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MC-16-1004 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL 77 � Phone: (305)795-2204 Fax: (305)75648972 Inspection Number. INSP-273421 Permit Number: MC-4-16-1004 nAAwr�AAr�w� A�wA Scheduled Inspection Date: December 21,2016 Permit Type: Mechanical- Residential Inspector: Perez,JanPierre Inspection Typ Owner: ARENAS,JORGE Work Classification: A/C Repla ement Job Address:286 NE 99 Street Ftvi,:�J Miami Shores,FL 33138-2435 Phone Number Parcel Number 1132060134310 Project <NONE> Contractor: BELOW ZERO A/C INC Phone: (561)300-3103 _wry irr■r�AArrn�Arrrrr AnAr�� rArirrnw�.Arrrr Building Department Comments INSTALL NEW A/C UNIT Inftectlo Passed Comments INSPECTOR COMMENTS False �l Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-257611. need revises plans Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 20,2016 For Inspections please call:(305)762-4949 Page 33 of 46 r 3 k #stmtf NCJ C+ x Miami Shores Village � e YVe we nica� 3� is 10050 N.E.2nd Avenue NE Maa � a RaplB ' Miami Shores,FL 33138-0000 ' Phone: (305)795-2204 �a g" EES �toamp � 71204g , Expiration: 10/2 1 Project Address Parcel Number Applicant 286 NE 99 Street 1132060134310 Miami Shores, FL 33138-2435 Block: Lot: JORGE ARENAS Owner Information Address Phone Cell JORGE ARENAS 826 NE 99 Street MIAMI SHORES FL 33138- 826 NE 99 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 BELOW ZERO A/C INC (561)300-3103 Total Sq Feet: 0 Tons:2.5 Available Inspections: Additional Info:INSTALL NEW A/C UNIT Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# MC-4-16-59412 $2.00 04/14/2016 Credit Card $50.00 $90.90 DCA Fee $2.00 Education Surcharge $0.80 04/27/2016 Credit Card $90.90 $0.00 Notary Fee $5.00 Permit Fee $122.50 Scanning Fee $3.00 Technology Fee $3.20 Total: $140.90 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 ther myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDO S, OORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informati n i ccurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-nam d tractor to do the work stated. April 27, 2016 Authorized Signature:Owner / Applicant ! Con a cr / Agent Date Building Department Copy April 27,2016 1 CEIV fiami Shores Villag � F TS J ®� Building Department ASR 1 2o�s r Iz - 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 TBY Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20(0 BUILDING Master Permit No.a ,- k233® . PERMIT APPLICATION Sub Permit No. l 0-46 - I r-IBUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL ❑PLUMBING $6 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP q CONTRACTOR DRAWINGS JOB ADDRESS: _�eG �\� 11) (&� tt�� City Miami Shores County: Miami Dade Zip: a31— Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ' �.�+� �ZC'��i�S Phone#: Address: Q, City: State Zip: Tenant/Lessee Name: Phone#: Email: �a 0► Q CONTRACTOR:Company Name: �� "- '��uij-Phone#: � Address: City: % ` State: Zip: uS L ,l Qualifier Name: Phone#:,�/1 ) State Certification or Registration l. I I t 7i 9 q j I Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: CC) Value of Work for this Permit:$ 3, i xl Square/Linear Footage of Work: Type of Work: ❑ Addition X Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: sjz� C.L. Q 4-c w Nric tom(— n'c i+C�c�C� Specify color of color thru tile: Submittal Fee$ J V ' 0Z) Permit Fee$ � CCF$ ® CO/CC$ Scanning Fee$ Radon Fee$ 2— DBPR$ 2 Notary$ (S Technology Fee$ R ® Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 0 TOTAL FEE NOW DUE$ O " (Revised02/24/2014) �4W— 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 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 of be approved nd a reinspection fee will be charged. Signature & I L - Signature _ q/ T%. OWNER or AGENT ZlzCONT OR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �4::2 day of 20 ,by day of 14 Li 20 t S ,by Z:f /{ who is personally known to 'S, ho is personally known to me or who has produced -f-'/ as me or who has produced �Cnwl pfd O ,,X-M Lt as identification and who did take an oath. identification and w ke an oath. NOTARY PUBLIC: NOTARY P ICs Sign: Si n- P Ni Notary Public State of Florida P t: ? Joanna M Feliciano :°. ,`c<:r Seal: 4 My Commission FF 082753 eal: �.g Notary I RAW P lic-State of Florida Expires 01/12/2018 �N `off;My Comm.Expires Mar 17,2018 t '+da � '••.;ocngp° Commission or FF 102775 APPROVED BY V � —Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) f Thursday May 28, 2015 State of Florida Miami Dade County Before me this day personally appeared !� 'i-sv5 /0'1 a Who being duly sworn deposes and says That he will be the only person working on the project located at 286 NE 99 Street Miami Shores, Florida 33138 Sworn to(or affirmed)and subscribed before me this—, ' lay of Ug 2015 Produced Id tification Print name and m f notary GGIE MONTO Notar Public Stat of Florida My C mm.Expires Mar 17,2018 o; 4ommission# FF 102775 REs yi „s Miami Shores Village o� Building Department �LpRjDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS a Signature:_,�u ( Owner State of Flor County of Miami-Dade The foregoing was acknowledge before me this i day oft0 . By�G1�C R UC�i'� Alen jM who is personally known tome or has produced as identification. Notary: SEAL: rv e Notary Public State of fr rWa �; Sindia Alvarez pP Expires 0910312018 From:Esther Shiling-Toled Fax:(306)823-4383 To:+13067668972 Fax: +13067668972 Page 3 of 3 02/24/2016 8:29 AM 7DATE(MMIDD/YYYY) Ld CERTIFICATE OF LIABILITY INSURANCE 2/24/2016 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 certificate does not confer rights to the certificate holder In lieu of such endomemen s. PRODUCER WNTA SHILING 6 TOLEDO INSURANCE INC PHONE 305 823-3881 FAX ,:(305)823-4383 PO Box 172412 wra E-MAIL S 1. l ngTo o sntinsurance.com Hialeah, FL 33017 INSURER AFFORDING COVERAGE NAICs Granada Insurance INSURED Below Zero Air Conditioning Inc. INSURERB: 4444 Crystal lake Dr INSUREHQ Deerfield Bch, FL 33064 INSURERD: (786)546-2179 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 TYPE OF INSURANCE WVQ I LICY NUMBER �F LI EXP LIMITS R COMMERCIAL.GENERAL UABILITY EACH OCCURRENCE 1,00 000 CLAIr S4VIADP ®OCCUR 50,000 0185FL00055462 12/30/1 2/30/1 MEDFxP �e �°" 5,000 AE PERSONAL&ADV INJURY 1 000 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE % 2,000,000 7C POLICY[]IPM& ®LOC PRODUCTS-COMP/OP AGG 1 2,000,000 AUTOMOBILE LIABILITY MBINED IN LE LIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNEDSCHEDULED (Per accident) $ AUTOS AUTOS BODILY INJURY HIREDAUTOS HNON-OWNED D E AUTOS $ UMBRELLA LIABOCCUR EACH OCCURRENCE EXCESS LIAR HCLAjW4AADE. AGGREGATE WORKERS COMPENSATION rR TH- AND EMPLOYERS'LIABILITY ITF ANY PROPRIETOMPARTNERIEXECUTIVE OFRCERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) 11 yes,describe under E.L.DISEASE-EA EMPLOYEE IN DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule.may be efteched I more space is required) Air Condition service and repair Miami shores village Building Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 Northeast 2nd Avenue, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miard Shores, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. Fax: 3057568972 ]AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD