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MC-10-905Scheduled Inspection Date: July 08, 2010 Inspector: Perez, JanPierre Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Job Address: 415 NE 105 Street Miami Shores, FL Building Department Comments July 07, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 144033 Permit Number: MC -5 -10 -905 Project: <NONE> � _, 4, I Contractor: ASSOCIATED BUILDING & AIR PRODUCTS q61 11� Passed tveu Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments For Inspections please call: (305)762 -4949 Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)758 -0539 Parcel Number 1122310430010 Phone: (954)217 -1080 Page 8 of 19 Project Address Owner information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 415 NE 105 Street Miami Shores, FL 1122310430010 Block: Lot: ST ROSE OF LIMA CATHOLIC CI Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $1.80 $0.60 $100.00 $3.00 $50.00 ($50.00) $2.40 $107.80 Address Parcel Number ST ROSE OF LIMA CATHOLIC CHURCH 9401 BISC BLVD MIAMI FL 33138 -2970 (305)758 -0539 1 Contractor(s) Phone Cell Phone ASSOCIATED BUILDING & AIR PRODI (954)217 -1080 Tons: REPLACE 4 TON Additional Info: MECH Classification: Commercial Approved: In Review Comments: Date Denied: Date Approved:: In Review Type of Work: REPALCEMENT 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 Phone Pay Date Pay Type Invoice # MC -5-10 -37953 06/07/2010 Credit Card 05/20/2010 Credit Card Amt Paid Amt Due $ 57.80 $ 50.00 $ 50.00 $ 0.00 Applicant June 07, 2010 Date Cell Available Inspections: Inspection Type: Final 1 June 07, 2010 1 1 -IMITS EAgiA(:CUR$�(!(CF S 1,000,000 p M o r te) $ 100,000 MF.D EXP (Anyone person) $ 5 , 000 PERSONAL& ADV INJURY $ 1, 000, 000 GENFFiALAGGRFOATE $ 2,000,000 PRfrIICTt. cal MP/OP ('- $ 2,000,000 COMBINED SINGLE LIMIT' (Es dent) $ 1,000,000 BODILY INJURY (Pat person) BODILY INJURY (Par are,dent) $ PROPERTY DAMAGE (Per &calden,) $ AUTO ONLY. EA ACCIDENT S OTHER THAN EA ACC $ AUTO ONLY: ACG $ FACFjQ,Y URRFNCP 1,000,00C $ i, 000 , 00C AGG R[3ATE $ $ $ 7� YJTp�Y i O FR - El. EACH ACCIDENT $ 5001001 E.L DISEASE - EA EMPLOYEE $ 500 i OW E.L. DISEASE - POLICY 1,IMIT $ 500,00 06 -07 -10 11 :50 From - ASSOCIATED AIR 1 ,..� ACC?Ra. CERTIFICATE OF LIABILITY INSURA CE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ALTER THE THIS AFFORDED BY THE POLICIIEEXTEND .OR PRODUCER (954) 724 -7000 FAX: (954) 724.7024 Keyes Coverage, Ira• 5900 Hiatus Road `,.�marao INSURED Fax Associated Associated 2111 North Weston 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. A( RFfi�4TF LIMITS SHOWN MAY HAVE BFFV REDUCP0 BY PAID IN AADDO IJ cRIT C OTHER FL 33321 # 954 384 9880 Aix Products LC d /b /a Building Services Commerce Parkway FL 33326 TYPE OF INSURANCE GENERAL. LIABILITY X COMMERCIAL GENERAL LIABILITY 1 CLAIMS MADE © OCCUR GEN%. AGGREGATE LIMIT PER 7 POLICY r - 1 p I ^ 1 100 AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS — SCHEDULED AUTOS X MIRED AUTOS X NON.OWNED AUTOS GARAGE UABIUTY ANY AUTO EXCESS/UMBRELLA UASILITY -- ' OCCUR CLAIMS MADE DEDUCTIBLE K ITFNTInN , 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIGTORIPARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? Uyaa, describe under CERTIFICATE HOLDER ACORD 25 (2001108) ■1san; CITY OF MIAMI SHORES 10050 NE 2ND AVE MINX SHORES, FL 33138 POUCYNUMBER zz7 s292B10 00 AZ.7 5293016 00 UPffiRZLLA FORM Lmffi 8292808 00 001 -W00 9A -60208 INSURE ` D: INSURER E +9543498385 P ATE EFFECTIVE O P DATE M/ DOf' 5/15/2010 5/15/2011 5/15/2010 5/15/2011 5/15/2010 5/15/2011 7/16/2009 7/16/2010 DESCRIPTION OF OPERATLONSILOCATIONSIVEHICLES )EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS INSURERS AFFORDING COVERAGE INSURERN HaruO'trer Amar Inn; Co AUTHORIZED REPRSSENTATNS Carey Keyes /MS T -163 P.01 /01 F -305 DATE (MMIDDMYYY) 5/11/2010 NAIC # 36064- INSURERS; HanoVer insurance Company . 22292 INSURER G; FCC) Ins Co 10178 CANCELLATION _ 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, 8Ul FAILURE TO DO SO SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THI INSURER ITS AGENTS OR REPREEENTATTVES. 0 ACORD CORPORATION 1£ 61 1A1� BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Tenant/Lessee Name Email Submittal Fee $ Permit Fee $ Miami Shores Village Building D epartment MAY 2 0 2010 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Owner's Name (Fee Simple Titleholder) 57. jPoss.oF al 0 d Phone # o S A Te$ o,3 Owner's Address odeeA . l City aka NW/ .S State l • Zip 33 13 Job Address (where the work is being done) iti .4/4 id s City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES Training/Education Fee $ 0.(00 Master Permit No. Phone # NO Flood Zone /4;• eOld)Covs /l rp uA// c9") y ouat.Sitpul., "0-4-01 I t� Notary $ Scanning $ O) Radon $ DPBR $ Bond $ Double Fee $ Violation date: •-� Structural Review. $ Total Fee Now Due $ (S ` •? See Reverse sid Permit No. mC-1 0 d ,/ leul GE f • Contractor's Company Name / 95;701,0/0 2) Zat7 �I or, Phone # 30s 4.r.Z 23' 'e - 1-2 al Contractor's Address QM/ N. coidArioAre2 G a PH City 14 • ssnmd State FL. Zip 3 332 4 Qualifier Name 7p y r1 e: Pct •it a dVA) Jet • Phone # 93. g' 6 £ 77 3" State Certificate or Registration No. ('4i / j `gl Certificate of Competency No. Contact Phone g-'6' 7 6, E -mail Architect/Engineer's Name (if applicable) WAL • Phone # Value of Work For this Permit $ A s'0 8.6 b Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration ['New le ❑ Demolition D sc ib Wor : .' P_ 74 ,x, urn 9, fe* * * ** ** * * ** ** * * * * * * * * * * * * * * * *F es ************** * * ** * *** * * * * * * * * * * * * * * * ** ** * ** if Ii& CCF $ . CO /CC $ Technology Fee $ 2 • 10 w Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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) da %fer the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspec, fee will be charged. Signature � gn �. , Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this /, The foregoing instrument was acknowledged before me this I1 day of , 20 /0 , by 1• ifef , day of Ml( ,20 (b , by o kW C. ptd:'C l (( who is personally known to me or who has produced who is personally known to me or who has produced �����1®lj�/ As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission * * * * * * * * * * * * ** APPROVED BY Engineer (Revised 07 /10 /07)(Revised 06/10/2009) NOTARY PUBLIC: Sign: Print: My Commissi RONALD R LAWS •'- MY CQMMISSION 0 OD9731 EXPIRES March 22.2014 '• %cx.' r. ..?f s1.'.=ti {.t,< �.;i: .'a * * ** - ********* *: Y*k*3r* 4c3e3r3e*9t* *4: *k9rFr**** *4e* *********9r**3r**** **** ** Plans Examiner Zoning Clerk checked