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MC-12-1972 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 j9 e6'� Inspection Number: INSP-180311 Permit Number: MC-10-12-1972 Scheduled Inspection Date: December 22,2014 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: WATSON, LEONARD Work Classification: Addition/Alteration Job Address: 165 NW 99 Street Miami Shores, FL 33150-1742 Phone Number Parcel Number 1131010230390 Project: <NONE> Contractor: KOOL FLOW INC Phone: (954)962-8843 Building Department Comments MECHANICAL WORK FOR NEW ADDITION OF KITCHEN Infractio Passed Comments AND FAMILY ROOM INSPECTOR COMMENTS False Inspector Comments Passed 10 Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 19,2014 For Inspections please call: (305)762-4949 Page 1 of 38 Miami Shores Village - Building Department artment Nov 14 2013 y 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 -f INSPECTION'S PHONE NUMBER: (305)762.4949 --- - FBC 20 BUILDING Permit No. I\" Ir, 12- - ) 9 7 1, PERMIT APPLICATION Master Permit No.J Z" Permit Type: MECHANICAL JOB ADDRESS: 16 S AZ 0 9 City: Miami Shores County: Miami Dade Zip: ? �® Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): J�Aa.fV&1A Phone#: 3(D5— -3�� 'J� q2— Address: ZAddress: 16!� /Vt..) 9(/ s City: LM-t er State: Zip: 7S 3 15 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: t��0 t! ICU Phone#: qj Address: J i_-y �` 1 City: State: �'`� Zip: 33®-L-3 Qualifier Name: S F, Phone#: '10 0 3z3®Z � State Certification or Registration#: b Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑Address VAlteration ❑New ❑Repair/Replace ❑Demolition Description of Work: FeQ 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$ © � O 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Si Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of tie°`,201L,by LeOAQ Jt "i Cave day of�njevAPY 20 t-') 'by Ge-lruckksc 14u, J who is personally known to me or who has produced who is personally known to me or who has produced_ Dt tVfN� b C--C-hN<—As identification and who did take an oath. bye Ofv' (_i C _ as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: &Alw Sign: (�f Print: Print: My Commission Expires: y ., gARBARAAESTEP My Commission Expire "-q,; MY COMMISSION#DD 955300 ;A�$vg BARBARA A ESTEP *' ;< EXPIRES:March 29,2014 $i ; MY COMMISSION#DD 955300 P q a Bonded Thru Notary Public underwriters , , EXPIRES:March 29,201 Underwriters APPROVED BY [lins Vxammer Zoning Structural Review Clerk Revised 3/12/2012X Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) -M � ' Miami Shores Village " R_�"'� Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address(where the work is being done): City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI(AHRI)DATA SHEET REQUIRED Change Disconnecting means:YES ❑ NO❑ ARHI Sheet Attached:YES❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG.UNIT MODEL# COND.UNIT MODEL# KW HEAT NOM TONS AHU CU PKG 1 M.C.A AHU CU PKG AHU CU PKG 2 M.O.P AHU CU PKG AHU CU PKG 3 VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Phone: State Certificate or Registration N. Certificate of Competency N. Signature Date: (Quallfler's signature only) 115 S.Andrews Ave., Rm. A-100, Ft. Lauderdale, FI. 33301-1895—954-831-4000 YAILI®OCTOBER 1,2013 THROUGH SEPTEMBER 30,2014 OSA.KOOL FLOW 1140 Rk?Ce'tpt#:EATING/AIRCONDITION CO RACT: Business Name. Business Type:tAzx CONDITIONING CTR) OM4W Itit8me:GERVAISE W HYLTON Business Opened:1 o/2 6/2 0 0 9 BluSln LoCatiort:5s89 SW 23. ST BLDG F State/County/CertJReg:cAci816347 WEST PARK Exemption Code: Business Phone: e: rttroats seats Employee" /Machines Professionals 1 For Vendkgi Business Only Number of Machines: Vending Type: Tax Armunt Tranoft Fee I NSF Fee Penalty Prior Years Collection Cosi Total Paid 27.00 3.00 0.00 0-.00 1 0.00 0.00 30,00 THIS RECEIPT MUST BE POSTE®CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Brorvard County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VAUMED 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. Mailing Address: GERVAISE W HYL70N Receipt #028-12-00000868 5889 SW 23 ST BLDG F Paid 08/23/2013 30.00 WEST Pte, FL 33023 2013 • 2014 STATE OF FLOMDA DBPARTJt�T OF BIISINBSs AND PROFESSIONAL REGULATION 1008 NORTH t IIST TCERSING BOARD (850) 487-1305 MMON Ts .ras�t81$8 FL 32399-0783 YLTTON G DISE 'WASHINGTON 7021 ANAR 30TR STREET FL 33023 h: Conga ClWkilionM •Yfth f;F.I� Ocerse you become�,�p.� � of the �one IIWiion y` t ea.Aj a w' .-, ,�'T"'m'.•�y^ Fkgid by{Sim STI Business Rvftsslonsl • 9t •: boxers to restaurants,and they keep PoWa s�ung ffaril ''✓�` 3w� +e,`� " � �G * ^� 3�aa.�r v.;mi 43, Every day we work to impiwe the way we do bushum In ofdw to swie you better. ,8 For NbrMallon about our serAces.plesse tag Onto www TherNe you can&W mom loon about our dMftns and the regulations that >li ' you, to department n and kwn more about the � �,� Departments irdtlatives. Our at the Departnient IS:Licence Oficlently,Regulate Fatly.We Thank �t to serve you letter so that you can serve yourcustomers. you doing In Florida,and congrartu on your new kwuaat ..3 •-:.p0 7 1.�' DETACH HERE A �Y;9, 3 y L •.. ;`� s ..:\�, i F �, '°e Y`+� e M�aLLFi�, y� a.:� s \a 4 a Y+• � S`�i b` Ta,^) + .,�s�•'t e; •�'. t-i SL�+g 6 '� 3t`�i t � t A �+' Lip yA^`4'•,i`^� ( L M t�,�{@ .1m,at ":'t4' �*p3 •;•� F5fy'.An �d`i�+$•+p.,it'r` -" ��i$9n r•r -,'�,a�x; At' a r'.8"� �� � ��r;.:/ � � .zr �"r..a a�+ a .r e,...- <t<l���SR'�7� i•a h ��. , 1i w �t y i ��: gig �i 1 t� � �>A.: �°S�t`i^���°aa�`•�j r ,� rti f i .� (a a, -�,,,b �Ya �'^f4f� llyy��� Yf`6%. . r Y• b / � '« � �d a 6 ',: air ?{ 3t #-y., iy; - £ e .,��"� .a spa �, .i' '' �'/+� f f .e• S.: y �_ •. A f,�rfgi. 7f'Q$r ?.' t•� Via A� CERTIFICATE OF LIABILITY INSURANCE °";1;06,20°13"' 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 cerdflcate 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Gail Sanoir OT ALL ABOUT INSURANCE PHONNo 954-284-8282 1 a No): 954-965 2325 7962 MIRAMAR PARKWAY ADDRESS: gail.allaboutins@gmail.com INSU S AFFORDING COVERAGE NAIC 0 MIRAMAR FL 33023 INSURER A: MERCURY INDEMNITY COMPANY 0 INSURED INSURER B: ASCENDANT INSURANCE KOOL FLOW INC INSURER C: 5889 SW 21 ST INSURER 0: BLDF 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. /LTR AME B TYPE OF INSURANCE POLICY NUMBER M POLICY EFF LILY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TOR-ENTED-- COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE E OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY EaMaa9deMSINGLE LIMIT $ 1000 000 ANY AUTO BODILY INJURY(Per person) $ AALL OWNED AUTOSUIED BA090000002610-03526 10/25/2013 10/25/2014 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Peraccident $ $ UMBRELLA LIM OCCUR EACH OCCURRENCE $ EXCESS WU3 CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU OTH- 1,000,000.00 AND EMPLOYERS'LIABILITY YIN T R ER B AFFICRER/MEMBOERPEXCLUDRIE ECUTIVE NIA ACI-52041-336044 10/26/2013 10/26/2014 E.L.EACH ACCIDENT $ 1,000,000.00 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave AUTHORIZED REPRESENTATIVE Miami Shores Village FL 33138 � ACORD 25(2010/05) (/ ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD A'%� CERTIFICATE OF LIABILITY INSURANCE °A 11/06/2013(x"' ' 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: ff the certificate holder Is an ADDITIONAL INSURED,the poticy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 CONIA7 David Reiter Sierra Insurance PHONE 954-788-1005 FAx ,�,;954-346-4801 4613 N University Dr,#481 david@slerracovers ou,com Coral Springs,FL 33067 INSURERIS)AFFORDING COVERAGE —NAIC 0 INSURERA: Westem Heritage INSURED INSURER B: Kool Flow Inc. 5889 SW 21st Street INsuRERC Bldg F INSURER D: West Park, FI 33023 POURER e:---- — ------ INSURER F COVERAGES CERTIFICATE NUMBER:: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEL HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON ITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN_ HAVE BEEN REDUCED BY PAID CLAIMS. L S TYPE OF INSURANCE POLICY NUMBER ADOLINNPOLICY EFF POLICY EXP LIMITS A COMMERCIAL GENERAL LIABILITY ✓ EACH OCCURRENCE $ 1,000,000.00 CLAIMs•MADE accue SCP0763755 �� �-- I PREMISES Ea occurrence $ 100,000.00 MED EXP LAry oneperson) $ 5,000.00 09/22/2013 09/22/2014 PERSONAL&ADV INJURY $ 1,00_0,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 rl PRO- PODGY ®LOC PRODUCTS-COMP/QPAGO $ 2,000,000.00 OTHER: — $ AUTOMOBILE LIABILITY CO iN. SINGLE IMIT _...... � ---.._.—._._ _$.._..........__....__........................... ANY AUTO BODILY INJURY(Per peraon) $ AU�rOS OWNED ASCtYIHOSULEO I BODILY INJURY(Per acadent) $ NON-0WNED (PROPERTY DAMAGE --- — --._._.._._.......—._........_ HIRED AUTOS AUTOS P �e $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _.._._....--...._. EXCESS LIAB CLAIMS-MADE I AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PER O AND EMPLOYERS'LIABILITY YIN I S N I _71 ANY PROPRIETORIPARTNERtEXECUTIVE ! OFFICERIMEMBEREXCLUDED? N 1 NIA E.L EACH ACCIDENT $ I(Mandatory In NH) - - E.L,DISEASE-FA EMPLOYE $ 1if yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I (! i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORO 101,Additional Remarks Sehaduts,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION City of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2 Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village FL 33138 AUTHORIZED REPRESENTATIVE O 1988-2013 ACORD CORPORATION. Ail rights reserved. ACORD 25(2013/04) The ACORD name and logo are registered marks of ACORD