MC-10-705Inspection Number: INSP- 141459 Permit Number: MC -4 -10 -705
Scheduled Inspection Date: July 29, 2010
Inspector: Perez, JanPierre
Owner: POZNER, MARCIA
Job Address: 9013 NE 4 Avenue Road
Miami Shores, FL
Project: <NONE>
Contractor: AIR SYSTEMS NC LLC
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
A 1 c
July 28, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
C Lv
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: Kitchen Hood
Phone Number
Parcel Number 1132060460070
Phone: (786)208 -3484
Page 5 of 25
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BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: MECHANICAL
Email
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Contact Phone
Value of Work For this Permit $
Type of Work: ['Addition
Describe Work:
Submittal e $
Miami Shores Village
(AO" St
Building Department AK 2 G 2010 ID
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Zip
Al 4 Phone #
_1;e- r - r.)( Os /4 L Ao L
90/3 V /IoE
County Miami -Dade
BY - - fir..- , - - - --
'
Permit No. IlC.10 ?Q S
Master Permit No. 'R G 10 --
Owner's Name (Fee Simple Titleholder) ; r fiz 'V - t � rn Phone # P 4:4 ° 22-3, Owner's Address 34- t3 / " c
City l 4.- MoJN Stat `� (
Tenant/Lessee Name
Zip 33 1s $
NO Flood Zone
Contractor's Company Name gc -��S q / r Phone # 30 , 5j' / /0 y 0
Contractor's Address 7 / ?f 4,1„) /..? _s7;
City 1P,: i4 State 1`1 Zip 33 0 - V
Qualifier Name / oy \pi7 (,) i .1 Z Phone # " 6S) /".-/ 0 0
State Certificate or Registration No. caz 0 33s- vV Certificate of Competency No.
Rd'e c), E -mail (, S &P.1lSo o-/ / ,
Architect/Engineer's Name (if applicable)
UAlteration
['Demolition
Phone #
Square / Linear Footage Of Work:
❑New ERepair/Replace
• C F$ "00 CO /CC$
Notary $ �y
Scanning $ W
Double Fee $
Structural Review. $ Total Fee Now Due $ 1
Training/E Fee $ O »p�, 0
Radon $ �'VlJV DPBR $ 0 - (01)
Violation date:
Technology Fee $ 0
Bond $
See Reverse sid ->>-��n
kt Y I
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 approved and a reinspection fee will be charged.
Signature (TN C> eet s .► , -— Signature
Owner or Agent 4i Contractor
The foregoin instrument was acknowledged before me this 01V The foregoing trument was acknowledged before me this c2 .
F .
day ofd n Jn 1 , 201 , by 1" day of 20 Jvby anc'..qp ct.•t re,re a Brarrd 8"0
who is personally known to me or who has produced L who is personally known to me or who has produced Pt- PHI-. r
Sign:
Print:
NOTARY PUBLIC:
My Commission Expire
4)4 1
APPROVED BY
As identification and who did take an oath. L. P es s2 as identification and who did take an oath.
NOTARY PUBLIC:
**
e
, aimaS.VItInillralsamkt:a■ A.,
Notary
STATE OF TEXAS
My Comm. Exp. August 7, 2013
61
*
* * * * * ** * * * * * * *.. * * * ** * * * * * * * * * * * * **
lit lans Examiner
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
sign: ______
Zoning
Clerk checked
FROM Accurate (MON)JUN 7 2010 11:05/ST.11:04/No.7500000510 P 1
AGORa
PRODUCER Accurate
6300 West Flagler Suite 114
Miami, FL 33144
Phone (3Q5)22&.8727
INSURED Air Systems A/C LLC
4698 NW 133 Street
Opa Locke, FL 33054-
COVERAGES INSURER F:
THE POLICIES OF INSURANCE LISTED 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 DE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
lNSR ADO% YOLICY EFFEETIVE POLICY EXPIRATION
DATE (Ii1DD,YY)
LT • TYPE OF INSURANCE POLICY NUMBER DATE tYa11DDhYI
i GENERAL LIABILITY
! COMMERCIAL GENERAL LIABILITY
00 CLAIMS MADE W1 OCCUR
A ❑ ;®
I ❑
GENML AGGREGATE LIMIT APPLIES PER
❑ POLICY ❑ PROJECT ❑ LOC
AUTOMOBILE LIABILITY
' D ANY AUTO
❑ ALL OWNED AUTOS
❑ ❑ SCHEDULED AUTOS
❑ HIRED AUTOS
❑ NON OWNED AUTOS
:D
GARAGE uABIUTY
' ❑ ANY AUTO
i ❑
EXCESBIUMBRELLA LIABILITY
❑
1. 1 OCCUR ❑ CLAIMS MADE
1 ❑ DEDUCTIBLE
❑ RETENTION S
WORKERS COMPENSATION AND
EMPLOYERS' IJABIUTY
9 ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER ( MEMBER EXCLUDED?
It yes, describe under
SPECIAL PROVISIONS beio_w _
OTHER
CERTIFICATE HOLDER
CERTIFICATE OF LIABILITY INSURANCE DATE 1A Y
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
....ALTERJHE COVERAGE AFFORDED BY THE.F OLICIES BELOW.
City of Miami Shores Village
10050 NE2Ave
Mlaml Shores, Fl 33138
Fax (305)2268757
NPPO478707 -2
WC0145869
INSURERS AFFORDING COVERAGE
INSURER A: Western World Insurance Company
INSURER B: North American Specieiy Insurance Co
r INSURER C:
INSURER,D:
INSURER E:
05/13/10
08/29/09
05/13/11
08/29/10
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS
AUTHORIZED REPRESENTATIVE
Lucia Estrella
EACH OCCURRENCE
15RXAGE70 RENTED
PREMISES (Ea occurence)
MED EXP (Any one person)
PERSONAL 8 ADV INJURY 1,000,000
GENERAL AGGREGATE 2,000,000
PRODUCTS - COMP /OP AGO 1,000,000
COMBINED SINGLE LIMIT
(Ea accidant)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
Per accident)
LIMITS
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
AUTO ONLY: AGG
EACH OCCURRENCE
AGGREGATE
Z� L�d _ .. ER
E.L EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
NAIC #
1,000,000
100,000
5,000
100,000
100,000
500,000
CANCELLATION
SHOULD ANY OF INS ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MALL.
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
30 75_678972
ACORD 25 (2001108) OF .. ACORD CORPORATION 1888