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MC-09-1987Inspection Number: INSP- 130569 Scheduled Inspection Date: February 25, 2010 Inspector: Perez, JanPierre Owner: ALLEN, MATHEW Job Address: 1290 NE 102 Street Project: <NONE> Miami Shores, FL Contractor: NORCA AIR CONDITIONING & REFRIGERATION cORP Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ‹7,) Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments February 25, 2010 For Inspections please call: (305)762 -4949 Phone Number Permit Number: MC -12 -09 -1987 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Parcel Number 1132050220020 Phone: (305)558 -1422 Page 10 of 25 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Expiration: 06/02/2010 MATHEW ALLEN 1290 NE 102 ST MIAMI SHORES FL 33138 -2618 Contractor(s) Phone Cell Phone NORCA AIR CONDITIONING & REFRIC (305)558 -1422 Tons: 1 1/2 ton and 2 ton Additional Info: 2 units Classification: Residential Approved: In Review Comments: Date Denied: Date Approved: : In Review Type of Work: Change out Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technolocsa-Fee Total: Amount $1.80 00.80 $105.00 $3.00 $50.00 ($50.00) $2.40 $112.80 9 LJ a In consideron of the issuance to me of this permit, 1 agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining trittreto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required fo ECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS FIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructioh3nd zoning. Futhermore, I authorize the above -named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Buildig Department Copy Invoice # Total Amt Paid Amt Due MC -12 -09 -36542 $ 112.80 $ 50.00 MC -12 -09 -36542 $ 112.80 $ 112.80 $ 0.0 Valuation: Total Sq Feet: $ 3,000.00 1600 Date For Inspections please call: (305)762-4949 Available Inspections: Inspection Type: Final 1 December 04, 2009 December 04, 2009 1 BUILDING PERMIT APPLICATION FBC 2004 Architect/Engineer's Name (if applicable) I �(, Value of Work For this Permit $ � ..9 0 0 • ° Bond $ !� Miami Shores Village Building Department /0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Cit t(1► (MY't S I �1/ S State F (, Zip Tenant/Lessee Name NI A E -MAIL: talc, NE � b2 sire ft Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # (1 --3 .t )5- - 2.2 - 002 C7 Is Building Historically Designated YES NO X County Miami -Dade Contractor's Company Name f o r :1A1 CO C,� �,�"f E- MAIL: Q r r I r t 2 Q r City �,1' at-e. � CL state F Qualifier Name Contractor's Address \ - I N �C `i' ' ` � Q.p State Certifi or Regis No. C � OO� b y rtifi Y1 . ( rls an (e 1 d�� � �2 Ce cate Code Enforcement $ Double Fee $ Permit No. Master Permit No. 33t Phone # Phone # Type of Work: ['Addition nn ❑ , Alteration ❑New Repair/Replace Describe Work: Q..Q pt Q (X -1A JU ,(21-Is n9 A'' c SI S ms ec‘u prn2nt (Y l . 6 112 - or an (L2- -JD r). Structural Review. $ Total Fee Now Due $ Zip 33132 Permit Type: Mechanical t I_� n r,, ' f Owner's Name (Fee Simple Titleholder) Ma 44 ' �C �� ( Phone # 1 R (0 q 2.?) 10 1 Co Owner's Address lag 0 N e 102 Phone # 31)S S - 1 1 4 L2 Zip 33 0 1 L0 Phone # 3O - s s - iq Z2 of Competency No. 0 0 00 0 (0 15 S3 Square / Linear Footage Of Work: I CO ® C) ❑ Demolition *********************************vr *********************************** Submittal Fee $_." _ Permit Fee $ CCF $ / go CO /CC �— Notary $ Training/Education Fee $ . 60 Technology Fee $ N • ¥C) Scanning $ Radon $ DPBR $ () Zoning $ (� See Reverse side - • • Bonding Company's Name (if applicable) n ' Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address J 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 w t be approved and a reinspection fee will be charged 1.. Signature er or Agent The foregoing instrument was acknowledged before me this a day of I).QC 20 09, by e who is personally known to me or who as produced) it As identification an who did take an oath. NOTARY P : LIC: Sign: Print: `�" � a � � � � n � IS N # D0685010 MY COMMISSION EXPIRES JUNE 13, 2011 My Commission Expires: APPLICATION APPROVED BY: (Revised 02/08/06) Signature (3 Contractor The foregoing instrument was acknowledged before me this L dayo'��-�. !r1\ ) 20 , by!T.Q,a.i,g k 4atrI 2 who is ersonally known tojne or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: SHEENA SOURD NOTARY P vigomON m : My Commission Expires: 685010 R S Plans Examiner Engineer Zoning Dec. 2, 2009 12:19PM 50 STATE SECURITY FROM : NQRCA AIR FAX NO. :305 8105 N,W. 98th Street, Hialeah Gardens, PL 33016 WWW.nOrCaair.com IIM POW. SUBMIT~ Allan Residence i STREET 1290 NE 102 Street CITY,STATE,EIF Miami Shores, FL 33138 AROHITRCT Replace existing units with new 16,000 RTU and 22,000 BTU mini splits. Price Includes Hook up excelling electrical Not Included Cost of Permit WE PROPOSE TWO.1houeerid Nine Hundred PAYM ENT TO BE M ADE A@ FOLLOU{B; AIR CONDITIONING & REFRIGERATION PROPOSAL __ PFIdNE Fax - 305 - 899-9 2 JOR NASTE Allen Residence E IACATIDH 1 200 Na 102 Street, Miami Shores. FL 33130 TE OF PLANE JO@ ONE COLUMNS ACCEPTANCE t 1 PROPOSAL. THE ABOVE PRIM, SPECIFICATIONS AND CONDITIINB ARE SATISFACTORY ANO ARE HEREBY ACCEPTED. YOU Arie AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENT WILL OE MADE AS OUTLINED ABOVE. slew:nee DATE ow ACCEPTANOP SIONATune No, 1544 P. 2 Dec. 02 2009 12;23PM P1'! 2, NO; DATE 02- Dec -09 Newel' TO FURNISH MATTRI4L ANO Moe. CbMFLETE iN ACCORDANCg W)TI A*OVr, $P@CIPICATIoNs, FEN THE BUM OF: AB Wok' a Swaim' rq 00 air sp4adrtd, en work or ne towhee(' m e vUllemee Re Mime, ameaelig re vleerlard pramtcta, anY irleredenF et detbdintl ROM above AUTIteRI2SD � /I� ,7WF inOlwpe Dim mirk MD be moveled wdy nom ,Men «dnri AAA will $ 0NATURE T Lonnme to eon nhatg8 Ovbr w w AWN. Ind dont00. All olONIVIRO CrmlingaS; um ildkes, BoCtdenls w dol9ye Woad err ooMWL owns by efeW Rre, rorevoo and eibet emeoppy Ineore' o, OLO WOMB we Iuby mend u++ Campmate' IssogArk MO: TM9 PROPOSAL MAY B tsfroonnwe BY us W uqT A BO WNW _, INWS 008664 CAC 012521 CMC 046650 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 CONTRACTOR 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 I TR ADD'L INSRC TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE 1MM any POLICY EXPIRATION (MM /DD/YY) LIMITS A INSURER A: Ameri sure Insurance Co GENERAL LIABILI Y COMMERCIAL GENERAL LIABILITY GL201168605 07/01/2 10 /01/2010 EACH OCCURRENCE $ 1,000 000 L. X DAMAGE TO RENTED PRFMISFR (FR nmirenra) $ 300 000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JEC n LOC PRODUCTS - COMP /OP AGG $ 2 000, 000 7 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA132602408 07/01/2009 10/01/2010 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ — X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY 20090107 07/01/2009 10/01/2010 EACH OCCURRENCE $ 5,000,000 OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ 10,000 $ $ $ A WORKERS COMPENSATION AND EMPLOYERS LABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC131478710 10/01/2009 10/01/2010 X I TY1Wif - 1 I OTH- FR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A OTHER Auto Physical Damge CA132602408 07/01/2009 10/01/2010 Actual Cash Value less deductible stated below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Ops: AC Contractor - 30 days notice of cancellation, except 10 days for non - payment of premium. ACORD CERTIFICATE OF LIABILITY INSURANCE 06/29/2009 PRODUCER (305)822 -7800 FAX (305)822 -1621 Col 11nsworth, Al ter, Fowl er, Dowl ing & French P. 0. Box 9315 Miami Lakes, FL 33014 -9315 Raysa Gomez THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Norca Air Conditioning & Refrigeration Corpor 8195 NW 98th Street Hialeah Gardens, FL 33016 INSURER A: Ameri sure Insurance Co 19488 INSURER B: St. Paul Fire & Marine Ins. Co INSURER C: INSURER D: INSURER E: CERTIFICATE HOLDER Miami Shores, City of 10050 NE 2nd Avenue Miami Shores, FL 33138 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE David Alter/VGP / i ..f A ACORD 25 (2001/08) FAX: (305) 795 -2207 © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) Business t NORCA AIR NDITIONING & REFRIGERATION 8195 NW 98 STREET HIALEAH GARDENS FL 33016 Business Type: AIR CONDITIONING /Sales -Se UCENS.E - 8658 ; j r City License CITY`. OF HIALEAH GARDENS 00 1 l 87TH AVE { - - HIALEAH GARDENS, FLORIDA 33016 USINESS RECEIPT DeftnquePC} A • per'Sx,nt.delinquent fee will he imposed if not ren irYed by October 1 and an additional 5 petc entfee is each month thereafter with total fee not to exceed 25 percent NOTES ' } 'ft CONDITIONING SALES & SERVICES: NO OUTSIDE STORAGE OR JUNK YARD, NO HAZARDOUS *TRIALS ORCHEMICALS, NO PAINTING OFANY KIND, NO AUTOMOBILES REPAIRS, ALL WORK SHALL BE DONE INSIDE BUILDING. TOTAL FEE PAID: $ 772.50 LICENSE` YE 2009 2010 LICENSE MUST BE .EXHIBITED CONSPICUOUSLY AT YOUR PLACE OF BUSINESS" E: 8/11/2009 Issued To: MANUEL RODRIGUEZ 10450 NW 133 ST HIALEAH GARDENS, 33016 arged f 1 W € �. �eP • OCAI. BUSINESS .TAXRECE,- MIAII(1� -IIADE :OUNTY ST`A.' OF FLORID EXPIRES SEPT. 30 `20-'10 sr I USTB€ DISPEAYE AT PLAG OF -Bt SINESS t ANT: a cc; CO € E • R $,11 A 005 SEE OTHER SIDE 4 NORCA AIR CONDITIONING. & REFRIGERATION CORP MANUEL RODRIGUEZ PRES 8195 NW 98 ST HIALEAH GARDENS FL 33016 h 111 tilhilb mi AAA lti i d DO NOT FORWARD