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MC-09-1443 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL +_ Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 123253 Permit Number: MC -8-09 -1443 Scheduled Inspection Date: February 09, 2010 Permit Type: Mechanic Commercial Inspector: Perez, JanPierre Inspection Type: Final Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Work Classification: A/C Replacement Job Address: 415 NE 105 Street Miami Shores, FL Phone Number (305)758 -0539 Parcel Number 112231043001 Project: <NONE> Contractor: ASSOCIATED BUILDING & AIR PROD UCTS Phone: (954)217 -1080 Building Department Comments REPLACE 4 TONS C/U #23 z z� Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 08, 2010 For Inspections please call: (305)762 -4949 Page 5 of 26 "114 I e „ Miami Shores Village 10050 N.E. 2nd Avenue ` �1 �. v. (W _ p il *�O,. !rt R{�al�t Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 r� � FtC>'V MD ajn 1 Expiration: 1 Project Address Parcel Number Applicant 415 105 Street 1122310430010 ST ROSE OF LIMA CATHOLIC CI Miami Shores, FL Block: Lot r, Owner Information Address Phone Cell ST ROSE OF LIMA CATHOLIC CHURCH 9401 BISC BLVD (305)758 -0539 MIAMI FL 33138 -2970 Contractor(s) Phone Cell Phone Valuation: $ 2, 700.00 ASSOCIATED BUILDING & AIR PRODI (954)217 -1080 Total Sq Feet: 0 Tons: 4 For Inspections please call: Additional Info: A/C CONDESING UNIT REPLACEMENT (305)762 -4949 Classification: Residential Available Inspections: Approved: In Review Inspection Type: Comments: Date Approved:: In Review Final Date Denied: Type of Work: MECHANICAL Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $1.60 MC -11 -09 -36316 $ 107.80 $ 107.80 $ 0.00 Education Surcharge $0.60 Permit Fee - Additions/Alterations $100.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $107.80 In consideration of the issuance to me of this permit, 1 agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated November 10, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy November 10, 2009 1 CII= H 200r9g2O197220 NOTICE OF COMMENCEMENT OR BIB 26792 Ps 4786; (IPS) RED 03/ 1812009 1$e22•13 A RECORDED COPY MUST BE POSTED Oa THE JOB WM At THE OF FIRST INEPE1: n*N HH;a4� S O l: FRIQA� PERMIT NO. TAX FOLIC? NC>. LAST PAW STATE OF FLORIDA COUNTY OF MIAMI - DAVE: THE UNDERWNED tOmby Sim natice that icnptovenwft wU' be made to certain rest property, sand in sacs rdance with Chapter 713, Florida Std. t� fottcnMi #nfor n3ftn is provided in thy. Nodce of Cammencoemerd 1. Legal desodptYon of �pmr and s"Waddrew. � �' � " 2. rptle�n of impsp E' 1,(�we 3' .,_ 3. owner(s name and address: O interest in property: Name and addrerss of fes simple trdehoid*r . _ 4. cm*acdor's name and address: 2 111 Id, 4MW 5. Surety: ( Payment bond required by Owner from con r, if any) Name and address. Amount of bond i B. Lender's name and addmm •'Y. Petaaone with the statue of Floride desigM tad by tamer upon whom no�+ces or other do umettts may be as provided by Section 713.1 1)(a)7., Florida Statutes. Name and addr9w. � 14 S. In addition to himself, C k m m designatm the foliuwing Wson(s) to receive g copy of the Liertor's Notice as provided in Sgdon 713A 3(1)(b). Florida Statutes. Nerm and adds: & S. Exolmtlon date Of Commencement: (the expiration date is 1 year from the date of recording unless air different date 1 ) 'o e Sign Ctva►ner 99 1 1�1 G�.S � �.. led by l L r t ACS Print Owners Name 9 ' . 20_• / ' Swam to and sut> abed before me thin$ „ _ day of "� ' /i 53l -7g Notary Public t FAYSi W OMRIM D IM14 Print Notary's Name r �'! , X90 manwtri am my commission expires. (seal) 919 -d l0 /l0'd ltl -1 9969 ORS+ 81tl HIMOSStl -wid 1011, 90 -90 -to Miami Shores Villa e 01 � g ��� AU6 z 7 2 0 , Building Department . °� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 - Tel: (305) 795.2204 Fax: (305) 756.8972 - ®- B UILDING Permit No. ' /0 PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type Mechanical Owner's Name (Fee Simple Titleholder) $7*t% ,6 *00,X ~ Q�j�gG`j Phone # 306 �7SS p 3 g Owner's Address /�f /�C �'�,f' 3• • City MI, Awe aS'/� Ca' State l�L. Zip Tenant/Lessee Name Iv I¢- Phone # E -MAIL: Job Address (where the work is being done) `}f�s �6 I ZD City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Nam e�ew b 24D• swee-c$ Phone # - 9.5 f(6 8 - 776 Contractor's Address 0?/// JDA9e.- c Ar • city /G State Zip 3 2 40 Qualifier Name 6lt1J IC- tA^IC i.J Phone # 9 1 - State Certificate or Registration o. e#eo Certificate of Competency No. . E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 276 ® b Square / Linear Footage Of Work: Type of Work: ElAddition ❑Alteration [- '■ Repair /Replace El Demolition Describe Work: of CG 4e 2Ws g j. ,bOdg/rt/ 7 � t • ._ Submittal Fee $ Permit Fee $ CCF $ CO /CC �r Notary $ Training /Education Fee $ ' tp Technology Fee $ L f 0 Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ I Ti, -• ._ See Reverse side -+ ' i Bonding Company's Name (if applicable) Bonding Comparty'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 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 dt v Signature d wn or Agent Contractor The fore oing instrument was ackn wledged before me this � The foregoing instrument was acknowledged before me this day of 5! , 20��, by �C C. /day of 1q 5 , 20 , by wh personally known me or who has produced who is p ersonally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: /S ✓ Sign: .I Print: Print: A q dN My Commission Ex ids: �* Commission # DD566865 My Commission b c , BRENDA FAY GORDON N o� t If @S At! o u st, 25, 2010. W COMMISSION # DD 524514 dc•ux9e eYx•uxxxetx &oY •x oY,oc3E�,x ' xxx9:iexx•xxxa: irxxaFxtir%iexxux• ' ( J4r Bwdeaihm NotW Puka undenVIRM I „ APPLICATION APPROVED BY: ` Plans Examiner Engineer Zoning (Revised•02/08 /06) 06 -13 -09 14:35 From - ASSOCIATED AIR +9543496365 T -064 P.01/03 F -756 aRD L CERTIFICAT F LIABILITY INSU N E 8 DATE 113/1009 F4k WOW (954) 724 - 7000 Sax: (954) 724 -7024 THIS CERTIFICATE IS i ORD AS A MATTER OF INFO RUATION Keyes Coverage, Z>ac_ HOLDEIL AND CEERTIIFIICATE�I)OES T AA�E�I�iD, OR 9900 Hiatus Road ALTER THE 22ME AFFORDED RY THE Igo LICIfis BELOW. Tamarac 3% 333 23. "OFFM AFFORDING COV GE NAIL E RMURM raz # 954 384 9880 aW-RM .F= Inn Co 16178 Associated Air Protb=ts Le a tw Ra v=1 Cam' 1 Ins co 33472 Associated Bui lding serv ices 1}sc 94SURMQ 2111 Nox*.b Co mlerce Parkway tNSt a: Reston VL 33926 s►s+WRE THE POLMIES OF INSURANCE LISTED BELOW HAVE BAN ISSUED TO THE INSLIRW NAMED ABME FOR THE P3= PfiRI00 INDICATEO. N0TWffM5rANo1Nr ANV REOU IREMENT. TERM OR CONWON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TKO CERTFMTE MAY I3E ISSUED OR MAY PERTAIN, T INSURANCE AFFORDED BY Ttlfi POLICIES DE8CRIBE3 HERI=IN IS SURACT TO ALL THS TERMS, EKCLLXIONS AND CONUMNS OF SUCH POLICIES. BY PAID Id a0Fi9. TIME OF DISURANf.6 Petw Lon QL4 9RALLuwLffv EAWCWUXVUMW. , 1,000,000 CCM L * UAWLt'FV g 100 ,000 1 IML410MAM ® F]l:= = 0005753 3 5/15/2000 5/15/2010 MEOEW $ 5,000 S mo TV vzxW"=Zz A g 1,000,000 2,000,000 GmtAocm GATE LIMIT Atpafis PEk C AM S 2,000 Pm.cY Lee MM MO 6IAMIIY pdMBtNEO Snit� E LII�QF ANYAM $ 1,000,000 ALL FnmmAuTas CA0008969 3 5/15/2009 5/15/2010 �L•IrtNilA�h, 9CHEDULED AUri95. P 1 $ K }nRM AVIVS BWILv INJURY $ �i Nt7N4mmmAuros (Fw ) PROPERTY naiuAM $ EPoraesiEeeO MARACa6RP/OUY A= &&Y- rA ACCIVEW $ AWAM OTHERTMAN r-A AMONLY. AGG- g IJABNFPY i 1,000,000 k OCUR ® CLAIMS NAM MMMKLLk FOM Aga s 11000,000 s R GHDt►Cf►BLE WS0008B9 0 5/15/2009 5/15/2010 vN '.o aaa �► 7� Ate Y ANV E L EAtI A sEaear S S001000 001- ma0aa-60200 7/16/2008 7/16/2009 MLnnEw. PA 500 000 WFOR saaNSe6eoa I I &U 1111 x - pCL1GYI.Ma S 50 0,000 oalgn Wooramm Am= sY P1NA/�llalDfS nERTIFICATE HOLDER CAI�ELLATION sm= AMP QF Tom AR&M Mom= anm ft cA Cmw no CI" OP' == .3M= E7tgRATMH OATS M=W DR =I= MUM WSL GWMV R TO MAL 10050 IZ 214D A9Z 10 DAve vanTm Ilan To Tm CFRIIIFICAm m N Tome LEFT; SIUT mxmu Snoms, !'L 33138 FAUMTOCOSOOMALLOOMNMCUMTMORLMMOPAWIMM FPS AGE CIR AWWWWATME& . Raw Carey Keyes /M3 — CORD 25 "I=) (DACM CORPORATION lift 14"R M'vom n®, P*Ah i .1 This fu was sent rat GFI FAXrrmkor fax sstm. For more inb mativn, visit http:!lvvww.95.c om "1 Y t d3 v STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 ASSOCIATED AIR PRODUCTS INC ASSOCIATED BUILDING SERVICES 2111 N COMMERCE PKWY WESTON FL 33326 i� �t�.� fi t`"' - zt� � } � � k " ,� �?',�•� L �� -�' + IF, sue. -- ---- --- ------- -- ---- -- - --- - -- --- a DETACH HERE -------------------- --- --- -- - ----- _ . _:...- ...... -- ...... - - - -- — '— ------ - -__-- ------------------------ _.- .._...- .._......... -..__ . .. _. _... FM v rn, .1 t'l 4._`.';?a ,tip �, 1. � s ��5' �e —�7i� _. x�,t fre=' Cy ' � S � -}' Fj �„� tit N -4 P 9t: -f\ a ♦ q L '4 li < ql+r. �. ,.�, a._.- �:..eA>•;....rr aa5 a ��,'�Ji�'"��u. .�3 � , ";�.',t� _s;r�'< s�. 5:�:. .,. 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ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE U9a0 Hiatus Rand ALA Y T WS C ABATE DOES v OT 0. �D OR rao FTj 33321 INSU AFF�CI NAIQ Fax # �5a 3s4 9eea A rcc= sae ca X01 g Associated Air riracluota3 LC & s FIXT Comm I Z lax Co 33472 .Associated Building 3es`vicxes I�ac 2111 North CUssme ne parkway c Aston FL 333260 1 INBLRIM E RE POLIClE9 CF aVSURANCB LI87 ED BELOW HAVE BEEN l88UgT TO THE INSURED NAMED ABOdE FGR THE t7LI THE INS dY PERIOD INDICATED. NBTwITN8TAN01NG AN RfIAUIREMENT, TERM OR CONomaN CF ANY CON' ROWT OR OTHER DOCUMENT WK RESPECT M WHICH 1H18 CERTIFICATE MAY BE lSSerEp OR MAY PERTAIN INSURANCE AFFORDED BY THE POLICIES 06SORSED HEREIN IS SUBJECT Tp ALL THE TERMS, EXCLU81 AND MAY BE ISS OF BUCK POl,t am BR. OF INSOItAplpg MOLL �mB19 CWBtAL LIAI3IMY g 00WAHMIAl i 000,000 A CLAIMSMnce =0905753 9 5115/2009 5/15/2010 fi e® 6 100.000 R 00 >� D EME P a 5,000 7 i $ z a0o 000 am uaurA 1:8 2,000.000 1',00 ,000 Au7o>erlDe uAmu�Y AWAUTo (ES aftw" NQLE e.uMR S 1,000,000 AL60VR i4DAVM CA0008969 9 5/15/2009 5/Z5/2010 X S�4LEQAUr09 BBDI IW alRT t�patBM) $ AUM VW i — MY MAW & t;ARAre IrAetui'1► AWAUTO Y" OTMR TKM AUTPOtcI.v " ALSI '" r $ 1, 000 OCCUR ❑ C.A..A. 000 PORK � 1 000 a 00 $ I x ele v�ooassa0 t 5/15/2009 s /LS/ a010 0 71DN AND AW � S00,000 y 001 ICUDA -80209 7/16/2009 7/1$/2010 a LMIM _ 500,000 an= ILL 018EME. IT i 560,000 R PRIQld OF OPlDLA710N pCp AM= BY fikVQr4CMWrrfiWE=ft pRUMBUM 0ERTI TE l: CEI CATION lItHM" ANY OF THIS ABOV9 01580 M POL1001 136 OAMMM BMW W 3.0050 T SHOWS VZLLMM MWMAUM DAV- THUMP, TN6 MUM esAM WILL ENnBAVOR TO t3AN. NCXNORTH BA AY 10 DAYS 1 t NE E 70 71i8 T® tIC�LOSR NAB 7ID TNf? I.eFT, EfU7 MCI ZMU FL 3 E $, FL 33338 FM " TODUSOMMLLWMXUaMJUWN GR UMIMCIFAWKWUPMTM ff$8qM9*fflZW2RffA AUIHORM F83qHavft7M ! Carey Keyes /MS "�" i do Ite me� na„ -40 A1r 26 (2fl0U08) a ACORD CORPORATION 1988 PRAA 7 .l9 11 -10 -09 09:47 From - ASSOCIATED AIR +9643498386 T -689 P -01/02 F -607 Cf •L � k� 5�s / ••�a A7-y � ... ,Y,j ` ��,j�"r �� b"y,r,,st�'••, � •n a' '4•)�'. ",•,}�''�.'�e• •:' 1:' '. ,•1 'ti. "e. i�.�•,�•�' Sti ..,,<r FF ,i�(yy�- ;t4sJ� • b i .f ^j' - j � yj t�•3:p , Q 'y.t° *t.� " ': - S • . a . . �i.:. ;: ', ;, :�f.'Y':i•K _��,tt;J,,,; 'C, +f! 13• . �r pC . � •s+ •• �� ' •'2' � 1•,�= "�ti.7 •.a' '• ' ' ., •,. , ' °� ' :it � raw .�. t.^:S'�� - 7:�r � , t•' +� • •�•PJ.. r' , r. � �- ,, - _ ,r r'� • � . •'::''� -:mss : .�: ;c' .' '� t•'►�"J t• �•.1 �'ti��?:� iyr � 'a�i� f � � r '- y - - °s• ;�. Ia��� #C�,Sj`�ti t ^r i• x�r�' {' '• +,.°�'•�r`:'.°ea+• •�(. _r .'•'�• i "• ':�;•i r., F • i•':. 'ti •_ `� � i.• ' r .'•"' � ".!•�¢"'"" T.•it�1•:,•f"� a.' •y.Y:�°j�, ?: •.4 ";f '. 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'� � .. �.s �. •' •'� �i '- v '�`4' 3` T•� rF +'C '-.rs. '-t. �.77� ;S.;a....ef 11 �' 1 7'r N•' •' � •„ �,� ' �i 7 + =' "? a <,ic.t L •p ��'� -'Y ,d�: � fr { �_ ,�•• ti ��' fy�tyw �• ^ 't� •' : b' `. •,!. ,�}4r�r .:Ytf .�'' ':[!7� ��••� f� ' ;•r. .�sf�r.a�;: E�'•n''.v /� .P.::- �•'r, ".. i. j, r �.• �:' =:`.: tt t• 5�'! 5 !'a:. C "•7 'r' g t f •. r.�T ?' s k ,��.��[' tri'latl•.f•F, _ •, 1P..• ',ri•.:.,;, Y. t � i W��{+i a• n `. • t S'••�. ai�l`i� M1 tTtf t }�! "'t: 'br:� • ," ':; � C i C �• '� i '� •�• j?�'% a {" y: .{„ ' ;� i-.' �.� . ^ \'k- � '• r �,.J.;”' :.}��:::: r ker �1l ; _ ; ti pp q F sir a "' : ` •, •-' �' r 'r- �? �a�p_ ; , e•�" �Z' •' �' ��`: ' �� ss'' : w ° u D� :':�` - �•' _� :ii wf. .'t' ]r rya - p'�'� "r•`'•"°:y�.�� : ' .r, r!- •'•.yy\.. � b• ', s t fl., C! " y �S .:d� ' r , fit °h. j '•y a:':i. -{ i' + ?.7, s • +1' r: , 9�t9C/� �{ 7►R °���•• f } ° r s i s D < •" • • -'LY: .. '1 - +�� '. •/• .,t w ►7'�ay�jy�. , c._ i �s.•.i.'� �'. Ft i L .rA Y;6 ,-B> � , �' �a*� �• L � S ': •b : �' Cr, a" r_ :, ! S��A'.' .,r.`%ta:r. \'�.�•� ,• •t� } 't ~:�.?: .Y, �" -+ w` : t• _ °;..r•; .`.•r.. } . =' r � , a'' •Y� '.1,t.:Sr •'�'.,.. ' '1 +S•' o�3.i•. ., t.a't "�'• ti•. er`. {��•t. �S: - _ .......... ._.�. ... ���. ..� .�. ... _. ... .— •- �— a..��. .-tip. �.. ,—, a 11 -10 -09 15:12 From - ASSOCIATED AIR +9543498385 T -699 P.01 /01 F -518 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1835 — 954 831 -4000 VALID OCTOBER 1, 2009 THROUGH SEPTEMBER 30, 2010 E DBA' Receipt #: 270-2549 i i Business Name ASSOCIATED BU SERVICES INC Business Type: MANuFACMRING (MF'G I Owner Name WALTER C DIC=1ZSON Business Location: 2111 N COMMERCZ FKWY Business Opened: 09 /22/2006 +; WESTON State /County /Cert/Reg: Business Phone: 954- 217 -1080 Exemption Code :NQ NEXEMPT Rooms Seats Employees Machines Professionals 2 • For vending Business 011110 Number of Machines: Vending Type: I Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid � 45.00 0.001 0 0.00 0 45.00 I , THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RE CEI P T This tax is levied for the privilege of doing business within Broward County and is WHEN VALIDATED non - regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that i Mailing Address: it is in compliance with State or local laws and regulations. ASSOCIATED BUILDING SERVICES INC Receipt #052 -08- 00000276 i 2111 N COMMERCE PARKWAY Paid 08/3Z/2009 45.00 WESTON, FL 33326 k