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MC-16-2494 .0' Inspection Worksheet Miami Shores Villages 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-266926 Permit Number: MC-9-16-2494 Scheduled Inspection Date: October 19,2016 Permit Type: Mechanical - Commercial Inspector: Perez,JanPierre Inspection Type: Final Owner: CHURCH, MIAMI SHORES Work Classification: A/C Replacement 000401-rCORAKI Job Address:602 NE 96 Street Miami Shores, FL Phone Number (305)751-5917 Parcel Number 1132060141410 Project: <NONE> Contractor: SHORELINE AIR SYSTEMS INC Phone: (954)485-3117 Building Department Comments CHANGE OUT OF 1 TON WALL UNIT,ALSO CHANGE Infractio Passed Comments OUT 1 1.5 TON WALL UNIT AND 1.5 TON MINI SPLIT. INSPECTOR COMMENTS False BOTH ARE HEAT PUMPS Lt) I ct, U"-�p Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 18,2016 For Inspections please call: (305)762-4949 Page 9 of 26 94 Miami Shores Village fieri*Tyke Meharltlal Cc�rlittlerclal 10050 N.E.2nd Avenue NE :'AIC i Miami Shores,FL 33138-0000 W PerTtxif 5te `. � PPo Phone: (305)795 2204 fi;OR 3 J3 'i� 'r 913016 Expiration: 03/13/2017 Project Address Parcel Number Applicant 602 NE 96 Street 1132060141410 Miami Shores, FL Block: Lot: MIAMI SHORES PRESBYTERIAN Owner information Address Phone Cell MIAMI SHORES PRESBYTERIAN 601 NE 96 ST (305)751-5917 - -- MIAMI 38 FL 33138-2741 Contractor(s) Phone Cell Phone Valuation: $ 6,950.00 SHORELINE AIR SYSTEMS INC (954)485-3117 - _._ ... - �.• _. Total Sq Feet: 0 Tons: Available Inspections: Additional Info:CHANGE OUT OF 1 TON WALL UNIT,ALSO Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $4.20 DBPR Fee Invoice# MC-9-16-61273 $3.13 09/14/2016 Check*1868 $ 184.96 $50.00 DCA Fee $3.13 Education Surcharge $1.40 09/08/2016 Check#:1867 $50.00 $0.00 Permit Fee $208.50 Scanning Fee $9.00 Technology Fee $5.60 Total: $234.96 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 7MING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and II work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor to o e ork st ed. September 14,2016 Authorized Signature:Owner / Applicant / Contractor A nt Date Building Department Copy September 14,2016 1 Miami Shores Village � S d � 281 Buildingearthen 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 71� INSPECTION LINE PHONE NUMBER:(305)762-4949 ` 4 FOC 20N BUILDING [Master Permit Ivo. Q.(, `o- 214 L, PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [RENEWAL (PLUMBING 0 MECHANICAL ❑PUBLIC WORKS Q CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 602 NE 96 STREET City: Miami Shores County: Miami Dade Zip_, Folio/Parcel#:11-3206-014-1410 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):NORTHEAST PRESBYTERIAN CHURCH phone#:3O5-754-9541 Address:602 NE 96 STREET City: MIAMI State: FL Zip: 33138 Tenant/Lessee Name: 91A Phone#: Email: CONTRACTOR:Company Name: SHORELINE AIR SYSTEMS, INC. Phone#: 954-485-3117 Address: 3801 NW 49TH STREET city: FT. LAUDERDALE State: FL Zip: 33309 Qualifier Name: DONALD A. RIST Phone#: 954-485-3117 State Certification or Registration#: CAC 1815384 Certificate of Competency#: DESIGNER:Architect/Engineer: N/A Phone#: Address: City: _ State: Zip: Value of Work for this Permit:$$6,950.00 Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work,.THIS PERMIT IS TO REOPEN#MC05-152. PERMIT WAS NEVER CLOSED. CHANGEOUT OF (1) 1.0 TON WALL UNIT W/A 1.0 TON MINI SPLIT, MITSUBISHI#MUHI2TN. ALSO, CHANGEOUT OF (a) 1.5 T©N WALL;'UNITW/A 1.5 TON MINI SPLIT, MITSHBISHI 9MUH17TN.. BOTH ARE HEAT PUMPS. Spicabr carr, o for MrU.tiled, Submittal Fee Permit Fee$ 'S CCF$ 9—® CO/CC$ Scanning Fee$ Radon Fee$ D�B(PR$ �•� Notary$ Technology Fee$ 5 Q Training/Education Fee$ I -f 0 Double Fee$ - Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �L:gw (Revised02/24/2�14) 1 Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N/A 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 i 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 irspectior will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 04 day o"f 20 l�2 by day of AUG t2ST 20 leo by .� abdy`[l,�t !�(zSe who is personaliY known to nblf A _ ! ! who i erson�ally k w o me or who has produced 12,6 rs @-I(—' 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: Sign: _ 01--� a �``ar P' . HE D.SARHAN Print: Print: �� rida r; EXPIRES:December 20,2019 *'e My Comm.Expires Aug 5,2018 Seal: Seal:Seal: %ay Arc Commission#FF 119260 I \**T APPROVED BY KPns Examiner Zoning Structural Review Clerk (Revised02/24/2014) ♦SHu I U Ay gos iami ShoresVillage Building Department �toRivA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE 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 SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: �I4ojQ6-L1Ke— Al2 ��ST�NLS �Cr. BUSINESS ADDRESS: -a2D] 4yj ;19-a' ='SiL CITY ET.LAUD TATE�„ZIP BUSINESS PHONE: (251—) q9573117 FAX NUMBER O_qq� LI�5 - t LJL1 CELLPHONE ( QUALIFIER'S NAME:_:bQtJ(� LD A . Ri ST QUALIFIER'S LIC NUMBER: a-Iq C',1 )53 ,? q VG IY1V1 1 1 ILI\L 'RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD t CAC1815384 The CLASS AAIR CONDITIONING CONTRACTOR . Named below IS CERTIFIED Under the provisions of.Chapter 489 FS. Expiration date: AUG 31;2018 RIST, DONALD.A �, SHORELINE AIR SYSTEMS INC 3801 N.W. 49TH STREET FT._LAUDERDALE`, : FL.33309 " al ISSUED: 08/14/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1608140002830 h •eli - WED BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 SEP O 12016 VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30,2017 DBA:SHORELINE AIR SYSTEMS INC Receipt#:183-1712 CONT }. TR Business Name: Business Type:(CERT AIR COND CONTRACTOR) Owner Name:DONALD A RI ST Business Opened:07/06/2007 Business Location:3801 NW 49 ST State/County/Cert/Reg:CAC1815384 FT LAUDERDALE Exemption Code: Business Phone:485-3117 Rooms Seats Employees Machines Professionals 18 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 59.00 0.00 0.00 0.00 0.00 0.00 54.00 t' l� 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 x it is in compliance with State or local laws and regulations. Mailing Address: DONALD A RIST Receipt #03A-15-00009360 3801 NW 99 ST Paid 08/26/2016 54.00 FORT LAUDERDALE, FL 33309 i i 2016 - 2017 3 Ty ri in n i 111UTV I fn"% A1 01 11 O W 1C 0 e =r w v i i 4 -� OP ID: HP '4r,C,,, 08/1616/22016016Y) �iR�l y CERTIFICATE OF LIABILITY INSURANCE D 1 / 0 THIS CERTIFICATE IS ISSUED AS A 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(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 certiflcate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: INNOVATIVE INSURANCE PHONE FAX CONSULTANTS,INC. A/C No Ext): (AJC' A/C No): 6461 UNIVERSITY DRIVE,#103 E-MAIL CORAL SPRINGS,FL 33067AADDDRESSR KELLY J.GOLDSTEIN CPRUOSTOMER ID#:SHORE-2 INSURERIS)AFFORDING COVERAGE NAIC# INSURED SHORELINE AIR SYSTEMS,INC. INSURER A:NATIONAL TRUST INSURANCE CO 20141 3801 NW 49TH STREET INSURER B:ZENITH INSURANCE COMPANY 13269 FT.LAUDERDALE,FL 33309 a INSURER C:MONROE GUARANTY INS CO I INSURER D INSURER E: 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, I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !LTR TYPE OF INSURANCE DL UB I=wyn POLICY NUMBER M/DD EFF MMIDD/Yri LIMITS ! GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY GL0008497 8 04/08/2016 04/08/2017 PREMISES Ea occurrence $ 300,00 CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURYPer ( Person) $ ALL OWNED AUTOS _ BODILY INJURY(Per accident) $T SCHEDULED AUTOS PROPERTY DAMAGE HIREDAUTOS (PER ACCIDENT) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONX WC STATU- OTH- LIMAND EMPLOYERS'!.LABILITY FR B ANY OFF IPROPRIIMBERPPARTNERIFEXCLUDEDCUTIVE Y/❑N N!A Z06-0237026 01/01/2016 01/01/2017 E.L.EACH ACCIDENT $ 1,000,00 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB It 1,000,00 C PROPERTY COVERAGE CP0006466 8 04/08/2016 04/08/2017 B-$262400,BI-$100K $1,000 DED,6%WIND DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CONTRACTOR'S LIC#CAC1815384 CERTIFICATE HOLDER CANCELLATION MIAMIS1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES,FL 33138 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD