MC-14-2707 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-225041 Permit Number: MC-12-14-2707
Scheduled Inspection Date:August 10,2016 Permit Type: Mechanical - Residential
Inspector: Perez,JanPierre
Inspection Type: Final
Owner: CEPERO, ROBERTO Work Classification: Addition/Alteration
Job Address:50 NE 91 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1131010200030
Project: <NONE>
Contractor: FERGUSON MARINE SERVICES AIR CONDITIONING&REFF Phone: (305)233-5336
Building Department Comments
REPLACE A/C UNIT ADDING DUCT WORK Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
n
Failed
. t
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 09,2016 For Inspections please call: (305)762-4949 Page 2 of 34
• i
iami Shores Village CrTN7pr:)
ilding Department MAR 0 2015
50 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 1�
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ESI/REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ;/MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
p r� CONTRACTOR DRAWINGS
JOB ADDRESS: 5z iy I S
City: Miami Shores County: Miami Dade zip 3 13 Q
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: - Construction Type:( Flood Zone: BFE: FFE: q
OWNER:Name(Fee Simple Titleholder):_ _fti�6� � `- f�,,g�g Phone#: 9L Z3�/
Address•5'-j fl1,�. oil rlEgat
City: M; C,, ;' FhJrej State: P C _ Zip: 33 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �� �J�� �7'�' � a Phone#:
Address: S�S' S z--/ ,� q
City: /?P1 4 State: / Zip: ��✓�J
Qualifier Name: qWfi-j Z�� Phone#: -77j--7 3 7--4
State Certification or Registration#: C' ey ld IS 0-70 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#: J-
Address: City State: Zip: tc
Value of Work forthisPermit:$ 500 Square/Linear Footage of Work: 2r-j T'.
Type of Work: u Addition / Alteration /® ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: filu G
Specify color of color thru tile: �--
Submittal Fee$ Permit Fee$ t CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ `
(Revised02/24/2014)
■
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. 1 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 not be ap ro ed and a reinspection fee will be charged.
Signature Signature 401J6.
OWNER or AGENT CONTRACTOR
The foregoing instrument wasacknowledgedbefore me this The foreg - instrument was acknowledged Tbefore me this
day of Accu ,20 ,� ,by day of
��� 20 l ,by
1?09 f ATo CC bO�JL� ,who is personally known to c�..+ � ��' yy � ,who is personally known to
me or who has produced as me or who has produced as
identification and take an oath. identification and who did take an oath.
C.PARRISH
NOTARY PUBLIC: `� MY COMMISSION*EE153394 NOTARY PUBLIC: o`"tt,6'6C.PARRISH
EXPIRES:DEC 14,2015 s MY COMMISSION#►EE153394
Son*through tst She la UM" /� EXPIRES:DEC 14,2015
Sign: Sig
i Ban&I fteugh t st ate Imume
Print: Gi r i S Print: Ol,r/—I b LA
Seal: Seal:
�ix�sx�a��+ear:�*�►*aa*�*a**reeses*��sxa*ss�s*s r�w*+raa *x���*a�:xs+�axe�ss�**+�a*x�x*aaex�srsx*�,�xx���mxxxwxx
APPROVED BY I PlI Exa finer Zoning
Structural Review Clerk
(Revised02/24/2014)
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ACbR' CERTIFICATE OF LIABILITY INSURANCE 1%ziiMI2o16
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 poUcy(ies)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: PETE SANTISTEBAN
THE SOLUTION INSURANCE SVCS INC PHHQ (305 595-6216
10855 SW 72nd St, Ste 7 L ac No:(305)595-6947
Miami, FL 33173 ADDRESS:solutioninsuranc@bellsouth.net
A231800 INSUMMM) AFPoRLIWG COVEWeE Naca
INSURER A:ATLANTIC CASUALTY INSURANCE COMANY
INSURED MERLO BROTHERS CONSTRUCTION, INC INSURER B:
11104 SW 127TH COURT INSURER C:
MIAMI, FL 33186 INSURER D:
jcml032@aol.com 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,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
UR I
ILTR TYPE OF INSURANCE s e
D two POLICY NUMBERD M D LIMITS
X( COM ERCtAL GENERAL,LtAsam
EACH OCCURRENCE Is 1 0.00 000
CLA9N5 MADE ®OCCUR UA To REITED
PREMISES Me occurran.1 I$ 100,000
MED EXP(Any one person} $ 51000
AL040001949-3 1/07/2016 01/07/2017 pERSONALt:ADVINIURY $ 1,000,000
GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
X POLICY[xi ECT ❑X LOC PRODUCTS-COMP/OP AGG $ 1,000,000
OTHER:
AUTOMOBILE LIABILfIY
ANYAUTO Ea acxldent Is
ALL OWNEDSCHEDULED BODILY INJURY(Per person) $
AUTOS AUTOS BODILY INJURY(Per acclder ) $
HIRED AUTOS NON-OWNED
it
AUTOS Per cedant Is
UMBRELLA LtA6 OCCUR
Is
EXCESS LIAB EACH OCCURRENCE $
DED I I RETENTIDNS CLAIMS-MADE
AGGREGATE $
WORKERS COMPENSATION $
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRiETCWPARTNBRtEXECUTNE
B OFFICERIMgMBER EXCLUDEf3? ❑NIA E.L.EACH ACCIDENT $
(Mandatory in NH)
If yes,describe under E.L.DISEASE-EA EMPLOYE $
DESCRIPTION OF OPERATIONS below
E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Rama"Schedule,may be attached If more space Is required)
OPERATIONS ARE THAT OF GENERAL CONTRACTOR / LICENSE # CGC 1510874
CERTIFICATE HOLDER CANCELLATION
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT SHOULD ANY OF DESCRIBED POLICIES BE CANCELLED BEFORE
THE 10050 NE 2ND AVENUE ACCORDA CCEPIRPAT1 E UCYPROVISIONS.E WILL 8E DELIVERED IN
MIAMI SHORES,FL 33138
AUTHORIZED REPRESENTAT
ACORD259&-2T1 3
t2013/04 TORDhe ACORD name and 1090 are registered marks of ACORD CORPORATION. All rights reserved.
Miami Shores Village
Building Department DEC 11 2814
10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No. C.-
PERMIT APPLICATION Sub Permit No. ' 2— 70 7
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING CHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
r f 4 CONTRACTOR DRAWINGS
JOB ADDRESS: J 0 N. £. rl I � Q
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: q
OWNER:Name(Fee Simple Titleholder): /Z1 Phone#: 3V
-'D0 /
Address':,,TO N z 9! r4r de
City: W cr.; f)'Nery! State: FL Zip: 3 3 3 8
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: (a�5 L Ar) 1vf �2b,V oro Phone#: -� 7 75— 3 �Z,
Address: �S �' / 9 7 F
City: State, ° Zip:
Qualifier Name: � 04, �� fl o Phone#: 33 ZIF
State Certification or Registration#: !�� ®� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
t ❑ New, epair/Replace F-1Demolition
Description of Work: 6�`/
Specify color of color thru tile:
Submittal Fee$ Permit Feef$ ° CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
O
A%j
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 not be appy ved and a reinspection fee will be charged.
Signature Signature IA44A
OWNER or AGENT CONTRACT R
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before, 'me this
day of�E
2 20 IL—J by J 1day of 4 u°�u '5+ 20 ''6 by
who is,gersonally known to j k (C °�® '� ,who is personally known to
me or who has produced 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: &G1,,.�"—
Print: Print: Qr n
Seal: C.PARRISH Seal:
�'` +s• MY COMMISSION#EE153394
EXPfRES:DEC 14,2015 ►�� C.PARRISH
Bonded through tst Sero IffiUme + MY COMMISSION#EE153384
�
e Bonded thfough 19t Site Insurance
APPROVED BY � Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
I A I C Ur rLUKIUA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
FERGUSON, JAMES MICHAEL
FERGUSON MARINE SERVICES AIR CONDITIONING&REFRIGERA-
TION LL
21515 SW 97 COURT
CUTLER BAY FL 33189
Congratulations! 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 STATE OF FLORIDA
from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND
and they keep Florida's economy strong. PROFESSIONAL REGULATION
Every day we work to improve the way we do business in order to CAC1815070 ISSUED: 08/10/2014
serve you better. For information about our services,please log onto
www.myfloridalleense.com. There you can find more information CERTIFIED AIR COND CONTR
about our divisions and the regulations that impact you,subscribe FERGUSON,JAMES MICHAEL
to department newsletters and learn more about the Department's FERGUSON MARINE SERVICES AIR CONDI
Initiatives.
Our mission at the Department is:License Efficiently,Regulate Fairly.
We constant) strive to serve you better so that you can serve your
customers. lank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS.
and congratulations on your new license! ExptMban d2to.AUG 31.2016 L140610=1634
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD ,.
CAC1815070 �
The CLASS B AIR CONDITIONING CONTRACTOR
Named below IS CERTIFIEDsy {�f�' �
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2016
0� Uj
FERGUSON, JAMES MICHAEL .
FERGUSON MARINE SERVICESAIR CONDITIONING$REFRI'GERATION LL
9233 SW 182ND ST
MIAMI FL 33157
CERTIFICATE OF LIABILITY INSURANCEDATE1 MID 4 YY)
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 Om1RER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,.AND THE CERTIFICATE HOLDER
IMPORTANT: B the cetfBk:ste holder Is an ADDITIONAL.INSURED,the policy(Les)must be endorsed. U SUBROGATION IS WAIVED,subject to
the terms and coniWons of the policy?,cettaln pales may require an endorsement A statement an this eettflcate does not cahfer r1911ts to the
corticate holder in Rehr of such endorswnerd(s}
PRODUCER ACT MO MAWREGOR
All American Insulhl m m015)2330865 No (305)235.8Eir16
9038 SW 152Nd St 15 IIUOTES(�f(IAfOINSURANCE.COM
Miami,.FL 33157 INSUREMARIORDINSCOVERAGE Nm*
Phone 2334M Fox 305)235-8M6 tHsuRER A: WESTERN WORLD INSURANCE COMPANY
INSURED INSURER : AM TRUST NORTH AMERICA
Ferguson Marine Services,A(r CorKMkm ng&Refrigeration,LLC INSURER C:
21515 SW 97th Court INSURER D:
Miami,FL 33189 rJW)2335338 INSURER E:
INSURER F.
COVERAGES CERTIFICATE NUMBER. REVISION NUMBER.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RINE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITI-ISTANDING ANY RECMIREMENT,TERM OR¢ONDMON OF ANY CONTRACT OR OTHER DOUAIENT 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.LBMHTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF DL4URANCE I POLICY Nt1MBEIt EFF LAY EXP LIMITS
Ghat.LWBILnY EACH OCCURRENCE $ 1000,000.0()
® C OMMERC CAL GEAf 3tAL LIABILITY DAMAGE MISE O, o "' $ 100,000.00
A C] ❑ CX
.AIMSMADE ® OCCUR JDEQE-0 MED EXP cm penin $ 5,000.00
❑ 02/27[2014 02/27/2095
PERSONAL&ADV INJURY $ 1,000,000.00
❑ GENERAL AGGREGATE $ 2,000 000.00
GEML AGGREGATE LWT APPLIES Pat PRODUCTS-COMPFOP AGG $ 1,000,000.00
❑POLICY ❑ PRO- ❑ LOC $
AUTOMOBILE LIABILffY acaf SiMGLE Lwr
❑ ANY AUTO BODILY INJURY(Per person) $
❑ ALL u OWNED ❑ p�� BODILY INJURY(Per $
❑ HIRED AUTOS ❑ AU OS® GE $
11 . ❑ $
❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE _ $
❑ EXCESS LIAR CLAIMS-MADE AGGREGATE $
OED $
WORKERS CONISATION VMC 3IATU- OTkI-
AND EMPLOYERS LIABILITY Y I N
ANY PROPRIEraRIPARTNERIEXECUTI149 2475733 E.L.FSI ACMIRIT $ 100,000.00
B OFACERnIa �EXCLUDED? NIA 0301=4 03101M95
(M In N El E.L.DISEASE-FA EMPLOYE $ 5M,000.00
under
OF OPERATIONS belaw EL D -POLICY LIMIT $ 1x,000.00
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEJi1CLES{Attach ACORD 101,Add#latat ReMaft s ole,If more space 18 Mqubad)
STATE CERTIFIED MECHANICAL CONTRACTOR.
LICENSE 0 CAC1815070
THE PARTY LISTED BELOW IS RECOGNIZED AS CERTIFICATE HOLDER.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
MIAMI SHORES BUILDING&ZONING THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEED IN
10050 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS.
MIAMI SHORES,FL pUn{ORIZED
19""ACORD RATION. All rights reserved.
ACORD 26(2010/05)OF The ACORD name and . are registered rmks of ACORD
001426
Local Business Tax Receipt
Miami—Dade County, State of Florida
THIS IS NOT A BILL-00 NOT PAY
3217858 � LBT -)
BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES
FERGUSON MARINE SERVICES AIR CONDITIONING oEMOMEON LSEPTEM13ER 30, 2015
21515 SW 97 CT 3352515 Must be displayed at place of business
CUTLER BAY FL 33189 Pursuant to County Code
Chapter BA-Art.9 8$10
OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED
FERGUSON MARINE SVCS A/C&REFRIG 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR
Worker(s) 1 CAC1815070 $45.00 09/04/2014
FPPU05-14-015449
This Local Business Tau Receipt only confirms Payment of the Local Business Tax The Receipt is not a license,
noe�governmeentor a �al regulatory lam aceflon of the nd requirements which apply m e business.to do business.Holder must complywith any governmental or
The RECEIPT NIX above must be displayed an aR commercial vehicles-Miami-Dade Code Sec as-W
For morn irdormation,visit www.mlamldade. _;