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MC-10-997Inspection Number: INSP - 144816 Scheduled Inspection Date: June 03, 2010 Inspector: Perez, JanPierre Owner: RUGGIERO, DOREEN Job Address: 848 NE 91 Terrace Miami Shores, FL 33138- Project: <NONE> Contractor: MAYOLI A/C & REFRIGERATION INC Building Department Comments June 02, 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 Permit Number: MC -6 -10 -997 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (786)286 -4039 Parcel Number 1132060050350 lt Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 24 of 39 848 NE 91 Terrace Miami Shores, FL 33138- 1132060050350 Block: Lot: MOJDEH SHUSHTAR A Project Address Owner Information MOJDEH SHUSHTAR 3928 GATEWAY Drive PHILADELPHIA PA 19145- i Contractor(s) Phone MAYOLI A/C & REFRIGERATION INC Cell Phone Tons: 3.5 Additional Info: MECHANICAL Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: CHANGE OUT Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Submittal Reversal Fee Technology Fee Total: Amount $1.20 $0.40 $5.00 $150.00 $3.00 ($50.00) $1.60 $111.20 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 either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy June 02, 2010 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address Parcel Number Phone Pay Date Pay Type Invoice # MC -6-10 -38055 06/01/2010 Check #: 4643 06/02/2010 Check #: 4646 Amt Paid Amt Due $ 50.00 $ 61.20 $ 61.20 $ 0.00 Applicant Available Inspections: Inspection Type: Final 1 June 02, 2010 Date Cell 1 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder NI 6 c - City f Sri' e5 State Owner's Address Tenant/Lessee Name r^ Email ®.1.U3 t�'ie Q I co CD1r1f Job Address (where the work is being done) 9 1v G ak 1 c County Miami -Dade Zip 331 City Qualifier Name City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name l4 L, (e_ `'�`� ; D , ; • Phone # 3 of g) 9? Contractor's Address (93 ) -5 &., /? 3 /-Y) - _ • State 4 1 ziel At) L; State Certificate or Registration No. Contact Phone �� ?- 9 /s , - Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ❑Addition Describe Work: 3 "Pe .� Notary $ .0 Scanning $ 3.00 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 ❑Alteration Ce. 2, icr® Zip Phone # Permit No. ' IC t o—( "el Master Permit No. Certificate of Competency No. Square / Linear Footage Of Work: ['New Repair/Replace v. ;,— +1 Phon # 1 b(4)z 4 NO Flood Zone Zi / 7 r Phone # 3 D s" E -mail 179)j) C4 . ;& 61,4 ;7'; 16 / T O Phone # ki 3" g . ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *F es ******************************************** Submittal Fee" �`� Permit Fee $ `® t �v CCF $ ITV CO /CC $ . + Training/Education Fee $ 0 • O Technology Fee $ («C QL Radon $ DPBR $ Bond $ Double Fee $ Violation date: //^^'�� Structural Review. $ Total Fee Now Due $ (.AI AO�J "I d See Reverse side -' [' Demolition 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 app -d and a reinspection fee will be charged. 0 1 ent Signature Sign: 4 Contractor The foregoing instrument was acknowledged before me this g The foregoing instrument was acknowledged before me this °I day of 1-14e , 201V , by`P OYtAru'.( 12441 V.01 , day of ■J(" , 20 (l1, by b...mrJb r./A5r 5L( who is personally known to me or who has produced 6 ' 4 - t who is personally known to me or who has produced FL IV As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Print: 5 • ® ' My Commission Expires: r ': ..... �,,��`��• Print: ~ � \ `` t% �°�� %' _ ors My Commissiol -122 , �Qt o AI t to Plans Examiner Zoning APPROVED BY At\ Owner o `\\ 01111111M/it, /i /i Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Signature NOTARY PUBLIC: Sign: 4 4 ., vsOtilii Clerk checked BATCH NUMBER LICENSE NZR 06/27/2008 '078173769 !CACO50363 Named below IS CERTIFIED The CLASS A AIR CONDITIONIVONTRACTOR Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2010 MAYOLI, ARMANDO MAYOLI A/C & REFRIGERATION INC 1537 SW 123 AVE MIAMI FL 33175 CHARLIE CRIST GOVERNOR - 7DA FRO NV owes - ReougmovvtAw lus c NOT Al.atmcsitott TME MOWS 0 7/02/2409' — _,09020184001 -] s400e7540 ' SEE OTHER SIDE OF FLORIDA DEPARTMENT OF BLZSINESS AND PROFESSIONAL REGUT-' ATtoN CONSTRUCTION INDUSTRY LICENSING BOARD ' SE(PLosoe27oc5f1 DO NOT FORWARD MAYOLI AIR CONDITIONING & REFRIGERATION INC ARMANDO MAYOLI PRES 1937 SW 123 AVE MIAMI FL 33175 1.111„111,1„111„,tim „. „, ii,11„1„1.11,1,„1,11,1 :;:ER: A:c BUILDING PERMIT APPLICATIO FBC 2001 Permit Type (circle): Building Contractor's Address City 1 AAA I Qualifier $ Value of Work For this Permit it • 5 0 Miami Shores Village Building Department 10050 N.E.2nd Aven a Mi• I�' . res Flo el ` 9 3 # a 3 N 5) s Electrical AUG Owner's Name (Fee Simple Titleholder) r Nil C.4 10 I Owner's Address [ D 4'D 4 E ?J Me City fitht441 414OQ1?$ State Tenant/Lessee Name Contractor's Company Name ASCLU . g(.E,e -1 Q-. 104( x1E Ab Lai 5 k- MMCE State Ft- Permit No. 'e C15 - 3 .Master Permit No.15PO 5 ' Plumbing Mechanical Roofmg Phone # Zip Q ✓5 1 'S Phone # Job Address (where the work is being done) l OA 37 14 C j de' City Miami Shores Village County Miami -Dade Zip 33 138 Is Building Historically Designated YES NO 7C Architect/Engineer's Name (if applicable) Phone # Phone # 7 71f0 21 S- Zip 33 7 State Certificate or Registration No._e_eaCati Q Certificate of Competency No. cO 00 [ 7 33c0 Square Footage Of Work: 500 Type of Work: ❑Addition Zralteration :New ❑ Repair/Replace � r ❑ Demolition Describe Work: t'i t' LAGtKT1VV1C.t 1144 1 D � EC E 4 3 • CA eQo1LT # SimRR-opM Submittal Fee $ Notary $ 0.- Training/Education Fee $ C. Technology Fee $ Z. Scanning $ .3.6 Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ 1 OO . 30 (Continued on opposite side) * * * * * * * * * * * * * * * * * * * * * * * * * *** F ees * * ** ** *** * * * * * * ** * * * * * * * * * * ** Permit Fee $ / et 40 r CCF $ 0.- (gc . CO /CC PERSON: FEIN: BUSINESS NAME AND ADDRESS: MAYOLI AIR CONDITIONING & REFRIGERATION INC 1937 SW 123RD AVE MIAMI FL 33175 SCOPES OF BUSINESS OR TRADE: 1— CERTIFIED AC CONTRACTOR MAYOLI ARMANDO t / 650389576 06 -17 -2009 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO RE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 08111/2009 EXPIRATION DATE: 08/11/2011 IMPORTANT: Pursuant to Chapter 440. 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance al the certificate, the person named on the notice or certificate no longer meets the re quirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet rte requirements of this section. )WC -252 CERTIFICATE OF ELECT! TO BE EXEMPT REVISED 09-06 QUESTIONS? (850) 413 -1609 CY PERIOD INDICATED. NOTWITHSTANDING Ni THIS CERTIFICATE MAY >, EXCLUSIONS AND CONDITIONS BE ISSUED OR OF SUCH tam EACH OCCURRENCE $ 000 000 PREM (Ea oawrence $ 100.000 MED EXP (Any one person) $ 5.00Q PERSONAL $ ADV RLI URY $ 1 . 00 Q GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGO $ 1.000,000 COMBINED SINGLE UMR (Ea accident) $ 50,000 BODILY INJURY (Per person) $ BODILY INJURY MfifatdaWay $ PROPERTY DAMAGE (Per acmtlanl) $ W1T0 ONLY - EA Ac IDENT $ OTHER THAN ACC $ AUTO ONLY: AGO $ EACH OCCURRENCE —� $ AGGREGATE $ 9 $ + yy�� gg I TOR ER . E,L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE . POLICY LIMIT 9 UMM:$10,000 EachPerscn $20,000 PIP:$10,000 /$0 Ded. PRODUCER ANDYS ASSURANCE AGENCIES 1441 W Flagler St Miami, FL 33135 (300) 262-2200 . RSURED Mayoli A/C & Refrigeration, COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLL ANY REQUIREMENT, TERM DR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO Wit MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. TYPF nF INeURANCE POLICY NUMBER _ . DA CM BYPECTIVE D1 YY � I D LACY CERT GENERAL LiAstrry X COMMERCIAL DENERAI„ LIABILITY CLAIMS MADE OCCUR X 5 0 b 8I /PD par claim GENL AGGREGATE LIMIT APPLIES PER X POLICY P CT LOC AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS X SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY R ANYAUTO EXCESS 1 UMBRELLA LIABILITY OCCUR _I CIAIMSMADE 05 09:07 FROM -Andy' Assurance 3052622227 T - 829 P001/001 F ""'l.'r III I%#P ■r 1,. Jr L ..111 X111L.1 1 T 1111OU1'+(A111ut, ___L_ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, FEND OR _, ALTER THE COVERAGE AFFORDEQ BY THE PQ, ICIES DELI, 1937 SW 123RD AVENUE MIAMI, FL 33175 DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PR$PRIETORmARTPRiRIEXEOUTIVE OFF EACL3IDED? Siandalory In HIS PROVISIONS I O PROVI6K1N9 De1Ow OTHER B Com. Auto CATE HOLDER ACORD2S(2009l01) YfN CI GL3329564 -3 0110 'L00003380 0110FL00003380 INSURERS AFFORDING COVERAGE Inc , INSURER A: Color1 / Insurance Co INSURER S: Gr$natd�, Xns C INSURER 0: INSURER 0: INSURER E. 07/01/09 0$/31/09 08/31/09 DESCRIPTION OP OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS AODED BY ENDORSEMENT! SPECIAL PROVISIONS Aaraenditianing Installation and Service. MT,ANI SHORES VILLAGE 10050 N.L. 2ND. AVE MIAMI BEACH FL. 33138 FAX 305 - 756.8972 ATTN: BUILDING DEPT. CANCELLATION AUTHORIZED R Y- 07/01/10 08/31/10 08/31/10 SHOULD ANY OF THE ABOVE DESCRIBED POUCIE$ 0E CANCELLED wane THE EIIPIRATION DATE THEREOF, THE RQORER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE . CERTIFICATE HOLDER NAMED TO THE LEFT, ,:.. AAURE TO 00 S0 SHALL 101 , r N0 OELIOATTON OR LIABIUTY OF ANY < - 0N THE INSURER, ITS ABENTa OR R$P ) Y : u /v "3/ NAIL# (01 804 + 9 ACORD CORP. • RATION. All rig eserved. The ACORD name and logo are registered marks of A ORD