MC-15-152BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC
▪ PLUMBING 0 MECHANICAL
JOB ADDRESS:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
RECE TD
JAN,, 2 2015
13
FBC20(o
Master Permit No. O ) L ' 2-181
Sub Permit No. MC ( 2
❑ ROOFING ❑ REVISION D EXTENSION nRENEWAL
❑ PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
City: Miami Shores
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load:
CONTRACTOR DRAWINGS
10
County: Miami Dade
ZIP: t2
NO
Construction Type: MECHANCIAL Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): L r 7-4 -y a Phone#:
Address: L{'
State: �I Zip: 3 ?j 1
City: G�
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: SANSONEWC Fm Phone#: 954-428-8919
Address: 590 GOOLSBY BLVD
City: DEERFIELD BEACH State: FL zip: 33442
Qualifier Name: SCOTT SANSONE
State Certification or Registration #: CMC1249260 Certificate of Competency #:
Phone#: 954-428-8919
DESIGNER: Architect/Engineer: Phone#:
Address:
Value of Work for this Permit: $
Type of Work: ❑ Addition ❑ Alteration
Description of Work: HVAC PER PLAN
City: State: Zip:
Square/Linear Footage of Work:
0 New
❑ Repair/Replace
Demolition
"2- -j-kivql
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
.Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ IG 2... 30
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 valu - exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law • chure will be delivered to the person
whose property is subject to attachment. Also, a certed copy of the recorded notice of com , : ncement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. 1 he absence of such posted notice, the
inspection will not . , a • . oved and a - . sp = ion fee will be charged.
The foregoing instru
's da of
Signature
CONTRACTOR
nt was acknowledged before rr�e this The foregoing instrument was acknowledged before me this
Lc h 20 ) , by 14 day of JANUARY , 20 15 , by
who is personally known to SCOTT SANSONE , who is personally known to
m - or who has produced as me or who has produced as
identification and who did take an oath. identification
NOTARY P
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Sign:
Print: (� A._ ✓ � °'�
NOTA
ASHA. DZIEWIT
at.it LEY MISSION M
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Seal: Seal:
**•■************** k**B***************
APPROVED BY
(Revised02/24/2014)
miner
Structural Review
Zoning
Clerk
01/19/2002 07:28 9544281405 SANSONE PAGE 01/03
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
•GoNSTRUG—TION-IN-DUST-RY'••6FOENS'INO-BOARD ' -. ........."".....-4850).4874395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
SANSONE, SCOTT JOHN
SANSONE AIR CONDITIONING
4570 GLENWOOD DRIVE
COCONUT CREEK FL 33066
Congratulations! With this license you become ane 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
wwwwmyfioridal cense.corn. There you can find more Information
about our divisions and the regulations that impact you, subscnbe
to department newsletters end learn more about the Department's
initiatives. '
Our mission at the Department Is: License Efficiently, Regulate Fairly.
We oonstan� strive to serve you better so that you can serve your
customers, hank you for domg business in Florida,
and Congratulations on your new license,
DETACH HERE
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RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
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DISPLAYAS REQUIRED BY LAW
SEQ # L1407030001187
01/19/2002 07:28 9544281405 SANSONE PAGE 02/03
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••
• 0 AND -COUNTY LOCAL BUSINESS TAX RECEIPT :4
• 115 S. ,Artdrews Ave., Rm. A-100, Ft. Ltuderdele, FL 33M-1895 - 954-831-4000
IA
VALIITOCT013ER-1 ;2014 - • THRO UGR- -sorramBER-3•0;2015' - - - - • • • • ' '
..;....,
DBA: SANSONE AIR CONDITIONXNG ReCelPt g:HIT7IINWIRCONDITION CON'I;liACTR
• :<•
Business Name: BUsinete Type: (taamwzchz coasmc-roa) 1
Owner Name: sccrr J SANSONE/QUAL . BUS1tlega.OPerleit12/11./ 2003
...
Business Loestionr, 590 GOOLSBY. BLVD . State/County/Cett/Reg:CHC1.2 4 92 6 o . 4.11
DEERFIELD sms,cro Exemption Code: i.i.
Business Phone: 9s4-428-8919
l'.
• !•
•
•
Rooms
Seats
Employees
75
Machines
Professionals
Number of Mach
Far Vending au nein Only
•
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Coat
Total Paid
180.00
0.00
' 0.00
0.00
0.00
0.00
150.00
•
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This fax is levied for the privilege of doing business within Browen:1 County and is
non-reguletay in nature. You must meet all County and/or Municipality planning
WHEN VALUATED 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 Andreas;
SCOTT .7 SANSONE/QUAL
590 GOOLSBY BLVD
insERPZELDA BEACH, FL 33442
Receipt 9302-15:40002980
08/14/2014 190.00
44
'
14
.•
2014 2015
temewnwortsmfamwmammistomearmamoommoomagemet4
•
01/19/2002 07:28 9544281405
AC RO D®
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(los) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain polities may require an endorsement A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
SANSONE
CERTIFICATE OF LIABILITY INSURANCE
PAGE 03/03
DATE 64MRIDNYTY)
1/21/2015
PRODUCER
Frank H. Furman, Inc.
131.4 East Atlantic blvd.
P. 0. Box 1927
Pompano Beach FL 33061
NA TACT
PN(OIINo. Fo (954)943-5050
A0
DR
INSURED
Sansone LLC dba Sansone Air Conditioning
590 Goolsby Blvd.
Deerfield Beach FTE. 33442
N'41 p42.010
1N$UR, 3S1AFF0RD1NOCOVERAGE
eisuareArNatiotsal Trust Ing Co
INSURER s :PCCI Insurance Co
NAIL B
20141
10178
wsuREHD:Bridgstield Smplt2Yers Ins CO
0701
INSURER D :
INSURER E :
INSURER, :
COVERAGES CERTIFICATIENUMBER:2015-16 W o/Endts REVISIONNUMBER_EiC
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUA
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 8Y THE POLICIES DESCR161
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED FBY PAID CLAIM
EXP
1X
TYPE OF INSURANCE �yq�
POLICY NUMBER POLICY DI lam )
GENERAL IJAOII TY
X COMMERCIAL esmum . UAOILrry
A CLAIMS -MADE W OCCUR
GEN'(. AGGREGATE LIMIT APPLIES PER
—I POLICY 1 7L IT Floc
AUTOHI09Il3 LIAnIUTY
X ANY AUTO
— AI.L OWNED SCHEDULED
AUTOS
X HIRED AUTOS x NNqq Attica
X UNARELLA UA9
EXCESS LIAR
B
OCCUR
OLArMS MADE
R
RTETtom$ 10,000
c WORIcER3 COMPENSATION
AND 11PI.OIr3R3 LIABILITY
Y/N
ANY PROPRIE1OR/PARTNER/BXECUTIVE
OFFICERPAEMBER EXCLUDED? N / A
(MendaIsy In Nit)
ratMyyeea� de.Crlbeu�nr1der
OF OFERATIQNS below
i2,0016162 2
OB0017402 5
Dem0011725 5
0030 54159
12/1/2014
12/1/2014
12/1/2014
1/1/2015
12/1/2019
12/1/2015
12/1/2015
1/1/2016
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Alma ACORD 101, AOWnonuI ROMER: Enhodu e, Elmo apace 1a remurnd)
Mechanical Contractor CSC1249260
CERTIFICATE HOLDER CANCELLATION
Fox.*
to
ED NAMED ABOVE FOR THE POLICY PERIOD
DOCUMENT WITH RESPECT TO WHICH THIS
D HEREIN IS SUBJECT TO ALL THE TERMS,
'a.
' LIMITS
EACH OCCURRENCE
$ 1,000,000
DAMAFMISI;I:ESTO LEaRENTED
P Deserve 1
$ 100, 000
MED EXP (My ons poses)
3 5,000
PERSONAL AADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -CGMP/OPAGG
$ 2,000,000
(Ens t mS SINGLE UNIT
S 1 000,000
BODILY INJURY (Per pews)
$
BODILY INJURY (Por ealdent)
$
PROP/Per medal*E DAMAGE
$
$
MCH OCCURRENCE
$ 3,000,000
AGGREGATE
$ 3,000,000
$
E mYLIMITS Et'.
EL EACH ACCIDENT
0 ].. 000. 000
3.L, DISEASE -F.A EMPLOYEE
3 1., 000/ 000
F.L. DISEASE • PaUcy LIMIT"
0 1, 000, 000,
Village of: Miami Shores
10050 )r 2nd Ave
Miami Shores, FL 33138
ACORD 25 (2010105)
SHOULD ANY OF THE ABOVE 0ESCRIBEI3 POLICIES ISE CANCELLED BEFORE
THE ExPIRATION DATE THEREOF, NOTICE WILL DE DELNEREO IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Dirk Aesong/RD
1988-2010 ACORD CORPORATION, All rights reserved.
DOM on n El The A OR11 name and Wee,, aro rnnr4tere,l mark* A( A('.(iRfl