MC-10-418Inspection Number: INSP - 137989
Scheduled Inspection Date: March 25, 2010
Inspector: Perez, JanPierre
Owner: RODRIGUEZ, MARIA LUISA
Job Address: 700 NE 93 Street
Project: <NONE>
Miami Shores, FL 33138-
Building Department Comments
Passed
(Akr
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Contractor: CENTRAL COMFORT AIR CONDITIONING CORP.
REPLACEMENT OF TWO 3 TONS NC UNITS WITH
10KW HEATER
Te azs �o
March 24, 2010
For Inspections please call: (305)762 -4949
Permit Number: MC- 3- 10-418
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number 1132060141480
Phone: 305 -598 -7575
Page 10 of 21
Project Address
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Re
3 3i
t T A C plac me t
i tat s: APPROVE
Expiration: 09/13/2010
Parcel Number
700 93 Street
Miami Shores, FL 33138-
1132060141480
Block: Lot:
MARIA LUISA RODRIGUEZ
Contractor(s) Phone
CENTRAL COMFORT AIR CONDITION 305 -598 -7575
CeII Phone
Phone
Tons: 3
Additional Info: A/C REPLACEMENT
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Date Approved: : In Review
Type of Work: MECHANICAL
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Amount
$4.20
$1.40
$5.00
$249.20
$3.00
$5.60
Total: $268.40
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
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC- 3- 10-37292
03/18/2010 Check #: 6791 $ 268.40 $ 0.00
Applicant
CeII
Date
Available Inspections:
Inspection Type:
Final
March 18, 2010
March 18, 2010 1
FOLIO / PARCEL #
Notary $ i19
Scanning $' ' 00 Radon $
Double Fee $
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
BUILDING PermitNo.MG 1041 c (
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: MECHANICAL
' 0-064DtitAkedarsone Lam) 252,- Ce�
Own er's Name (Fee Simple Titleholder) ‘ t�1cam e # O5 1 5 VI
Owner's Address 10 ® N E. 3 SA
City I I N 9 a ""°''rz?r+ i State ' Z i p 3 3 13 Z.
Tenant/Lessee Name
Email
Job Address (where the work is being done) 1 N e `1 ` � 9A
Training/Education Fee $ 1 '`" J
Phone #
City Miami Shores Village County Miami -Dade Zip 31
Is Building Historically Designated YES NO Flood Zone
Contractor's Company Name C: Q Ni `t at. Qv oca A Phone # (3t) E c\ 8 -
Contractor's Address C t 1 S �.1 \ 'p 2. kv T2,0
City i ea 1-4, State e I i1 Zip `3 3 1 -1 L
Qualifier Name 0 6'4 \ . Phone #
State Certificate or Registration No. C--A (.- 0 S 1 S'S /.... Certificate of Competency No.
Contact Phone 3 r U 0 ) 8 is 7 5' E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ - 1 1 1 ' • Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ONew N Repair/Replace ❑ Demolition
Describe Work: (9-42?)A02 m Q,n} l 3 40,0 plc, t. 1. 1 ►r +M 1: 110 • st@ 2.
`,a ,N)- 10 14.., -4 A e+N 4e
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * ** * ** * * * ** * ** * * ** * * * * * * * * * * * ** * * * * * **
Submittal Fee $ Permit Fee $ , 4 1 i CCF $ 4 CO /CC $
Technology Fee $ -:
DPBR $ Bond $
Violation date:
Structural Review. $ Total Fee Now Due $ 0 -4
See Reverse side ->
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.
Sign:
Print:
APPROVED BY
0 '-ror gent
The foregoing instrument was acknowledged before me this / The foreg g instrument was �acknow edged bef ey nte this I, day of h116.ae201O, by (L1 A. p1?_1(crtJ .) , day of , 20` (3, by el
who is personally known to me or who has produced
Q ntification and who did take an oath.
NOTARY PUBLIC:
who is personally known to me or who has produced C 1 i
M identification and w hp did take an oath.
.... va ✓ � i
My Commission Expires:
(Revised 07 /10 /07)(Revised 06/10/2009)
* * * * * * ** * * * * **** * * * * *** * ** . * - * * ** ** * *** • ** * ** * * * * * *•** ** * ** *: * ****** * ** ** ** **** * *** * * * * **•* * ** ****
Signature
al 10-J
OT ' Y PUBLIC:
Sign:
Print:
My Commission Expir,, •
Contract
Plans Examiner Zoning
Engineer Clerk checked
SYSTEM EQUIPMENT AND TYPE OF MATERIAL USED:
/A 1 3 — / - 0/J 17 Poi∎l- /6 CePil loyek4i4 Lu444
Art P Ezzutil u.t✓, 4 1 - Ti
al so 010.44,.� Cc '' C62.'4 •ZZ-(3
UNIT 1 SUPPLIES eo SEER /(p
Job Price $ 59
APL Rebate $ SS-
REMARKS:
JOB TOTAL $ 3 9 0 d
• KITCHEN ❑ DINING ROOM • RETURN
• BATHROOM • FLORIDA ROOM • WATER PUMP
• LIVING ROOM • BEDROOM • ADDITION
■FAMILY ROOM ❑DEN • j �.
. 4k,` (''''''---A)
❑ ■ • dt (Soo
°OUR SERVICE IS YOUR COMFORT°
t
Customer:
Owner Purchaser Acceptance
Seller Approval:
Salesperson.
_)740wAy
PROPOSAL AND CONTRACT
L J
Sales • Service • Installation
Licensed & Insured • CACO57552 �q
State Certified Contractor Date' ' v
9721 South West 102nd Avenue Road • Miami, FL 33176 -2735
Tel: (305) 598 7575 • Facsimile: (305) 598 -8210
24 hours Service
Job No.
Home Phone: ?'S 7V ?' 2 Bus. Phone.
Address' 'MO /QC q 3 S' City N ` I" State Zip - /3ci
WARRANTY
I
- Foe_ L N) r t s .
e
r oe
NOTE:
PAYMENT:
❑ CASH ❑ CHECK ❑ VISA
❑ MasterCArd ❑ Am.Ex. ❑ FINANCING ❑ 3 Months ❑ 6 Months ❑
INSTALLATION SCHEDULE
We will be ready to begin installation approximately by Contract Expiration Date.
Date:
Installation Date:
DATE
ULATION
-S _005.
• :
14 •
ANY •••••• •. ••••- ••rvur WO I nu ritLUW
MAY PERTAIN, THE INSURANCE AFFORDED
POLICIES. AGGREGATE LIMrrs SHOWN MAY
11AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
BY THE Po DESCRIBED HEREIN SUBJECT TO ALL TTERMS
HAVE BEEN REDUCED BY PAID CLAIMS.
PERIOD INDICATED. NOTWITHSTANDING
EXCLUSIO AND oNOIT O S OR SUCH
INSR
1_,,__ TR
A
ADD 'L
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
POLICY NUMBER
DATE (MWDDNv/
SATE fM EXPIRATION
LIMITS
—
070 -2409
09/23/2009
09/23/2010
EACH OCCURRENCE
$ 1,000,000
8 100,000
$ 6,000
$ 1,000,000
p s 5 (Ea o ,sea
1 CLAIMS MADE OC,CIIR
MED EXP ( ono Parson)
PERSONAL B ADV INJURY
GENERAL AGGREGATE
$ 1,000,000
$ 1,000,000
GENII.
AGGREGATE UAW APPLIES PER:
POLICY Eige 7 LOC
PRODUCTS - COMP/OP AGO
— II
AUTOMOBILE
LIABILITY
ANY AUTO
AU. OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea eltle
$
BODILY INJURY
(Per porton)
$
_
BODILY INJURY
Tar naoda t)
$
—
PROPERTY DAMAGE
(Par a®Idani)
$
GARAGE
LIABILITY
ANY AUTO
•
AUTO ONLY • EA ACCIDENT
$
EA ACC
$
OTHER THAN
AUTO ONLY: AGG
$
EXCEBSNMBRELLA
LIABILITY
OCCUR El CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
R
$
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICIcWMEM$ER EXCLUDED?
fl e, deec und
SPECIAL PROVISIONS 6a1ow
W607079746
09/30/2009•
09/30/2010
JJ
x I Tf7RYGLIMITS I 1 ° a
E.L EACH ACCIDENT
$ 100
E.L DISEASE - EA EMPLOYEE
$ 100
E.L. DISEASE • POLICY LIMIT
8 500
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
AIR CONDITIONING CONTRACTOR. 3500.00 DEDUCTIBLE B.I. & P.D. PER CLAIM APPLIES. WRITTEN NOTICE FOR WORKER'S COMPENSATION SHOULD
READ 30 DAYS IN LIEU OF 45.
03/15/2010 12:46 305 - 220 -2263
AOORD., CERTIFICATE OF LIABILITY INSURANCE
PRODUCER (305)220 -2280
Eastern United Insurance
175 Fontainebleau Blvd.
Suite 2A -1
Miami, FL 33172
INSURED
COVERAGES
CENTRAL COMFORT AIR CONDITIONING, CORP.
9721 SW 102 AVE, RD.
MIAMI, FL 33176
(305)281 -7597 Ext.
C HOLDER
ACORD 25 (2001/08)
MIAMI SHORES VILLAGE
10050 NE 2 AVE,
MIAMI SNORES FL 33138
(305)758 -8972 Ext,
EUI
DATE (MMIDDNYYY)
3/15/2010
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
INSURER a: NATI OVAL GROUP INSURANCE CO.
INSURERB:AE4UICAP INSURANCE CO.
INSURER C:
INSURER D:
INSURER E:
CANCELLATION
PAGE 01/02
NAIC #
12218
21431
SHOULD ANY OF THE ABOVE DEacmEED POUCIEB BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE IBSUINO INSURER WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN
NOTIOE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
REPREMENTATIVEL OF UPON THE INSURER, ITS AGENTS OR
IMPOSE NO OBLIGATION OR LIABILITY
AUTHORIZED REPRESENTA
eat/
ACCITMORPORATION 19813
ALEX SINK STATE OF FLORIDA
CiiIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPMISATiON LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation Taw.
EFFECTIVE DATE
PERSON
FEIN:
BUSINESS NAME AND ADDRESS:
CENTRAL COMFORT AIR CONDITIONING CORP
8721 SW 102ND AVE RD
MIAMI FL 33176
01120/2009 EXPIRATION DATE 01/20/2011
MARTINEZ ALEX A
650781851
SCOPES OF BUSINESS OR TRADE
1- CERTIFIED AC CONTRACTOR 2— MECHANICAL CONTRACT
01 -20 -2009
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 nut recover benefits ar compensation ender this chapter. Pursuant to Chapter 440.05(12) F.S., Certmfcates of election to be exempt... apply only within the
scope of the business or trade listed en the tmtice of election to be exempt Pursuant to Chapter 440.05(13) F.S., Notices of election to be exempt that certificates of
election to be exempt shalt be sobjett to revocation if, at any time after the filing of the notice or are issuance of the certificate, the person named an the notice or
certificate no longer meets the requirements 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 the requirements of this section.
QUESTIONS? (850) 413 -1609
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS COMPENSATION
CONSTRUCTION INIXNSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS COMPENSATION LAW
EFFECTIVE 01/20/2009 EXPIRATION DATE: 01/20/2011
PERSON ALEX A MARTINEZ
FEIN . 650781851
BUSINESS NAME AND ADDRESS:
CENTRAL COMFORT Aat cONDmONING CORP
9721 SW 102ND AVE RD
MIAMI, FL 33176
SCOPE OF BUSINESS OR TRADE
1- CEmmD AC CONTRACTOR 2- MECHANICAL CONTRACT
IMPORTANT
i D Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
H exempt - apply only within the scope of the business or trade listed on
R the notice of election to be exempt
E 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 of the
certificate, the person named an the notice or certificate no longer meets
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at airy time far failure of the
person named on the certificate to meet the requirements of this
section.
QUESTIONS? (850) 413 -1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
1.5
44-4
tr 44C 4 0,9 11 7. Oti V:
l'ffeCit itr4
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'''' .. ,i.:ti'P . . '
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,4111 .;
?
SEE OTHER SIDE
DO NOT FORWARD
CENTRAL. COMFORT AIR CONDITIONING
CORP
ALEX MARTINEZ PRES
Olt-SW-142-AVE-RD
- TNIANZ - FL - S3t7 . 6
37