MC-11-204Inspection Number: INSP - 155795 Permit Number: MC -2 -11 -204
Scheduled Inspection Date: February 16, 2011
Inspector: Perez, JanPierre
Owner: BROOKS, FLORENCE
Job Address: 1500 NE 104 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: A -TECH SERVICES 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
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
C 1,
Parcel Number 1122320320350
Phone: (561)988 -3200
AIR DUCT SUPPLY REPLACEMENT ONLY
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
February 15, 2011
For Inspections please call: (305)762 - 4949
Page 13 of 21
BUILDING
PERMIT APPLICATION
FBC 20
Value of Work for this Pe
Type of Work: CI Addres
Description of Work: 14 t
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
Permit Type: MECHANICAL
OWNER: Name (Fee Simple Titleholder): 1 I o ar • v. c o 1 - . t � rn o
Master Permit No.
K
ONew ORepair/Repla
y 1�
Permit No. « C I I Z I
Phone #:
Address: l 0 ME 1 0 4.. Si
City: VI/V.& YY 1 5 tet n ► r e 5 State: F L Zip: 3
Tenant/Lessee Name: Phone #:
Email: in 0 0..l 4 S f o e (4 a a so V I-n • r+ e r
JOB ADDRESS: 1 S 0 0 N3 E 1 0 4
City: Miami Shores County: Miami Dade Zip: 3 1 3 e
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Y Flood Zone:
CONTRACTOR: Company Name: A s , k S \A CATS r - Phone#: 6 f 9 e?
Zip: 7 e 7
Address: 72- v. t.J A 3?
City: c " State: -- L_
Qualifier Name:2) 1 - '`( Tin 1 `
State Certification or Registration #: 6 57 Certificate of Competency #:
Contact Phone #:. / '&"'"? Email Address: - Q G rri 141 1 • Coin
DESIGNER: Architect/Engineer: Phone #:
Square/Linear Footage of Work:
7Cr4 - _ g 3 i c �
Phone #:
FEB 0d201i VP
ODemolition
kJ C �
Submittal Fee $ rmit Fee $ CCF $
Scanning Fee $ Radon Fee $ DBPR $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
CO /CC $
Bond $
TOTAL FEE NOW DUE $
' 2 j 1 V16'
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 comznenceznent 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
Owner o Agent 1
The foregoing instrument was acknow edged before me this 1 The foregoi re instrument was acknowledged befo e this
day of Fdiru' , 20 I , by CeA 0
Print:
who i. personally k own to me or who has produced
As identi
NOTARY PUBLIC:
Sign: 40 1141A- ' ? -: �
My Commission Expires:
APPROVED BY
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
pFfi!'•tiA •C ;LULL
tr '' C ' ' OD 741512
'h .`. April 6,2012
L:, .� In Notary Pub&i undeiwrlters
Plans Examiner
day of
who is
Structural Review
Sign:
Print:
My Commission Expires:
..
, i 4 ,20 / /'
o me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
� 704
Y COMMISSION# DD 957095
'NDI
Bottled Thtu SeMces
Zoning
4 'os O�os`
Clerk
b7'L
Re0 s
Closet
Living Room
00 Kitc
Herman Eilberg Contractor Inc.
322 NW 100 Lane
Coral Springs, FL 33071
CGC1506369
Cell 954 695 0324
Fax 954 827 8079
aoo
er
Bedroom 2
Mechanical
Closet
Miami Shores Village
APPROVED
ZONING DEPT
05 758 535n
BY l DATE
b
SUBJECT TO COMPLIANCE WITH ALL FEDERAL
STATE AND COUNTY
BLDG DEPT 421
Air duct supply replace only
Existing 3 1/2 Ton unit to remain
140o C.5-11) tZ+x 12_,112,
, d0
trrik
oset
Florence F. Brooks
1500 NE 104 Street
Miami Shores, FL 33138
786 877 8319
3
2143 x,
T r
Dinning Room
i
Master Bedroom
crrel
10,90 10V6
24'10
911
DuarB .
Gara
F1e; � ;
A R
DATE (MMIDDJYYTY)
02/03/11
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 cerfiflcate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Peoples Insurance
4107 N. State Rd. 7
Ft. Lauderdale, FL 33319
Phone_ (954)733 -8500
INSURED - -
I A -TECH SERVICES INC.
7200 NW 2ND AVENUE #39
BOCA RATON FL 33487
COVERAGES CERTIFICATE NUMBER: I INsuRER F
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR —
r LTR TYPE OF INSURANCE
ADDLSUBR
mum__ POLICY NUMBER POLICY EFF POLICY EXP
(M ARM/YYYY) (MM/DDIYYYY)
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
❑ ❑ CLAIMS -MADE ❑ OCCUR
A j❑
! GEN'L AGGREGATE LIMIT APPLIES PER
� POUCY ❑ t ❑ LOC
AUTOMOBILE LIABILITY
U ANY AUTO
❑ AUTOS ❑ SCHEDULED
AUTOS
❑ ❑ HIRED AUTOS ❑ AUTOS 0
❑ UMBRELLA MB ❑ OCCUR
❑ EXCESS LIAR ❑ CLAIMS -MAD
_�❑ DED
RETENTIONS
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE / N
OFFICER/MEMBER EXCLUDED? j N /A i
(Mandatory in NH)
, If yes, describe under
1 _ i DESCRIPTION OF OPERATIONS below
■
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space Is regulred)
AIR CONDITIONING REPAIR SERVICES
CERTIFICATE HOLDER
MIAMI SHORES VILLAGE
10050 NE 2ND AVE
MIAMI SHORES FL 33138
ACORD 25 (2010/05) QF
CERTIFICATE OF LIABILITY INSURANCE
Fax (954)730-.0329
TCNR014470
CONTACT
NAME:
PHONE
_LAIC. No. E (954)733 -8500 1 ( . No): (954)730 -0329
ADPRES5 PICinsurancett�south,r
BV,StIRER{S) AFFORDING COVERAGE
INSURER A : LLOYDS OF LONDON
INSURER B :
INSURER C :
INSURER D :
INSURER E
CANCELLATION
10/24/2011
10/24/2012
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (My one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
COMBING SINGLE LIMIT
(Ea accident)
PROPERTY DAMAGE
(Per accident)
UMITS
PRODUCTS - COMP/OPAGG
BODILY INJURY (Per person) $
BODILY INJURY (Pm accident $
$
$
EACH OCCURRENCE
AGGREGATE $
ni WC STATU- 0111
TO LIMITS ❑ �R
EL EACH ACCIDENT $
EL DISEASE - EA EMPLO $
EL DISEASE - POLICY LIMIT $
$ 5,000.00
NAIC 1/
$ 1,000,000.00
$ 50,000.00
$ 1,000,000.00
$ 2,000,000.00
$ 1,000,000.00
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
2010 ACORD CORPORATION. All rights reserved.
ORD name and logo are registered marks of ACORD