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MC-10-1595Inspection Number: INSP- 150938 Scheduled Inspection Date: October 07, 2010 Inspector: Perez, JanPierre Owner: CAPRI, JOHN Job Address: 375 NE 99 Street Miami Shores, FL 33138 -2436 Project: <NONE> Contractor: CHANIN MECHANICAL Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Number: MC -9 -10 -1595 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement hone Number Parcel Number 1132060135530 Phone: (305)865 -1729 5 TON SLIPT SYSTEM REPLACEMENT AND DUCTWORK REPAIR Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments October 06, 2010 For Inspections please call: (305)762 - 4949 Page 13 of 31 ENO. STATE OF FLORIDA:: COMITY O+u a- : THE t moped% lard in gict*Atalvtmlitt Crate 713 � puvtded antis Nottego ot 1 Legal descti t 3' wP f- 2. it in Nem Vt 7, Ptirtons within tile provided by 7i In + Nowa, 1111 Scotian Titian* POOR hintsly Print Nom:ft Aire.; my PASS OF MIS BtlaterAistiltoceclginfaintion 5. sway: paptent boa Nem and edict= Amount of Don4 B. Lendoes name arrd 37S u 1 HEREBY CERTIFY thtthisisadue qriginisi M my "HARVEY 111111111111111111111111111111111M111111111 CFI 2010R0630152 OR Bic 27423 Ps 3110; Ups) RECORDED 09 /16 /2010 15:31.53 HARVEY RIJVfl4r CLERK OF COURT MIANI -DAOE COMM FLORIDA LAST RAGE dontrainatWeatIrbe attract** i-e s -O rag ,-.. tomato 375' ' • 5 4-4.5, f of 1,10tOec fitotioetC.Otoraided Miami Shores Village BUILDING PERMIT APPLICATION FBC 20 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 Permit No. Y1r1G. t c.) Master Permit No. Permit Type: MECHANICAL ; Ni NER: Name (Fee Simple Titleholder): L� t -` . Cl r e v e► Phone #: 6 " 90 C7CA-1) Address: 3- c=r9 City: 1 t 1 �� C> cc? S State: EC_.. Zip: ?a 3 ( ?j Tenant/Lessee Name: IV f N�- Phone #: Email: JOB ADDRESS: 31 S I�) ' cz° City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: e- 1( C.. +CJl- Phone #: L 3(S 8 (o S 1 1 Address: I I1® r, — I [ S7 City: N t g _ r-t State: Zip: 3 3' � 1 Qualifier Name: C) �L '� C i`15■-) r Phone #: l� � (�, S / `1 "x-1 State Certification or Registration #:C ec Cop S Co Z-9 `)-- Certificate of Competency #: Ga. C. 0 (p 1 3 3,D_ Contact Phone #: c3 e S °- ) - 1 -9 Email Address: S rxr -ov-% car_c_t=gri trt DESIGNER: Architect/Engineer: Phone #: • ®ry Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: 5 1 f 1 S ( t c s. 42- 2i p i Gt-e-O ✓v. cr,v� l ********* ***** ************** * ** ******* *F es ************* * *** *** ********** * **** ********* Submittal Fee $ Permit Fee $ 306 i � CF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ �7 C-4 . 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 ET .E,CTRICAL 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 properly 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 approvv '. reinspection fee will be charged er or Agent The fore oing ' y <;! ent was acknowledged b fore me this day of 2(N_, , N' tJ fj 4.► who is personally known to me or who has produced k tic NOTARY PUBLIC: Sign: Print: My Commission APPROVED BY ** ** **** * * ** * ** * * * ** < As identification and who did take an oath. (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) . MY COMMISSION # DD 772112 r !!' Plans Examiner Structural Review Signore ontractor 2 The fore : oing instrument was acknowledged before me this J 0 day of who is person . iy known to me ,r who has produced Sign: Print: My Commi: , 20/ 4 lD / as identification and who did take an oath. NOTARY PUBLIC: 6Y COMMISSION # DD 772112' EXPIRES March 24, 2012 (407) 308.0153 FloridallotatySeMce.com Zoning Clerk ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE 0 DISCIPLINE APPLIED FOR: PLUMBING ELECTRICAL PERMIT # MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT BATH TUB SWITCH OUTLETS SPACE HEATERS FEE DISHWASHER LIGHT OUTLETS CENTRAL HEATING `� �{ DISPOSAL RECEPTACLES r' � NC (WIND) 1 FLOOR DRAIN SERVICE TEMPORARY A/C (CENTRAL) 5 T GREASE TRAP SERVICE SIZE IN AMPS r- DUCT WORK � 0� i INTERCEPTOR SERVICE REPAIR/METER CHANGE REFRIGERATION LAVATORY APPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP UNDERGROUND TANKS CLOTHES WASHER OVEN ABOVE GROUND TANKS SHOWER WATER HEATER U.F. PRESSURE VESSELS SINK. POT /3 COMP. MOTORS 0 -1 HP STEAM BOILERS SINK, RESIDENCE. MOTORS OVER 1 -3 HP HOT WATER BOILERS SINK, SLOP. MOTORS OVER 3 -5 HP MECHANICAL VENTILATION TEMPORARY WATER MOTORS OVER 5 -8 HP TRANSPORTING ASSEMBLIES URINAL MOTORS OVER 8 -10 HP ELEVATORS /ESCALATORS WATER CLOSET MOTORS OVER 10 -25 HP FIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25 -100 HP COOUNG TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP VIOLATION A/C UNIT • NC WINDOW REINSPECTION FIRE SPRINKLER AIR CONDITIONERS HEATER -NEW INST. STRIP HEATER HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL GENERATORS TRANSFORMERS SWIMMING POOL GENERATORS TRANSFORMERS WATER SERVICE SPECIAL PURPOSE. SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY -SEWER SIGN TUBES UTILITY -WATER SIGN TRANSFORMERS SEPTIC TANK SIGN TIME CLOCK RELAY FIXTURES FAINFIELD, 4" TILE/RES. ANTENNA PUMP & ABANDON SEPTIC TANK TELEVISION OUTLETS SOAKAGE PIT CU. FT. VIOLATION CATCH BASIN REINSPECTION DISCHARGE WELL • DOMESTIC WELL AREA DRAIN ROOF INLET • SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE 0 DISCIPLINE APPLIED FOR: PLUMBING ELECTRICAL PERMIT # MECHANICAL AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 7 i-ern SQ 17° ` Y County: Miami Dade Zip Code: ki 3 ty: Miami Shores Village ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD,ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUUMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO IE Sheet Attached: YES 1. Minimum Circuit Ampacity (Wire Size): (®® 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): , A 4. Size Disconnecting Means: cm Contractor's Company Name: C_IvtkobN''a/-v Phone:- State Certificate or Regist s (Qualifier's signature only) Certificate of Competency N. Miami Shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NO ❑ Contract Attached: YES Date: sk UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER `-bALR,■ 4.9_. AHU or PKG. UNIT MODEL # COND. UNIT MODEL #° ic N'N N,° t t:izi® Ce.'s%) b (p KW HEAT \ ' NOM TONS U Q PKG 1) M.C.A Cb PKG , ®. ®& 11 CU PKG 6 2) M.O.P CU PKG _ AHU, ICU . )1D146-1,1 AHU CU ® 3) VOLTS 1 V ' Y P iro rUT / EERJSEER 1/4s • YES NO REPLACING DUCTS 0 YES NO REPLACING THERMOSTAT NO YES NO NEW 4 "CONCRETE SLAB NO YES NO NEW ROOF STAND. YES �( YES NO NEW RETURN PLENUM BOX YES AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 7 i-ern SQ 17° ` Y County: Miami Dade Zip Code: ki 3 ty: Miami Shores Village ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD,ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUUMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO IE Sheet Attached: YES 1. Minimum Circuit Ampacity (Wire Size): (®® 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): , A 4. Size Disconnecting Means: cm Contractor's Company Name: C_IvtkobN''a/-v Phone:- State Certificate or Regist s (Qualifier's signature only) Certificate of Competency N. Miami Shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NO ❑ Contract Attached: YES Date: sk a STATE LICENSED AND INSURED CACO56292 We, the firm of Chanin Mechanical, L.C., propose to furnish, install and service the air conditioning and heating system for: Mr. Brian Nugen Job located at: 375 N.E. 99` Street- Miami Shores - Florida In accordance with following conditions and specifications: EQUIPMENT TYPE: Carrier Option #[115 Ton Infinity Series - Two Speed - Seer 16.0 Qty — [1] Condens Unii - Mode 24ANA160A003 Qty — [1] Air Handler - el # FE4ANB006T00 With 10 KW Heat Option #121 5 Ton Performance Series - Two Sneed - Freon R -410 - Seer 16.5 Qty — [1] Condensing Unit - Model # 24APA760A003 Qty — [1] Air Handler Unit - Model # FV4CNFOO6T000 With 10 KW Heat Option #131 5 Te Qty — [1] Condensing Qty — [1] Air Handl Option #141 5 T1�n Ba Qty — [1] Condensin Qty — [1] Air ler LC Air Conditioning Contractor "SALTS, SERVICE & INSTALLATION" mfort y $eries - Two Speed - Seer 17.0 odel # 24ACB760A003 Model # FV4CNB006T00 With 10 KW Heat DATE: August 27, 2010 sic eries - Single Speed - Freon R-410 - Seer 16.0 It - Model # 24ABC660A003 nit - Model # FV4CNFOO6T000 With 10 KW Heat LOCATION OF EQUIPMENT Air handler to be closet installed on new metal stand with built in filter rack Condensing unit to be relocated to the West side of home on a new prefabricated concrete slab. PH: 305- 865 -1729 FAX: 305 - 864 -1354 1965 71 STREET MIAMI BEACH, FL 33141 PIPING: Will install new Freon lines according to factory's recommendations and tie to existing drain line. WIRING: Will tie to existing high and low voltage wiring for air handler condensing unit wiring by purchaser will quote upon request MISCELLANEOUS: Option 1 -Qty [1] Infinity Controller Option 2,3, & 4: Qty-[1] Performance Programmable digital heat and cool humid stat Option 1, 2, 3 &4 Qty-[1] Condensate over flow safety switch Initials: • In the event of default by purchaser, purchaser agrees to Seller's reasonable Attorney's fees and cost incident thereto. A finance charge of 1 -1/2% per month will be applied if account is not paid in full within 30 days. Seller shall not be, responsible of any delays in delivery of installation as a result of strikes, fires, floods, acts of God, or any other causes or acts of nature beyond the control of the Seller. INSTALLATION SCHEDULE: 1. The equipment will be ready in approximately _ days from the date of our approval of this contract. TERMS: Contract Amount: ess FPL Rebate of $1,005.00 Total $9,425.00 Less Carrier Rebate of $ oa � .,Option # [2] $8,780.00 Less FPL Rebate of $1005.00 Total $7,775..00 Less Carrier Rebate of r 1 $500.00 Total $7,275.00 0 Less FPL Rebate of $1,285.00 Total 7,515.00 Less Carrier Rebate of Op ' FPL Rebate of $898.00 Total $6,502.00 Carrier rebates must be applied for by purchaser on line, program ends 8 -31 -2010 Units qualified for one 81,500.00 tax credit. Please consult your accountant. Factory's parts warranty: Compressor 10 years, Parts 10 years Note: The cost for local permits and processing fees will be billed separate from the contract price. Drew Chanin President ACCEPTANCE: The proposal is accepted by: Date: D /3(-- �0 . DEALER APPROVAL: This contract is approved by . Date: • (Title: ) vwahr idrrectory.o ; Certificate of Product Ratin s AHRI Certified Reference Number: 3484162 Date: 9/1/2010 Cooling Capacity (Btuh): 59500 EER Rating (Cooling): 13.40 SEER Rating (Cooling): 16.50 This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2010. Product: Split System: Air - Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 24APA760A30 Indoor Unit Model Number: FV4CNB006 Manufacturer: CARRIER AIR CONDITIONING Trade/Brand name: PERFORMANCE 17 PURON AC Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING Rated as follows in accordance with AHRI Standard 210/240 -2006 for Unitary Air - Conditioning and Air- Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI- sponsored, independent, third party testing: * Ratings followed by an asterisk (') indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the products) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at wwwahtidirectoryorg. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shag only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; entered Into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at wwwahridlrectory.org, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which is listed below. ©2010 Air - Conditioning, Heating, and Refrigeration Institute ' Air - Conditioning, Heating, • 0111 and Refrigeration Institute CERTIFICATE NO.: 129278360193664601 Carol Capri KaUlche Attorney at Law Becker & Poilakof,P.A. 3111 Stirling Road Fort Lauderdale, FL 33312 954. 987 -7550 File Number 315707 Will Call No.: Parcel Ikon No. 11-3206413-5530 _Pp= Above This Lino For Recording tstaj Warranty Deed �y� (STATUTORY FORM - SECTION 689.02, F.S.) This Indenture made this G f tap (Wilily, 2019 between Job: tai, an as arrIsd wan whose post oboe address is cie Carol Kailiche, 6821 Hancock Road, Southwest Ranches, FL 33330 of the County of 'inward, State of Florida, grader", and Bryan Nis, a single mom whose post office addl ss is 378 NE 99 Street, ilda d1 Shona, FL 33138 of the County of ani-Dade, State of Florida, grantee*, Wftnesseth that said grantor, for mid in oonsdderation of the sum of TEN AND NO/100 DOLLARS ($10.00) and other good and valuable emakiermions to said grantor is land paid by said padre, the 'acetyl whereof is hereby acknowledged, has granted, bargained, and sold to the said grantee„ and goatee's hers and assigns forever, the following described hard, situate, lying and being in Miami-Dade County, Merida, to -wit: Lot 22 and the West half Lot of Lot 23, of Block 40, of AMENDED PLAT OF MIAMI SHORES, SECTION NO. ONE, aoeariiug to the list tymeee`, reeonled h; halal soak 0, Page 70, of the Mae Remote eMlsaai -Dade county, Florida. Subject to taxes for 2010 and subsequent years covenants, conditions, restrictions, easements, reserve;!... and I ad4htfour of nosed, Katy. and said gdantor does hereby fully mistreat the title two said land, and will dead the same against lawful claims dell persons whomsoever. Ia Witness WhereeI grantor has hcsnanto set grader's lead and seal the day and year fast above wrihteo. Kj w,. 1/4 S 4 ) Witness Name: I-d S. /71.4 * "On .tor" and •3daotesr am and hn impler or plenk err contact minim 111111111111111111111111111111111111111111111 CFN 2010R0531020 OR 8k 2737E Pas 4486 — 4487; (2pss) RECORDED 08 /06/2010 04:40:56 DEED DOC TAX 2v100.00 HARVEY RUVIN, CLERK OF COURT MIAMI —DADE COUNTY? FLORIDA DoulisThma. Book27378/Page4486 CFN #20100531020 Page 1 of 2 State of Vermont County of Bennington The ftwelloisii meat was acknowledged betas me this dg ofJu y, 2010 by Carol C.epcl Kathd as Attorney in Fad for Jahn Capd, who [J is peraoaally known or [Xi has licenses, identillation. r ` f `a Seal] Printed Name: OR BK 27378 PG 4487 LAST PAGE 6 1(80 — Te;, b% M commission Expires: o a t fp l a 1 mmordwr ammi my rons1- P 1 2 OoutitsThns. Book27378/Page4487 CFN #20100531020 Page 2 of 2 , Rb® DATE (MMIDDIYYYY) q` CERTIFICATE OF LIABILITY INSURANCE OP 1D AS 09/10/10 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 endorsement(s). PRODUCER International Insurance Center 7990 SW 117 Ave Suite 209 Miami FL 33183 -3845 Phone:305- 279 - 5446 Fax:305- 279 -4045 INSURED Chanin Mechanical LC, Ltd. 1965 71st Street Miami Beach FL 3 141 L.UN IAk.1 NAME: I FAX (A/C, No): 1 PHONE (A/ Ext): A ADDRESS: PRODUCER CUSTOMER ID #: CHANI -1 INSURERS) AFFORDING COVERAGE INSURER A : Associated Industries Ina. Svc INSURER B : Mid- Continent Group INSURER C : INSURER D : INSURER E : INSURER F : NAIC # COVERAGES CERTIFICATE NUMBER: 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 REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP (MM/DD/YYYY) INSR B A TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL UABILITY CLAIMS -MADE l X 1 OCCUR GEN'L AGGREGATE LIMIT APPUES PER: POLICY n JEC 1 I LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LAB OCCUR EXCESS UAB CLAIMS -MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' UABILITY YIN ANY OFFICER/ME BER EXCLUDED? ECUTIVE� (Mandatory In NH) 'ryes, describe under DESCRIPTION OF OPERATIONS below AUUL INSR NIA WVD POUCY NUMBER 04GL000802710 AWC1005067 (MM/DD/YYYY) 06/24/10 04/28/10 06/24/11 04/28/11 LIMITS PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE I WC STATU- OTH- TORY LIMITS I ER E.L EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L DISEASE - POLICY LIMIT $1,000,000 $100,000 EACH OCCURRENCE UAMALit I U HtN I tU PREMISES (Ea occurrence) MED EXP (Any one person) $Excluded $1,000,000 $2 000,000 $1,000,000 $ $ $ $1000000 $1000000 $1000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedu e, If more space Is required) CERTIFICATE HOLDER ACORD 25 (2009109) Miami Shores 10050 NE 2nd Ave Miami Shores FL 33178 CANCELLATION 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 The ACORD name and logo are registered marks of ACORD REVISION NUMBER: CORPORATION. All rights reserved. V Inspection Number: INSP - 151571 Scheduled Inspection Date: October 04, 2010 Inspector: Devaney, Michael Owner: CAPRI, JOHN Job Address: 375 NE 99 Street Miami Shores, FL 33138 -2436 Project: <NONE> Contractor: SHINE MAINTENANCE ELECTRICAL Building Department Comments ELECTRICAL FEED FOR NC UNIT 5 TON Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments October 01, 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: EL -9 -10 -1693 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060135530 Phone: (305)688 -2000 Page 15 of 33 4- D 2 A Permit Type: Electrical Email: JOB ADDRESS: 31 I V E City: Miami Shores Miami Shores Village Building Department Tenant/Lessee Name: Phone#: County: Miami Dade zip: 31 Zip: 3313&& 4a***** ***************** ****** + *******Fees****** * ** x * ******* x** ** *****************x *** SEP 2 2 2010 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 Permit No. l 10 1 (0 9 3 PERMIT APPLICATION Master Permit No. FBC 20 OWNER: Name (Fee Simple Titleholder): J® 11) Mali) 14104a) Phone# 2 : p -10g 300 `Y Address: �� n �3 01% CI 1 City: 61 Awki State: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: pd r iM M�lrilt j C - f . Coyle Phone #: Address: 'VW t 11 ( City: O Q A t):40 4 State: ft. Zip: 3305 Qualifier Name: fILIVAC,D fig . Ittire..7 Phone #: 1 $ (2 (:)1- 324.1 .1 State Certification or Registration #: r'.Ci0OO 1„51 11' Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ � 000 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: CM CAI, F F02 v iv i r (j rt &) jr Submittal Fee $50 �,{� 0 - CO Permit Fee $ /4 " CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ • Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ y l / TOTAL FEE NOW DUE $ 134 ( . 0--- 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 A>,IH'IDAVIT: 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 properly 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 The foregoin day of who is APPROVED BY ment was acknowledged ledged before me this — A I 20 l.Q, by#'f/ me or who has produced As identification and who did take an oath. M)1: mis 0 caner or Agent (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Signature Contractor The foregoing instrument was acknowledged before me this 3 day of 5e0e14-er, 20 la, by F • S Ct f'6 6, , who isipersonally known to me 4r who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: Ants\ -QJ � � �� ``� Y PV g, Ansley Huezo My Commission Expires�. a L ) % i com ISSION #DD784481 '-, ��/ EXPiRES:JUN. 24, 2012 ''•a w •`� WWW.AAR0NN0TARYcen 1`2,P/® Plans Examiner Zoning Structural Review Clerk VILLAGE OF MIAMI SHORES 10050 NE 2 AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 1DIMMI O MAIL 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. AUTHORIZED REPRESENTATIVE = . LOSS E MAFTSN .°`` °® CERTIFICATE OF LIABILITY INSURANCE °A 9/21/110 PRODUCER All Motors Insurance 11934 S.W. 8th Street Miami, FL 33184 Phone (305)559 -8818 Fax (305)227 -0977 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 SHINE MAINTNANCE ELECTRICAL CONTRCTR CORP D /B /A SHINE ELECTRICAL ENGINEER 3876 NW 125 STREET- 10PALOCKA, FL 33054 INSURER A SCOTTSDALE INS. CO. INSURER B: NORMANDY INSURANCE COMPANY INSURER C: LLOYDS INS. CO. INSURER D: PROGRESSIVE INSURANCE CO. INSURER E: 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 BE 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. INSR LTR ADD'l INSRD TYPE OF INSUR POLICY NUMBER PDUCY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A il GENERAL LIABILITY 0 COMMERCIAL GENERAL LIABILITY FJFEA -J 07/27/10 07/27/11 EACH OCCURRENCE 1,000,000 RENTED PREMISES EaEoc curence) 50,000 III 0 GEN'L • ❑ CLAIMS MADE V OCCUR MED EXP (Any one person) 5,000 Blanket additional insur Waiver of Subrogation AGGREGATE LIMIT APPLIES PER: PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 3,000,000 PRODUCTS - COMP /OP AGG 1,000,000 POLICY 1 PROJECT • LOC D AUTOMOBILE • LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS . COMBINED SINGLE LIMIT (Ea accident) 5 • • BODILY INJURY (Per person) n 0 BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) • II GARAGE LABILITY • ANY AUTO El AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY • OCCUR • CLAIMS MADE • DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE B WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below NHFL100081 09/23/10 09/23/11 • WC STATU- 0 OTH- TORY LIMITS ER E.L. EACH ACCIDENT 500,000 E.L. DISEASE - EA EMPLOYEE 500,000 E.L. DISEASE - POLICY LIMIT 500,000 C OTHER . DESCRIPTION OF OPERATIONS / LOCATIONS / VEH CLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS ELECTRICAL CONTRACTOR INCLUDING FIRE & SECURITY SYSTEM, PHONE LINES ELECTRICAL ENGINEERING CANCELLATION ACORD 25 (2001/08) QF