MC-10-845Protect Address
Owner information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
1300 NE 102 Street
Miami Shores, FL 33138-
1132050230110
Block: Lot:
RAFAEL PALMEIRO
RAFAEL PALMEIRO
1300 NE 102 Street
MIAMI SHORES FL 33138-
Valuation:
Total Sq Feet:
$ 2,500.00
0
Contractor(s) Phone
JOSE C YANE AIR CONDITIONING & /
Cell Phone
Tons: 5
Additional Info: MECHANICAL
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
Technology Fee
Total:
Amount
$1.80
$0.60
$150.00
$3.00
$2.40
$157.80
Address
Parcel Number
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
Expiration: 11122/2010
Phone
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC -5-10 -37883
06/01/2010 Check #: 2252 $ 157.80 $ 0.00
Applicant
Date
CeII
Available Inspections:
Inspection Type:
Final
June 01, 2010
June 01, 2010 1
Inspection Number: INSP - 143207
Permit Number: MC -5 -10 -845 I
Inspection Date: July 15, 2010
Inspector: Perez, JanPierre
Owner: PALMEIRO, RAFAEL
Job Address: 1300 NE 102 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: JOSE C PANE AIR CONDITIONING & APPLIANCES SERV IN(
Building Department Comments
July 15, 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
Phone Number
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Parcel Number 1132050230110
5 TON AC SPLIT SYSTEM CHANGE OUT
1 3 0 I
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
W 5
Page 1 of 1
4
4‘vI 1 A0
. 7,
BUILDING
PERMIT APPLICATION
FBC 20
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
T0(305) 795.2204 Fex (305) 756.8972
Permit Type: MECHANICAL . -
Owner's Name (Fee Simple Titleholder) 41/1 ,e/Z 0 .. . 1 " : 159 — 14- •
Owner's Address /300 A/ E 1 ,OE ...> •
...
cit _ 40 X.....f' State •/...- fl Zip.
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done) /3 1 00 / 4 2 r
City Miami Shores Village County Miami-Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO Flood Zone
• Contractoes.Company Name s s e 4.-yiti Phone # 4 73 • Vt
.
Contractor's Address / 0 .2- / 'At E J S r
. zip : I
City /14 o Site FA- • DQualifier Name \PS E__ e._ y A, 4 i Phone # — — a Vr
State Certificate or Registration No. 64e /fri',5 7 I Certificate of Competency No..
ontact PhOne 7Ii1 Cej 9;4"
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Ty t of Work: 0Addition
escribe Worrk: IV
1 -.of.fei. a&r-t akollioedtkleilavoL-AgAt.
•
0Alteration
1 301111WIE
BY:
Permit No. MCA 0' S
Master Permit No,.
Phone #
Square / Linear Footage Of Work:
WlNew
0 Repair/Replace
• • •
Submittal Fee
• .4
• Notary $
Scanning SO '0 Radon $
DR $. ?Awing
•
Bond $ .
Code Enforeement $ .Double Fee $
Structural Review. $ Total Fee Now Due $ 151
s ' •
See Reverse side
0 Demolition
,...,,,k-
dm 7 , 2 :.:-...' 1 •..olf.
' ? - i.. . , 7N . ict-Te i.7.., 64 ... - , .rf,, , ,,, :t • . „„•,.,...,....„,,,,..,„.,
r.,
c't .1',7. ::i , c -.-. ..', ':,;: ; t •
, .. •'' ' 4 ‘.. ,.,-....,' “,. '.'" ,-... ' , ' .';':'
:a. • ' ,i.,...:." ' .1' L04 :'::' (,..t f; ••• ' • ";F:qk ,, • _ _,_9' , 4 Ar.*!../.4 - Nt''' • Ifg.1?"- 'II ,.,
krt*,,1 *
Permit Fee $ • , -1
CCF $ 1` CO/CC . *.
9raining/Education Fee $ 0 •(0f.) Technology Fee $ 40
•
RP It
Bonding Company's Name (if applicable)
Bonding Company's Address
City Stae. 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 FT.ECTRICAL 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'cbpy 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 b ' approved and a reinspection fee will be charged.
Signature - .
Owner .or Agent
The foregoing .instrument was acknowledged before me this (O .1r
day of. 1 \f 1 V , 20 10 , by � '-1
who is personally known to me or who has produced 140A-
N arba 00 g � T 7r A,{�
Nt ll A:SY tl aJ iir L1C:
Sign: 1 , �` , A
Print: V�(!� N1' I. `OW tl
My Com
APPLICATION APPROVED BY
•
(Revised 07/10/07)
As identification and who did an oath.
JUAN M. MONIES OE OCA
Notary Pic • Slab of l
My Comm. &pima Jan N. 2013
40. CommtsSion • 00 844493
B o n d 'Rai* M a i n NINO Assn.
* *** * ** ; * * ** **r* *I"* *-- )iri*MI *T4 7:* x * ****** ** * ************
ans E
Engineer
Signature,.
•
Conn
The forego' _ i nstrument was acknowledged before me this t4.
day of 144, 20 [.0_, by ter ri-. Yo-ftZ L, >
who is personally known to me or who has produced
p�,T
SZAR U . b ass identification and who did take an oath.
NSI ARY i" is LAC:
Sign:
Print: IRV O V OM w" OCA"
My Commission Ex . ires:
JUAN M. VOTES 02 OCA
Notary Public - State a1 RM1N
My Comm. Expires Jan 28.201
Commission • 00 844493
Zoning •
Clerk checked
ACORD CERTIFICATE OF LIABILITY INSURANCE
1 DATE 1 /22o 0
PRODUCER (305) 512- 5880 x210 FAX: (305) 512 -5881
Torres Insurance Agency irxc,
6135 NW 167 STREET # E25
Miami Lakes _ FL 33015
THIS CERTIFICATE 13 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
Jose C Yanes Air Conditionin Appl icaa s
1021 NE 132 Street
North Miami FL 33161
INSURER A: Nat7.On81 Group Insurance
INSURER B:
INsuRERC:
INSURER D:
INSURER E:
1
THE
REQUIREMENT,
THE
AG
INSR
t;
A
POLICIES
INSURANCE
RFC
ADD'
, - ; .
OF INSURANCE LISTED BELOW
TERM OR CONDITION OF ANY
AFFORDED BY THE POL
TF I IMIT; SHOIQM MAY HAVE RFF
TYPE OF INSURANCE
GENERAL LABILTTY
HAVE BEEN ISSUED TO THE INSURED
CONTRACT OR OTHER DOCUMENT
CIES DESCRIBED HEREIN IS SUBJECT
REDUCED BY PAID CLAIMS.
POLICY NUMBER
011. 0002704 01
NAMED ABOVE
WITH RESPECT
TO ALL THE
POLICY EFFECTIVE
D TE MM •
3/7/2010
FOR THE POLICY
TO WHICH THIS CERTIFICATE
TERMS, EXCLUSIONS
POLICY EXPIRATION
DATE MOD
PERIOD INDICATED. NOTWITHSTANDING
MAY BE ISSUED
AND CONDITIONS
LIMITS
. --
ANY
OR MAY PERTAIN,
OF SUCH POLICIES,
1,000,000
X
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$ 100,000
:
CLAIMSMADE X OCCUR
. -
M D P :u me rsan
$ 5,000
3/'/2 -0
• •:.
$ 1,000,000
■
-
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY n .7 % 17 LOC
• . - - - _ ,
$ 1,000,000
AUTOMOBILE
■
■
■ NOOWNED
■
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
N• AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Pe' Pin)
S
BODILY INJURY
(Per QI�1)
$
PROPERTY DAMAGE
(Per madder{
$
GARAGE LWBIUTY
AUTO ONLY - EA AC IDENT
$
ANY AUTO
OTHER THAN ,
AUTO ONLY AeG
$
EXCESS/UMBRELLA Maury
■ OCCUR CLAIMS MADE
r. : I. •
S
o s-
$
$
DEDUCTIBLE
RETENTION $
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
R _ •VI. I+ N'below
I TORY I IRI U. 1 1 FT
E.L EACH ACCIDENT
$
E L DISEASE • EA EMPLOYE
$
E.L IR_ - ■
S
OTHER
DESCRIPTION OF OPERATI ONS ILOCATIDN5IVEHICLFS/ExcWS1oNS ADDED SY ENDORSEMENT/SPECIAL PROVISIONS
Aix COadit-Loning
CERTIFICATE HOLDER
(305) 756-8972
Miami shoreesm
10050 Ne Ave
Miami Shores, FL 33130
ACORD 25 (2001/08)
INS025 (0108).OEa
May. 12. 2010 1:0OPM TORRES INSURANCE AGENCY
CANCELLATION
No. 5071 P. 1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO pc SO SHALL IMPOSE N,.O/0 : -. ' : TION OR LIABILITY OF ANY KIND UPON THE
INSURE IT' AGENTS OR EP
A
ACORD CORPORATION 1988
Page 1 D
ACORD 25 (2001/08)
1NS025 (oWs ?.osa
May. 12. 2010 1:OOPM TORRES INSURANCE AGENCY No. 5071
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.
1930202
WORK TO BE PERFORMED AT:
DATE
NAME j ;
•
NAME
ADDRES
73 G L AI -E / a'
ADDRESS
CITY STATE
f / fi f
CITY, STATE
PHONE
PHONE
4 -1 r -: ris- 4 ''- / L , < / / 'T <
•
-
yi /-,/ / e'X'
ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED, AND THE ABOVE
AND COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER FOR THE
731/ 7/ /l� [ 1* l / 1[' i) /Z
WORK TO BE PERFORMED IN ACCORDANCE
SUM OF:
) DOLLARS
WITH THE CONTRACT
$ 2 9 U
WITH PAYMENTS TO BE AS FOLLOWS:
ANY LTERATTON OR DEVIATION FROM ABOVE SPEC1FICATWNS LNVOLVING EXTRA COST
WILL BE EXECUTED ONLY UPON WRITTEN
ORDER. ANC WILL BECOME AN EX TRA CRARI.E
OVER AND ABOVE THE ESTIMATE ALL AGREEMENTS CONTINGENT UPON STRIVES
ACCIDENTS. OR DELAYS BEYOND OUR CONTROL.
CUSTOMER'S SIGNATURE
❑ ACCEPTANCE OF PROPOSAL
❑ ACCEPTANCE OF CONTRACT
CONTRACTOR'S SIGNATURE
DATE
' J
JOSE C. PANES pagIIVIEn
AIR CONDITIONING MAY 4 20110
APPLIANCES SERVICES, INC.
1021 NE 132nd STREET, NORTH MIAMI, FL 33161 BY: ...GC44TRACT to
LICENSED & INSURED CELL: 786.683.9345 FAX: 305.895.3565 PROPOSAL O
- 7 11 7 9 14- ' "T Vreq
p.
A
PP.?
SEE OTHER SIDE
DO NOT FORWARD
JOSE C VANE AIR CONDITIONING &
APPLIANCES SERVICE INC
JOSE C VANES PRES
1021 NE 132 ST
N MIAMI FL 33161
WhAuAdhflulid.HLUALJALAMI