MC-14-1301Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL L/
Phone: (305)795-2204 Fax: (305)756-8972 — _ ISp
Inspection Number: INSP-214491 Permit Number: MC-6-14-1301
Scheduled Inspection Date: March 16, 2015 Permit Type: Mechanical - Residential
Inspector: Perez, JanPierre
Inspection Type: Final
Owner: LUND, KENNETH AND ALEXANDRA Work Classification: Addition/Alteration
Job Address:1001 NE 96 Street
Miami Shores, FL 33138- Phone Number (714)721-2270
Parcel Number 1132060143740
Project: <NONE>
Contractor: ALVAREZ APPLIANCE Phone: (954)680-5658
3unainq uepartment comments
RE INSTALL 3 AIR HANDLERS AND DUCTS. REMOVE 1
AC VENT IN MASTER BEDROOM REPLACE WITH 2
SMALLER VENTS. RELOCATE KITCHEN RANGE HOOD
03-11-15
Construction project is active. see inspections related under
14-744
INSPECTOR COMMENTS
False
<:�t z' � � (5
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
March 13, 2015 For Inspections please call: (305)762-4949 Page 3 of 36
6A
BUILDING
PERMIT APPLICATION
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
❑BUILDING ❑ ELECTRIC ❑ ROOFING
Fnv
ECFTJUN 19 2014
:
FFBC20) �
Master Permit No. T ,01A ,- 13 D
Sub Permit No. n-c-1 k4 — 1-301
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING M MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /dd ( /'ii I'-" {, S/- c
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:
OWNER: Name (Fee Simple Titleholder4""// /JNI) Phone#:
Address: l004 yve Ste'
City: z2e14 -' i S' a�PC State: % Zip:
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: A t I (jC'le'Z
Address: 1<--% 00 Sw S G {'
City: State: Zip:
Qualifier Name: Phone#: O 'fir( 6
State Certification or Registration #: CAI✓) �1 Certificate of Competency #: i° A L IL 1 % b ;� �
DESIGNER: Architect/Engineer: Atd/ /Q g- 0 Phone#: 3 ° r - 51y1 O/i/q/
Address: �� �tr �'� City: //p"favi State: �� Zip:'
Value of Work for this Permit: $ �00- vv Square/Linear Footage of Work:
Type of Work: ❑ Addition
�ze"'o
❑ Alteration
❑ New ( / /Repair/Replac-eD �p ❑/.Demolition /�
X
Description of Work: d�
r- Ce „ '
C- I �ti 3 /`.It- c-
d'� �C '�` �TrN /N orjl t -
-%° rP IGcC floor5.
J(P�
e /`C4nOV4 I v t!
ej4'3 ,r /1C VP ;n, C
tc �� CIIA?
ica P fP�/ S �C �orc riJN C, Ck-,
. —Cxod,lG.0 e M� dP
Specify color of color thru tile:
Submittal Fee $
Permit Fee $
®� `� CCF $
CO/CC $
Scanning Fee $
Radon Fee $
DBPR $
Notary $
Technology Fee $
Training/Education Fee $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ t
01 )2
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 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 ved and a reinspectio a will be charged.
Signatur _ Signature ;&�
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
���12 day of �_ 20 l`1 by
IY/(Z�r`►�l�'� b- J , who is onal kno to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: ���� tttt�III///,/
l en;,
Sign:
Print:
The foregoing instrument was acknowledged before me this
v day of �L6�� 20 (`� by
y 4( -impersonally known to
me or who has produced ^f�Z� L C,> as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
\out
.; I'D %
es •• _
Seal: ' F` 4f°�d+ Seal:
�n�„,nittHtt
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. _\ COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
B. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
C. COPY OF LIABILITY INSURACE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor licens mber_
BUSINESS NAME: A ✓G,-,eZ
a�
BUSINESS ADDRESS: !S 70 D -vj S% CITY
STATE r( ZIP CODE 3 33
BUSINESS PHONE: ( A { i) 6 6 FAX NUMBER O
CELL PHONE ) �`fsG �� - D QUALIFIER'S NAME:
QUALIFIER'S LIC NUMBER: eX < le' '7 d 2-
`�
A�`� CERTIFICATE OF LIABILITY INSURANCE (SAYE(MMIOOlYYYY)
06/12/2014
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(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 endorsements .
PRODUCER CONTACT ,PABLO M CONDE
NAME........_...._....._...._................... ......... ... ........................ _.............................................................. .....................................
A&A Underwriters, Inc, (A",c y,. ><t 305- 20-T4A/ iarc,.Nol:,?05-220-4821
aria sw a St F•1Y1A1L
ADDRESS: pmc(�aaunderwriters,com
__...........—............._............_.........._....... ....... ....._..._.....---....... ---..... _........_..._.........._..._......... — —
MIan11, FI 33174 INSURERlS) AFFORDING COVEf2AG[ NAIC ri
iNSURER..A.; SCOTTSDALE INSURANCE COMPANY
_ .......... ........... ....... ...... .......
_.....
INSURED INSURFRO: INFINITY INSURANCE COMPANY
Alvarez Appliance InStBUi�tIUn & Repair, Inc. _............... ......... _......... —..._._........_..............__.._.....__.._ _._�_... ......_._ ..........----........— .........
wsURERC: BRIDGEFIELD EMPLOYERS INSURANC CO
........._.......... ...._........................................................... ......... ......... .... ... ...... —...... ........ ..... _.... .............. ............... ...........
15700 SW 56 TFi ST INW!T! D
iNaurtlaR L
Southwest Ranches FL 33331 _.. _...----.............................................. ............................ ..... ....... ................................. —..................... _............. .................
.................
INSURER P :
CUVFRAv:FR rcDTI9:Ie'Arc n111KA0120• t�C,.t.�,...1 .•„�..» ,,.
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 REOUIREMENT, 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 DESCR18ED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIQ CLAIMS.
wssa...._.._.._..............................�i ;SD.t�.k......._.__..._.................._...._.................__.........._....._..
UTp TYPE OF INSURANCE - POLICY L-FF ^"POLICY E%F
_ POLICY NUMBER :(MMIDU/YYYY�'. MM„lL')O/YYYY
.......................................................................................
""'
LIMITS
..................
X ,COMMERCIAL GENERAL LIABILITY
EACH RE'NCE
t 1,000,000
• CLAIMS -MADE L..x....i or:CUR
AI ...................._
0AM xru/rn:.F................._..
Prr Af .......... ......
> .........
...................�QD 000.........
_. _............. ._........
C PS1854036 08/31/13 08/31/14
rn1 gex.S...... ..
Any on<i vetrwrp......._..
s 5,000
_.................
!............................'..... ..................—....-........... -.......................................
PEJzsnNAL A ADV INJURY
$ 1,000,000
......................2,000,,1]QQ.......
G -N`L AGGREGATE LIMIT' APPLIES PER: !
GENERAL AGG'RECATE..._............$
PRO.
'.._%�.. I'+171.J C;v i.......__I JIiCT I_.......I L.UC: I
...... .._... ..... ................... ..................-
PR<)C)UCTS - C,0MP1gN AG
....._........_.—...._.—
...x ......................1,000,Q00.......
..............._
....................................._..............
AUTOMOBILE
LIABILITY
OOMBINEL ? NOL `' LIMIT
$ 100,000
:...
09 8000Q
ANY AUTO --6325-01 Ub/30/13 06/3U/14
- .............
!,Io ii Y IN tt_i^Y far.. emr.,n
........_...............
ALL OWNED
X AIJT'O$
_.. ...........................
AUTOS
h10DII.Y INJLAY (Por accoont)
$
X
HIRED AUTOS ;. X, Ai IUtiWNfi:6
PRO�PEATYDAMAGE
$ .............
X
PIP $1000 D X Comp/Cull
..... ,,.
UMBRELLA LIAR (Jt�t=Uf2
.............
-
EACH OCCURRENCE
S
;. .............
EXC[=R.R I.FAF! C:LAIMta-MA66
... _.._,..._._......_........ ............i. ................. ....,
........ ........ .......... ...._ ...................
AGGRGG ATE .....$
........... _... ......—....._................
._.................. ............................... .......
DED3C'lTE'NT'ION 5
.....,,.....,...J.�,,,,.....�...,„W.,�.�.,...
...................................................---
$
WORKERS COMPENSATION
P�_
X
ANd FMPLPYpfes' LIA0ILITY Q83O 36402
Y/N;
ANY PtOPRierOR/PAr;TNLgq/t:xl:c U•rIVL: -- ; - 05/22/14 05/22/15
(. ;dF'FtG'�R/MEMAFFt E=YGLUOEn1Y7 Y :NIA; !' i
TT'I.�TFE�R....................
.-E.L.._EiACI,i .ACCIDENT,,,,,, ..
... ..._
R .....100,000.....
._._.....................
���100,000���-��
(M�ntlatory In NW) --
It yHF, Uesr:YibO UnClef
„E.L. DISEA,SE. � EA EMPLOYEE'
... DISEASE .................. ...... �
$
......................... ����SOO,OOO�����
I')_,: RIPTION OF OPERATIONS
FL . I-ne FASf.; - POI,IC;V LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Rbmarks Schodufo, may bb atUdhod if MOM spaca is toquirod)
Air Conditioning Contractors
Miami Shores Village
Building Department
10050 NE 2 Ave
Miami Shores Villages, Florida 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
w� Tr,aa-ZUls ACURD CORPORATION. All rights reserved.
ACORD 25 (2013/04) The ACORD name and logo are registered marks of ACORD
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014
Dme:ALVAREZ APPLIANCE INSTALLATION & Receipte"HEATING/AIRCONDITION C
Business Name: REPAIR INC Business Type: (CLASS A AIR CONDITION
CONTRACT)
Owner Name: EDILBERTO ALVAREZ Business Opened:02/04/2009
Business Location: 480 W 84 ST State/County/Cert/Reg:CAC1817624
MIAMI DADE COUNTY Exemption Code:
Business Phone:
Rooms, SeatsIV', plyr esjylahi�, Professionals
kFor Vend ing;Busin_ ess Only 9tl a
Number of Machines: 'In "vo.,�r:,n T,.,o•
Tax Amount
Transfer Fee
S ee
- rao�"Y "'r k
Collection Cost
Total Paid
27.00
0.0
0.00
29.70
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:
EDILBERTO ALVAREZ
15700 SW 56 ST
SOUTHWEST RANCHES, FL
33331
2013 - 2014
Receipt #03A-13-00000275
Paid 10/10/2013 29.70
RICK SCOTT ISSUED: 09/2912013 SEQ # L1309290000753 KEN LAWSON
GOVERNOR . nl,QPl AV Ac RGni ntaGn aV i AIAr gF(.PFTAPY