATE HOLDER CANCELLATION ITHESHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Chanin Mechanical LC ACCORDANCE WITH THE POLICY pR0 EXPIRATION NOTICE WILL BE DELNERED IN 1965 71st Street VISIONS. Miami Beach,FL 33141 AUTHORIZED REPRESENTATIVE :ORD 25(2010!05) The ACORD name and logo are registered,na9r88-ZOw�ACRD CORPORATION. All rights reserved. IMBURGIA CONSTRUCTION SERVICES, INC STATE CERTIFIED GENERAL&ENGINEERING CONTRACTORS 12555 Biscayne Blvd#888 North Miami,FL 33181 305-940-6957/305-675-3983 03/11/2013 Wedgewood Air Conditioning,Co. 370 Ansin Blvd. Hallandale,FL 33009 To Whom It May Concern: This letter is to inform you that you are hereby relieved on the Butler Residence located at the followiu address: 1461 NE 102° Street Miami Shores,FL 33138 We appreciate your service on this project and look forward to working with you in the future.Again,this letter is to inform you that you are terminated from the Butler project. Contact our office with any questions or concerns. Sincerely, Loci burgi n . Owner Imburgia Construction Services,Inc. Imburgia Construction Services,Inc. 12555 Biscayne Blvd#888 North Miami,Florida Ph.305-940-6957 Fx.305-675-3983 Miami Shores Village Building Department 10050 N. Ind Avenue,Maui Shores,Florida 33138 Td:(305)795.2204 Fax:(305)755.8972 INSPECTION'S PHONE NUMBER:(303)762.4949 BUILDING Permit No. PERMIT APPLICATION Muster Permit No. &.Oq 2at,-Q FBC 20, Permit Type:MECELA AL OWNER:Name(Fee Simple Titleholder): � "L"d - ' '2 Phone* Add=&* 1--)k(6( kki 102sa" City: 11.E 6kM j SK 6+Z State: ft- Tenantd,essee Name: Phone* Email: JOB ADDRESS: Ol Nom' st— City: Miami shores County: Miami Dade Zip: S&!?>,6 Folio/Parcel#: Is the Building Hbhwkeft Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: "Armes Un cmh,—., e j haI -8 a• 1.- C:ty' _...State.f P Qualifier NameltR phot; State Certification or Registration 6° of Competency 4: a DESIGNER:ArcbitecUEngineer: P, ; Vie of Work iortbis Permit:$ i \�,D'J SggarqLifn w Footage of Werk: Type of Work: []Address UAlteration &W ORepair/Repjace ODemolition Description of Work: ' 9 Submittal Fee$ Permit Fee$ Z IQ I CCF$ CO/CC$ Swuning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ TrainbieUueadon Fee$ Technology Fee$ Double Fee$ Revfew$ TOTAL FEE NOW DUE$ 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,W01M. 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 lite 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 trust be posted at the jolt 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 igna `towner or Agent Contractor The foregoing instrument was acknowledged before me thi The foregoing instrument was acknowledged before me this day of 06r ,20 Ll,by etoTthwvf day of ,20by C4-tANtN who is Personally known to me or who has produced who is personally known to me or who has pmduced, � ► ) As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: UJS POF111AS NOTARY PUBLIC: EXPIRES:Jtdy 30,2014 0 Om-w� =WTft NOY a undo sSign: Sign:Priop nt: Print: My Commission Expires: `�a 1 sol q My Commission Expires: APPROVED BY �/ ` Plans Examiner Zoning Structural Review Clerk (Revised 07/10/07XReAsed 06/10l2009)(Revised 3/15/09) Miami Shores Village all* Building Department 10050 N.E.2nd Avenue RxpP► Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR 1 ARCHITECT Permit N. P L 1 L °- Z(5 Owner's Name(Fee simple rtle Holder) _ vt'UKX , �c,{UE�'L_ Phone#: Owner's Address: ' l Lf(o t AIF— t2 s1z- City: i'''1)1-0)VLA I su a t,£.,s State : 4?- Zip Code: S3 f 3.8 4ob Address(Of where work is being done): 'fit- 1 oLStf City: Miami Shores State:_Flodda Zip Coder Contractor's Company Name- (-9 4h,try ''' EWAA? 4U44- Phone#: Address: t"i(O`'_ -1I City: V'' 10'e 1 ge/d'4'K State: Zip Code: Qualifier's Name : 'VLrt'^' (-114-^'t'^J Lic. Number: CAL- a S (62—ct2 Architect/Engineer of Record Name: 'ft�S* Phone#: Address: City: State: Zip Code: Describe Work: ti's-w Ari L S S't"C �� KJE.,,L--, IA611 �-� 4� C� -- � )pt.AAX-1 I hereby certify that the work has been abandoned and/or the contractor/architect is unable or nwilli to complete the contract. I hold the Building Official and the 'a i S ores h less for all legal invo Signatur Signat ownero ConhactororArchitect The foregoing instrrJment was aknowledged before The foregoing instrument was aknowledged before me this 15 day of w+&a* ,2013by tA4-5.T this 1.C,�a'" d '"P*22C31 Who is personally known to a or who has produced who is��ally�or who has produced as indents ication. as indentftation. Notary Sign: 9 g Seal: � +,w�rtirwwn. two t. seal: , '°' KW"Robwt Jew My Com*Wm EE 831947 My Com *Wm EE 831947 p E)p*s 0910302016 Eros 08/03/8018 Miami Shores Village �, n 10050 N.E.2nd Avenue NES Miami Shores,FL 33138-0000 Phone: (305)795-2204 3 � � `� Expiration: 08/2812011 Project Address Parcel Number Applicant 1461 NE 102 Street 1132050240140 JACQUELINE BUTLER Miami Shores, FL 33138-2621 Block: Lot: Owner Information Address Phone Cell JACQUELINE BUTLER 1461 NE 102 Street MIAMI SHORES FL 33138-2621 Contractor(s) Phone Cell Phone $ 18,500.00 Valuation: WEDGEWOOD AIR CONDITIONING 954-4549636 Total Sq Feet: 0 Tons: Available Inspections: Additional Info:mechacnial Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Underground Date Denied: Type of Work: Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $11.40 Invoice# MC-2-11-40101 DBPR Fee $9.72 03/04/2011 Check#:4933 $700.34 $0.00 DCA Fee $9.72 Education Surcharge $3.80 Permit Fee $847.50 Scanning Fee $3.00 Technology Fee $15.20 Total: $700.34 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable taws regulating construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated March 04,2011 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 04,2011 1 q17 , Miami Shores Village ° f EB 17 1011 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: """ Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No. Ac' l 1--U0Z PERMIT APPLICATION Master Permit No. 0(:�—2-U09 FBC 20 Permit Type: MECHANICAL OWNER:Name(Fee Simple Titleholder): t 4Cd1%k).1Ut, JJTLVA Phone#: Address: 1'40 NV— City:"tAa t s4A°Q-X' State: moi' Zip: 3313 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: N,01 NiG 16� r City: Miami Shores County: Miami Dade Zip: 3313 Folio/Parcelk Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: LL Wad i� w 0 A. Phone#: Address:N70 W4 i N �(lam! ti City: I _ State: - Zip: /WV Gt Qualifier Name: l� Phone#: R�—frY -[G; State CertificationorRegistration#: L� D '7 S]E Certificate of Competency#: Contact Phone#: [ '4fr't'Q Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ ( 0; �40 ► Square/Linear Footage of Work: Type of Work: DAddress DAlteration ONew ORepair/Replace ODemolition Description of Work: tALyJ A(( 614 beeD e ��lFc�lOy T Submittal Fee$ Permit Fee$ r CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Tndning/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ l C�. ✓ ' v 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. "WARMING 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 issu the absence of s posted notice, the inspection will not be approved and a reinspection fee will be charged. Signator Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The fo g instrument was ackno edged befor e thi n day of t6trodr ,201,by day of ,201,by ppQ�pp� who is personally known to me or who has produced Who is personal1 kno to me or who has p uced As identi a —a identification and who did take an oath. NOTARY PUBLIC: WOOD OTA PUBLIC: 1V NCt.�Y 2014 4-4 � Sign: 0SignPrint: OR-¢�- Print: SI �i7,tip11 �4 My Commission Expires: lot� 30 t ?9t y My Commission Expires:,4(��'►.,SX00 $• d� a1�x��xxx��x+xx�esxx�xa���x�x+x��x+xx��x+x+xesx +xxa�xae�axsax+ae�+s� d � APPROVED BY P ans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Reviw4 3/15/09) I MIAMI-DADE COUNTY 2010 LOCAL BUSINESS TAX RECEIPT 2011 FIRST-CLASS TAX COLLECTOR MIAMI-DADE COUNTY-STATE OF FLORIDA U.S.POSTAGE 140 W.FLAGLER ST. EXPIRES SEPT.30,2011 pAlp 1st 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 592463-5 THIS IS NOT A BILL—DO NOT PAY RENEWAL I BUSINESS NAME/LOCATION RECEIPT NO. 618039-2 WEDGEWOOD AIR CONDITIONING CO STATE# CAC035530 DOING BUS IN DADE CO OWNER WEDGEWOOD AIR CONDITIONING CO Sec.Type of Business R WORKER/S 196 SPEC MECHANICAL CONTRACTOR 10 TRIS IS ONLY A LOCAL BUSINESS TAX RECEIPT.IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS THE DO NOT FORWARD COUNTY OR CITIESES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE NOT REQUA CERTIFICIRED 13Y n IO lsOF WEDGEWOOD AIR CONDITIONING CO THE HOLDER'S OUALIFlCA- THE H KROHN BARRY PRES 370 ANSIN BLVD PAYMENT EC MIAMI-DADE COUNTY TAX HALLANDALE FL 33009 I.COLLECTOR: - 07/22/2010 60070000177 { } jj {{ ll ii ff 000075.00 �1111:II1111111tilI I!111111111,11111411 fill 1111!ll)I,f2+0 9` SEE OTHER SIDE 1 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1,2010 THROUGH SEPTEMBER 30,2011 DBA: Receipt#-183-1432 Business Name:WEDGEWOOD AIR CONDITIONING Business Type:HEATING/AIRCONDITION ypeHEATING/AIRCONDITION CONT ACTR (CLASS B A/C CONTRACTOR) ', l' Owner Name:BARRY C KROHN/QUAL Business Opened:03/15/1988 Business Location: 370 ANSIN BLVD State/County/Cert/Reg:CAC035530 HALLANDALE Exemption COde:NONEXEMPT Business Phone: 954-456-6066 I Rooms Seats Employees Machines Professionals 10 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 i I 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 must meet all County and/or Municipality planning 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 it is in compliance with State or local laws and regulations. I Mailing Address: BARRY C KROHN/QUAL Receipt #13A-09-00008721 370 ANSIN BLVD Paid 07/26/2010 27.00 HALLANDALE, FL 33009 I I 2010 - 2011 LCJ1- LYO CITY OF HALLANDALE BEACH BUSINESS TAX RECEIPT 400 S.FEDERAL HIGHWAY HALLANDALE HALLANDALE BEACH,FL 33009 l l ALLANDALE BEACH TELEPHONE—(954)457-1341 City of Choice October 25, 2010 WEDAWOOD AIR CONDITIONING 370 AMIN BLVD HALLANDALE BEACH FL 33009 - THIS IS YOUR,BUSINESS TAX RECEIPT.PLEASJE DETACH AND POST INET A CONSPICUOUS PLACE AT THE BUSINESS LOCATION. PLEASE D9 NOT REMIT ANY PAYMENT. THIS IS NOT A BILL. PENALTIES IF PAID BE {. :,EMBER-15'% E - g ,. . MBER 31,—25% k FLORII? k _ k> y SST T UMBER: 11-00001188 41, ontrol Number:"'. OP009 ' " Business" us nes cat io 370 376 ANSIN BLVD uRAL LATDAI R` a$C , 3009 Y 1,a� � ..jji[[JJ041 z gyp . w� .tIL Q .ham t Owner/Officer:`. Busi `es n- Exe' I .,. .License Fees Paid: Comments:'" WEDGEWOOD'AIR GONDONING CONTRACTORS µ. Restrictions: NOTICE — In the event business for'which this license was issued changes hands, said license may be transferred within 10 days of such change or will become null and void. �. This license is receipt for payment of tax due:sIssuance of license shall not be evidence that the business isi3 lawful nor that it complies with laws and regu Ions. w.�'` .' 1� }�:'yj (/'� �. ��, s d.7Jj' �- "`.'i {��F} ./��w�����'1lw'A�.} "✓��M1��12:`-�l'fy1'�'1,�q��/.i"!•+�}3���`J}.b`.�..�r.:{�t,3h*?_`..—./,��.. TIF—nr7 r=:A.",-- .-,j MENT OF BUSINESSSSIONAL" REGULATION ti CONSTRUCTION IN} � T�SCENSING BOARD > 1 � ' Lloas3�oalSa .' ,._ LICENSE NBR'.�' ♦�* �r ., 'sK "i "'"\ /.`• /"\ - Y ter ' . 08/31' ,2 010 108059445 6AC035530-' � _ •���� ,}`�) x'�����"`;; �!��C�! +� '�'���,��: �-lx�. i The MeASS B AIR CONDITIONING CO Named below ISCERT`IFSED — i x J -m-a-, Under the' provi s ions _ _Chap ter ' _ .�� EX�p3. la ,a^date A,U '' /r��t 01,+iM r `� 3 �* M-4. (f� 1��{/, _ t'"�`'�" ,v? o's� / ; a / '��9 r r.�,'Y:`f { V _'' �. �[ Y\ ,'`f \ rt{y�� `=�4 � ..,. . � �.�'�.�"��•�., :: :�`'�>=` --�s`� -� � �"ks.�ti ..t'G.. ,d �y� � ..�..:..k�v.+.= -✓ -�-�i A.r�r ��i � lei A�.� M�'P..�ti. KROH11; $ARRY 'CHARES' �k * w `° `� �� �� rr" :fn ' x _ ' i WEDGEWOOD< AIR CONDI: .+ a r r r `4 n,s1 y64 370 ANSIN BLVD, "i rtfes` NDALE , `{ IMU-g 0 WE �' {4,}/'�`� tly�»�, IA "� / '45� � `f -�f`(7 :i ,�'.�--_..aON t _ j.,.,a .- ��' E ? 1� s ! �� . ) REG2lJIRED BY LAW ?gl'• } t e-r ,c K Collinsworth, Alter, Fowler & French LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. 0. Box 9315 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Miami Lakes, FL 33014-9315 ' INSURERS AFFORDING COVERAGE NAIC# INSURED Wedgewood Air Conditioning Co. ,Inc. INSURERA: FCCI Insurance Group 370 Ans i n Blvd. INSURER 6: Hallandale Beach, FL 33009 INSURER C: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLIC'ATEY EFFECTIVE POLICY EXPIRATION LIMITS T. GENERAL LIABILITY GLOO10216 04/25/2010 04/25/2011 EACHOCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS MADE [X] OCCUR MED EXP(Any one person) $ 5,000 A X 500 Deductible PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR a CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 001WClOA64191 04/25/2010 04/25/2011 X I Two CSTATU- 13- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Village of Miami Shores BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 10050 NE 2nd Avenue OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE `} Chris Morris/SANDYS - ACORD 25(2001/08) ©ACORD CORPORATION 1988