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MC-10-1613Inspection Number: INSP - 151060 Scheduled Inspection Date: September 14, 2010 Inspector: Perez, JanPierre Owner: REYNALDOS, JAVIER Job Address: 246 NE 92 Street Project: <NONE> September 13, 2010 Miami Shores, FL 33138- Contractor: CAPITAL AIR INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 i For Inspections please call: (305)762 -4949 Permit Number: MC -9 -10 -1613 Permit Type: Mechanical - Residential Inspection Type: Rough Duct Work Classification: Addition /Alteration Phone Nu fiber Parcel Number 1132060133400 Phone: 954/792 -4942 B IZ INSTALL 2 EXACUST FANS FOR BATHROOM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 15 of 28 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) / f,4 44 /-S hone # Owner's Address Z42 4 / 4 - Z City t"l (nib/ ( j€ State Zip Tenant/Lessee Name Email Job Address (where the work is being done) 2 4 /C'' < 1 c J City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name Value of Work For this Permit $ Type of Work: ❑Addition Describe Work: /.US TA` Architect/Engineer's Name (if applicable) 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 County Training /Education Fee $ Miami -Dade Permit No. mc(o- (( f.6 Master Permit Noe& ° l Z l Z Phone # Contractor's Address ?4 / $iii,/ 2-1 7 City 7 �o�,f/� State f 7 Zip Qualifier Name �� Coz-1V!,T f� Phone # State Certificate or Registration No. (4 Cp 77 Certificate of Competency No. (1-- 1.- Contact Phone < 7 2,, ViY2-- E -mail / 7 /9/"C' 1c L) // Phone # 951- 7 5 • ❑Alteration New 6 " $ NO LV Flood Zone Phone # Square / Linear Footage Of Work: p MgWISIR SEP 0 9 010 g) BY:...: ....... Zip Repair/Replace ❑ Demolition *************************************** ees ************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $5V .tJl� Permit Fee $ 1 40 v0 CCF $ CO /CC $ 440 Notary $ Scanning $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ \U ki2 L) See Reverse side -* Radon $ DPBR $ Bond $ Technology Fee $ 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 is In the absence of such posted notice, the inspection will not be awed and a reinspection fee will be charged. Signature Sign: Owner or Agent The foregoing instrument was acknowledged before me thisl The forego day of J0 20 (0 , by C Sc Ilj , (� A "ay of who is personally known to me or who has produced who As identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: APPROVED BY Print: . • �� ° Print: " ; �� \o� My Commission „ ES L t 3 � � \% -- % , ;.srn„° Comm# DD0836028 � "4. 41 Expires 1 /13/2013 * ** * * * ** * ** ** * * ** *********14 iT a.r.r SaC . .i'. \� ....... ' - . - Fbr11�INotalY (Revised 07 /10 /07)(Revised 06 /10/2009) \11IIIII11 /1 /, Vera /// /% aminer Engineer Signatu Contractor g instrument was acknowledged before me this rsonally known to me NOTARY PUBLIC: Sign: 20 l6 , by 4 , e4 or who has produced as identification and who did take an oath. Zoning Clerk checked CORD CERTIFICATE OF LIABILITY INSURANCE DATE 9/16/20 9 MIDDNYTY) P RODUCER (305) 714 -4400 FAX: (305) 714 -4401 `�1WN & BROW INSURANCE -HBA DIVISION . JO NW 79th Avenue Suite# 101 Miami FL 33122 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Capital Aix, Inc., DSA: Capital Air 2961 SW 23 Terr. Bay #2 rt. Lauderdale FL 33312 INMRERA:Amerisure Insurance 19488 INSURER B:Technology Insurance 42376 INSURER C: INSURER D: INSURERS COVFRAGFS 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 POL CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN5R AOD'L I TR INSRQ TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE DATE (MM(DD(YY) POLICY EXPIRATION DATE (MMIDD(YY) _ LIMITS A GENERAL LIABILITY 0L2064420AIC 9/16/2009 9/16/2010 � $ 1 X COMMERCIAL GENERAL LIABILITY PRE MI cu $ 50 000 I CLAIMS MADE X OCCUR (Fa o r MEDEXP (MY One oereon) , $ 5,000 PFRRONAI & Ar1V INAIRY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L — I AGGREGA LI A PER: GA POI ICY 1 1C �� Fl l I LI� LI oc PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 4 C AUTOMOBILE X _ X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NQN COME' &COLL DED:$1000 CA2064421Azc 9/16/2009 9/16/2010 COMBINED SINGLE UMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per moon) $ BODILY INJURY (PeraWdeat) $ PROPERTY DAMAGE (Fer accident $ _ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ _ ANY AUTO OTHER THAN FA ACC $ AUTO ONLY: AGM $ A EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE CU2064422AMI 9/16/2009 9/16/2010 ,pACH OCCI IRRENCI= $ 1,000,000 AcORFGATF S _ DEDUCTIBLE RETENT•N , $ $ $ B EMPLOYERS` LIABILITY ON AND ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? dyes, describe under SPFCIAL PROVISIONS Wow TWC3222694 1/1/2010 1/1/2011 y � r � O T flIAAATITR R H - E.L. EACH ACCIDENT s 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 F L DISFASE. P01 ICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLE $ IXXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Sep. 10. 2010 9:52AM RTIFICATE HOLDER ,• MIAMI SHORES VILLAGE 10050 NE 2 AVENUE MIAMI SHORES, FL 33138 ACORD 25(2001/08) INS025 (0108).08e CANCELLATION No. 2785 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY XiNO UPON Y1.I INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE H INSURANCE GROUP /CIH ACORD CORPORATION 1988 Page 1 of