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MC-10-1682Inspection Number: INSP - 151517 Scheduled Inspection Date: October 05, 2010 Inspector: Perez, JanPierre Owner: THOMAS, BRYON Job Address: 136 NE 101 Street Project: <NONE> Contractor: MASTER MECHANICAL SERVICES, INC. Building Department Comments October 04, 2010 Miami Shores, FL 33138- 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 -9 -10 -1682 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number P rcel Number 1132060132000 Phone: 305 -825 -3004 CHANGE OUT OF A/C COMPLETE 2 TON Qc&. *IS err AcPc 3:00r .1 (f300k \oei r t}t� 60 Passed c� Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 9of16 912111 City: Folio/Parcel #: • BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): `f ' , Phone* ,ai 1 Address: �3CP �� I ' D City: 1� 1 -rn t 5 io(e 5 State: F- Zip: 35 ! 3 FC Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 15‘.0 1 101 5 Miami Shores County: I� -3 wc, - o 1 3 - iccO Miami Shores Village Is the Building Historically Designated: Yes NO Value of Work for this Permit: $ 2- Type of Work: ❑Address /ry ❑Alterati n Des17pon °Work: C GEC 0 <-4 Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BY- - INSPECTION'S PHONE NUMBER: (305) 762.4949 Miami Dade Permit No. RN SquareiLinear Footage of Work: Flood Zone: TOTAL FEE NOW DUE MCM13 Zip: 3131 l0 -r 42_ Master Permit No CONTRACTOR: Company Name: � M O" a WrilarN t Z (5a iCOPhone #: , b2� . 4 Address: (z (p)( 1J u) 3 ;) p Cit Kean liC e (' Will State: �� Zip: 3 W Qualifier Name: i Il I on i cw State Certification or Registration #: 0.--rne-C 1 72-00 — Certiificatte�of Competency #: Contact Phone# • S2 . Email Address: I-- A 1 ' InCOterincthonicalserVion ' corn DESIGNER: Architect/Engineer: Phone #: Phone#: ❑New f Repair/Replace ❑Demolition We- eo030)Je ,;24 ■, ******+ x***u. ** ********* ****** ** *:n*******F *�u�u** nix+ x+ x* �x�x+ x+ x�x+ x*** * *+u+x+x�x+xa�a��u *a�+x�x�xm*** Submittal Fee $ 5l�• Permit Fee $ \ O 1, 9 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Technology Fee $ Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State N 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 FT.RCTRICAL 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 - 1 Owner or Agent pl The foregoing instrument was acknowledged before me this 1 l day of AAA r , 201®, by on 1 f n S who ' ers known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: LILBETII AIKEN �«�7 ; 4 � Y P �, , Comm# DD064138 Expires 2118/2011 .p��d: ° Fl;��la R1c�a As�r�..1nc �,I r ' r 62(1 � \n0oeae0 5 ' 3 ::'" .la0 �krNrN�krNNi+ k+ k�k�k�SrF�k�krN &+krN�k�k�krF�k�N�k�N T+AF rNrF+kK�+k APPROVED BY B000•0110000000••00 00 620001! - = i7/eeu (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ans Examiner Signature , Contractor 10') The foreg ing instrument was acknowledged before me this day of ,2010 ,by 1II(arn ( 1 who is : ersonally kno o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Si Print: My `! mmission E Zip A 000007000 OOl70! "'Hu i% Comm# DD0641388 _ Expires 2/18/2011 P1 , Inc t CM" Florida Notary Assn, 000!.000 Zoning Structural Review Clerk 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 INSURANCE 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. IN TYPE OF INSURANCE ADDL INSR SUBS WVD POLICY NUMBER POIICYEFF (MM/DD/YYYY) POQCYEXP (MM/DD/YYYY) LIMITS A GENERAL LIABILnY COMMERCIAL GENERAL LIABILITY OCCUR GL00088922 oe /01/10 . 08/01/11 EACH OCCURRENCE $ 1000000 X PREMISES (Ea occurrence) $ 100000 CLAIMS -MADE X MED EXP (Any one person) $ 5000 PERSONAL BADVINJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT POLICY n JEa APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 7 LOC Emp Ben. $ 1000000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA00140692 08/01/10 08/01/11 COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) BODILY $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLALIAB EXCESS UAB OCCUR CLAIMS -MADE UMB00095461 08/01/10 08/01/11 EACH OCCURRENCE $ 4000000 _ AGGREGATE $ 4000000 DEDUCTIBLE RETENTION $ 10,000 $ — X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N f I� N / A 83037562 03/14/10 03/14/11 X TORY - I T E.L. EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYEE $ 100000 below E.L. DISEASE - POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES Attach ACORD 101, Additional Remarks Schedule, K more space Is required) Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores FL 33138 MIAM - 04 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 AC R � ® CERTIFICATE OF LIABILITY INSURANCE OP ID AA I DATE(MMlDDnYYY) 1 08/02/10 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 Kahn- Carlin & Company, Inc. 3350 S. Dixie Highway Miami FL 33133 -9984 Phone:305 -446 -2271 Fax:305 -448 -3127 INSURED Master Mechanical Services, Inc 15181 NW 33 Place Miami FL 33054 wNIA1.r NAME: PHONE (A/C Lo, Ext): ADDRESS: PRODUCER CUSTOMER 100: MASTE -2 FAX No): INSURER(S) AFFORDING COVERAGE INSURER A : National Trust Insurance Co INSURERS: Bridgefield Employers In Co INSURER C INSURER D : INSURER E : INSURER F : NAIC 0 20141 10701 COVERAGES CERTIFICATE HOLDER ACORD 25 (2009/09) CERTIFICATE NUMBER: CANCELLATION The ACORD name and logo are registered mark of ACORD REVISION NUMBER: All rights reserved. Primary Zone: 1000 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds/Baths: 2/1 Floors: 1 Living Units: 1 Adj Sq Footage: 1,571 Lot Size: 5,750 SQ FT Year Built: 1925 MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 10 Legal BLK 15 LOT SIZE 50.000 Description: X 115 OR 17759 -4572 0897 1 OR 17759 -4572 0897 00 Folio No.: 11- 3206 -013 -2000 Property: 136 NE 101 ST Mailing Address: BRYON J THOMAS 136 NE 101 ST MIAMI SHORES FL 33138 -2321 Year: 2010 2009 Land Value: $51,865 $57,523 Building Value: $108,618 $115,164 Market Value: $160,483 $172,687 Assessed Value: $82,477 $80,309 Year: 2010 2009 Homestead* $25,000 $25,000 2nd Homestead: YES YES Miami -Dade My Home Show Me: Property Information Search By: Select Item Text only Property Appraiser Tax Comparison Property Appraiser Tax Estimator Portability S.O.H. Calculator Assessment Information: Exemption Information: Taxable Value Information: Year: Taxing Authority: Regional: County: City: 2010 Applied Exemption/ Taxable Value: $50,000/ $32,477 $50,000/ $32,477 $50,000/ $32,477 2009 Applied Exemption/ Taxable Value: $50,000/ $30,309 $50,000/ $30,309 $50,000/ $30,309 Srrhnnl Rnarri• My Home Summary Details: Property Information: $25,000/ $25,000/ ACTIVE TOOL: SELECT Aerial Photography - 2009 St Q. ct A IME 0 ® 112 ft My Home 1 Property Information 1 Property Taxes 1 My Neighborhood 'Property Appraiser Home 1 Using Our Site 1 Phone Directory 1 Privacy !Disclaimer I If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site © 2002 Miami -Dade County. All rights reserved. Page 1 of 2 MIAMI-DADE Legend Property Boundary Selected Property ivy /r/ Highway Miami -Dade mr;Vriiir! County Water Street http: / /gisims2. miamidade .gov /myhome /propmap.asp 9/17/2010