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MC-17-270 (2)LE 10 83J Miami Shares Village 03AI3338 Building Department U-11 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 s4�X FBC 201`t BUILDING Master Permit No. T2C( (o— 2.14'1 , PERMIT APPLICATION Sub Permit No. --Mc G n -Zlpo (BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION r7RENEWAL PLUMBING M MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR JOB ADDRESS: 515 Grand Concourse DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206-017-1340 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Gregory Palmer Phone#: 954.410A695 Address:515 Grand Concourse city. Miami Shores State: FL Z;p: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Sansone AC Address: 590 GOOLSBY BLVD Phone#: 954-428-8919 city: DEERFIELD BEACH State: FLORIDA Zip; 33442 Qualifier Name: SCOTT SANSONE Phone#: 954-428-8919 State Certification or Registration M CIVIC 1249260 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address City: State: Zip: Value of Work for this Permit: $ �,+ f� Gi 0 Square/Linear Footage of Work: & G 0 )4i Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: HVAC PER PLAN L t a-t ta. S -TbK-s Specify color of color thru tile: OD Submittal Fee $ S,0 •00 Permit Fee $ QUCF $ /! r• $ ( LCO/CC $ Scanning Fee $ Radon Fee $ Z DBPR $ �-t • Z� Notary $ Technology Fee $ •� Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ iRevisedo2/24/20141 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 promise In good faith that a copy of the notice of commencement and construction lien low b whose property is subject to attachment. Also, a certified copy of the recorded notice of comme for the first inspection which occurs seven (7) days after the building permit is issued. In t inspection will not Pe approved and a reinspection flee will be charged. Signature Ci�. t,Signature Ing $2500, the applicant must vill be delivered to the person must be posted at the job site ce of such posted notice, the OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this day of t— -e 20 t-7 . by `eC cwho is personally known to me or who has produced • as identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was acknowledged before me this 1 day of FEBRUARY 2017 by SCOTT SANSONE who isperson � ally known to me or who has produced as identification and who did take an oath. ii NOTARY PUBnn& i 1 Print: Seal: +° r.••.� * MY 640SION t FF ISM27 Seal: * EXPIRES: M81ch16.2019 ASHUYDZIEWIT or oesor4wTta 84d Notary $►"*e% Vy CX)MM1SSION k "9 "39 +4,ap EXPIR 'Nebnay07.2= APPROVED BY . Y Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,iCORblt CERTIFICATE OF LIABILITY INSURANCE %.,-' DATE(MMIDDNYYY) 1 12/1/2016 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 coMftcats does not confer rights to the certificate holder in lieu of such endarseme a). PRODUCER Randi Arnold Frank H. Furman, Inc. PHONE (954) 943-5050 FAX (954)942-6310 1314 Bast Atlantic Blvd. E10 randiBfurmanineurance.com P . O. BOX 1927 1 AFFORDING COVERAGE NAIL / s+SURERAITational Trust Ina Co 120141 Pompano Beach FL 33061 INSURED _IMSMR S FCCI Insurance Co 10178 iNsuRERCFrid efield Employers Ins Co 10701 Sansone LLC dba: Sansone Air Conditioning 590 Goolsby Blvd. INSURERD: INSURER E Deerfield Beach FL 33442 INSURER F: ""VY wmt.CM w1^ A ^"ff mmnw It• wliaz ==. 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. INSR TYPE OF INSURANCE POLL EFF EXP LIMITS A X COMMERCIAL GENERALLU15JUTY CLAIMS -MADE ❑Y OCCUR GLOO161624 12/l/2016 12/1/2017 EACHOCCURRENCE S 2,000,000 DAMAGE TO RENTEDencal $ 100,000 MEDEXp one ) $ 51000 PERSONAL BADVINJURY $ 11000,000 GENI. AGGREGATE ppLIMIT APPLIES PER POUCYTJECT ELOC OTHER: GENERAL AGGREGATE $ 21000,000 PRODUCTS -COMPIOPAGG $ 2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALLOWNEDODUlEO AUTOS AUTOS HIRED AUTOS N AUTOSPROPERTY CLOO2740207 12/1/2016 12/1/2017 COMBINED $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ DAMAGE $ B X UMBREWILIAB EXCESSL.IAB OCCUR CLAIMS -MADE UMOOZ17257 12/1/2016 12/1/2017 EACH OCCURRENCE $_ 5,000,000 _ AGGREGATE $ 5,000 000 DED I X I ReTewioiis 30 000 S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/O(ECUrIVE OFFICER�A�EMBEREXCLUDED7 (MandgmInNN) R yyeess,� describe under DEBCRIPrONOFOPERATIONS behw NIA 003054159 1/1/2017 1/1/2018 X CT"_ STATUTE 1 1 ER E.LEACH ACCIDENT S 2,000 000 E.L. DISEASE - EA EMPLOYEE S 1,000 000 E.LDISEASE- POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more qmc* is rsqulred) RE: XECRANICAL CONTRACTOR LICENSE # CMC1249260 MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE DeJong / RA 01989-2014 ACORD CORPORATION_ All rinhtc rAaA,-ArP_ ACORD 25 (2014MI) The ACORD name and logo are registered marks of ACORD INS025f2mA H) 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2016 THROUGH SEPTEMBER 30, 2017 DBA: Receipt#:�TING%AIRCONDITION CC Name' SANSONE AIR CONDITIONING Business Type: (MECHANICAL CONTRACTOR) Owner Name: SCOTT J NSONE/QUAL Business Opened:l2/11/2003 Business Location: 590 GOOLSBY BLVD State/County/Cert/Reg:CMC1249260 DEERFIELD BEACH Exemption Code: Business Phone:954-428-8919 Rooms Seats Employees Machines Professionals 75 For Vending Business Only Number of liNachines: Vendinn Tvnw_ Tax Amount Transfer Fee I NSF Fee I Penalty I Prior Years Collection Cost I Total Paid 150.00 1 0.00 0.00 1 0.00 1 0.00 1 0.00 150.00 • 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. Mailing Address: SCOTT J SANSONE/OUAL 590 GOOLSBY BLVD DEERFIELD BEACH, FL 33442 2016 - 2017 Receipt #04B-15-00007802 Paid 09/01/2016 150.00 STATE OF FLORIDA a, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ;. CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 SANSONE,SCOTTJOHN SANSONE AIR CONDITIONING 590 GOOLSBY BLVD. DEERFIELD BEACH FL 33442 Congratulationsl 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 I og onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the 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. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMEN,LOF BUSINESS AND PRO CMC1249260 CERTIFIED SANSONE, SANSONEi 14' a. I5 CERTIFIED under th EzptrG doh AUG 31, 2018 DETACH HERE e R;r'Mslons of Ch.488 FS. 0605WOW1379 KEN LAWSON, SECRETARY STATE OF FLORIDA i DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CMC1248260 - —_-- The MECHANICAL CONTRACTOR Named below IS CERTIFIED - Underahe -provisions of Chapter 489 FS. I Expiration date: AUG 31, 2018 - SANSONE, SCOTT J-OHN _... , I , ,.SA �NE.AIR CC NAI -5t� OCJ SBV ".QI=ERNELIJ. r r-,•' �„r'F% Wit,• ..-_ `. � = "- .r "^'^•-�,"i" ISSUED: 06/0212016 Tr'✓ -.a: �t'LA AS 1711 � t N' ' ■ a N. Ely SEQ # 0606020001379