MC-11-1112Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 161117
Scheduled Inspection Date: July 20, 2011
Inspector: Perez, JanPierre
Owner: BESSON, GEORGE
Permit Number: MC -6 -11 -1112
Job Address: 390 NE 98 Street
Miami Shores, FL 33138 -2410
Project: <NONE>
Contractor: JM ARCE SERVICE
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number 1132060135670
Phone: 305 - 262 -3589
Building Department Comments
TO REPLACE 2 CONDENSING UNIT
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
July 19, 2011
For Inspections please call: (305)762 -4949
Page 10 of 20
`iII'll 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
JUN 0 REr��
BUILDING Permit No. ', "C k 1 —I. 14 L.
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: MECHANICAL
Owner's Name (Fee Simple Titleholder) C;),,e64._ 5-(0/.B Phone # 3 to 9 70 7
Owner's Address ' %0 N %-
City ti 11,0 e r State re A Zip 3 3 / e
Tenant/Lessee Name
Email
Phone #
Job Address (where the work is being done) 3 9P N -Led-
City Miami Shores Villa e County Miami -Dade
FOLIO / PARCEL #
Is Building Historically Designated YES
Zip 33(3(
NO Flood Zone
Contractor's Company Name <-A , PA - P E 5 ho (2 ' 251 —00k?
Contractor's Address ( Q •
City •-k. State c
Zip
3.31�S
Qualifier Name Phone # 'j (o — 2-5 1 — 00l e
State Certificate or Registration No. (?k( Q S' 7 S ( Certificate of Competency No.
Contact Phone -7 gG - ZS (— 00k E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $
Type of Work: ❑Addition EAlteration ❑New
Describe Work: ' tti ' >� _ �'.1-„ 1, / z, fJ.1, y 1- 1.r, -�
KT
I- -0 Square / Linear Footage Of Work:
r❑' Repair/Replace El Demolition
GC( Y f- 'Oct ,
* * * * * * ** * * ** * ** * * ** * * * * * * * * * * * ** * es ***** ***** *** * * * *** * * * * * ** * * * * * * ** * * * * * * ** **
Submittal Fee $ ,� Permit Fee $ CCF $ CO /CC $
Al
Notary $ 0 Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $
See Reverse side -+
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 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
er or Agent �/
The foregoing instrument was acknowledged before m this l/`�
day of 0 , 20 J(, by (g CO adi— ,1%
who is personally known to me or who has P roduced h. _.1 IP �► ►►u n u ruii/,an,oath.
As identification an�hc�c�glc
NOTARY PUBLIC:
Sign: f �- �` , 2 ; , E.--
ign: O�
Print: , /,..."9"//.. ox e
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * **
APPROVED BY
Signature / /`,
Contractor
The forego
Jfr
rument was acknowledged before me thisc
day of , , 20 I/ , by
who is pe onally known to me or who has produced
as identification and who did take an oath.
Plans Examiner
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
NOTARY PLIC;
P..
Sign:
Print: �S'�Y.FUA4
My Commission Expires
rE OF FOR
LUIS FERNANDEZ
* MY COMMISSION # DD 832441
EXPIRES: November 7, 2012
Bonded Thru Budget Notary Services
Zoning
Clerk checked
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
AIR CONDITIONING REPLACEMENT DATA
PERMIT NUMBER: MC I ( "ill Z
This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data
sheet. Multiple units on single sheets are not acceptable.
Job Address (where the work is being done): 5 '10 1\.0 ¶ S-7
City: Miami Shores Village County: Miami Dade
Zip Code:
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
ARI (AHRI) DATA SHEET REQUIRED
Change Disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
rS c ape
KW HEAT
NOM TONS
'`J • 0 (21
AHU CU
PKG
1) M.C.A
AHU CU NG
AHU CU
PKG
2) M.O.P
AHU CU PKG
AHU CU
PKG
3) VOLTS
AHU CU PKG
PKG UNIT
/ I
PKG UNIT I l
EERISEER
c3. 0 0 /
YES
NO
REPLACING DUCTS
YES NO
YES
NO
REPLACING THERMOSTAT
YES NO 1,(
YES
NO
NEW 4 "CONCRETE SLAB
YES NO
YES
NO
NEW ROOF STAND
YES NO i/o
YES
NO
NEW RETURN PLENUM BOX
YES NO ✓
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse /Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: ) iL4 Phone: 7 V6:,
State Certificate or Registration N. CM), Certificate of Competency N.
Signature
(Qualifier's = ignature only)
Date:
Licensing Portal - License Search Page 1 of 1
7:28:00 PM 9/112010
Data Contained In Search Results Is Current As Of 09/01/2010 01:27 PM.
Please see our glossary terms for an explanation of the license status shown in these search
results.
For additional information, including any complaints or discipline, click on the name.
License Type Name Name
Type
Certified Air
Conditioning ARCE, JOSE M Primary
Contractor
License
Number/ Status/ Expires
Rank
CAC057951 Current, Active
Cert Air 08/31/2012
License Location Address *: 6030 SW 22ND ST MIAMI, FL 33155
Main Address *: 6030 S.W. 22ND STREET MIAMI, FL 33155
Certified Air
Conditioning 3 M ARCE SERVICE DBA
Contractor
CAC057951
Cert Air
License Location Address *: 6030 SW 22ND ST MIAMI, FL 33155
Main Address *: 6030 S.W. 22ND STREET MIA441, FL 33155
Current, Active
08/31/2012
• denotes
Main Address - This address is the Primary Address o.. file.
Mailing Address - this is the address where the mall associated with a particular license will be sent (if different from the Main or
License Location addresses).
License Location Address - ibis is the address where the place of business is physically located.
C;.
HP OfficeJet 7210
Impresora/Fax/Copiadora/Escaner
Registro pare
ANGEL CALDERIN
3052213953
08 20 2010 2:17PM
1110ma transaccitn
Fecha Hora Tipp Ident fficaci+n
08 20 2:15PM Fax env. 3054993952
Duracic n Paws' R Itado
1:40 7 OK
scERr►FICATEIS15suED CERTIFICATE OF LIABILITY
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY INSURANCE
BELOW. THIS CERTIFICATE OF INSURANCE MATTER OF INFORMATION ONLY DATE THIS rvyyY)
ATIVELY AMEND AND EXTEND CONFERS AL NO RIGHTS UPON E THE CERTIFICATE HOLDER. ES
REPRESENTATIVE OR PRODUCER, RANCE DOES NOT CONSTITUTE OR AL 06118/11
ERr AND THE CERTIFICATE HOLDER.
TITUTE A C TER THE COVERAGE AFFORDED BY THE POLICES
� •
IMPORTANT: K the certificate holder is CONTRACT BETWEEN THE ISSUING
the terms and conditions of the an ADDITIONAL INSURED, INSURER(S), Al!
certificate holder In lieu of such policy, certain �, the pollcy(les) must be endorsed. h SUER
i PRthe to podoy, certain policies may require an endorsement. A statement on this c nOo s confer S11'
�nsU►tants Of Dade `� dO� n'��COM�' 11g1>ts to the
2470 NW 102 Place Ste 203
Miami, FL 33172
Phone (305)406-1659
.1 INSURED
I J.M. ARCE SERVICES
6030 SW 22nd St
Miami, FL 33155
/786) 251-0018
COVERAGES
Fax (305)599 -3281
CERTIFICATE NUMBER:
THIS IS TO CERTIFY SURER F:
Tom' THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE
INDICATED. NOTWITHSTANDINd ANY REQUIREMENT, OR TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Q
EXCLUSIONS AND CONDITIONS OF SUCH PERTAIN, S INSURANCE SHOWN AFFORDED MAY HAVE BY BEEN E POLICIES
BO BY PAID HEREIN IS SUBJECT TO ALL THE POLICY �
POLICIES. LIMITS SHOWN MAY �� BEEN REOIICED BY PAID cu►uYls. WITH RESPECT TO WHICH THIS'
1irLy
,
POLICY NUMBER
TYPE OF INSURANCE
ACI282887PC
REVISION NUMBER:
08/06/2010 08/06/2011
50,000
two
1,000.000 �
2,000,0001
7,0oo;oo
LIABILITY
ANY AUTO
ALL OWNED AUTOS
M/LED AUTOS
El I-EAIM AUTOS
INS -OWNED AUTOS
El
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP /OP AG°
BODILY INJURY (Per person)
EACH OCCURRENCE
I_- MENTION
women
AND EMPLOYERS' LIABIL)TYON
Y
ANY PROPRIETOR/PARTNERIEXECUnVE
OFFICERIMMER EXCLUDED?
(MandatMMyln NH)
P IE
descrite under
y �? 1FPQNCF OPERATIONS below
ISCRIPTIONOF OPERATIONS., LOCATIONS / VEHICLES (Attach ACORN tot, Additional Romarke Schedule, H more apace Is required)
TALLATION SERVICE ,REPAIR AND SALES OF LP GAS APPLIANCES ,EQUIPMENT AND PIPING,INCLUDING RESIDENTIAL,COMMERCIAL AND
DUSTRIAL APPLICATIONS.
EL EACH ACCIDENT
EL DISEASE • EA EMPLOYE
ERTIFICATE HOLDER
MIAMI SHORES VILLAS
10050 NE 2 AVE
MIAMI SHORES FL 33138
CANCELLATION
4008 ACORD CORPORATION. AU rights reserved.:
name and logo are registered marks of AC ORDI
•
SEE OTHER SIDE
DO NOT FORWARD
J M ARCE SERVICE INC
JOSE M ARCE PRES
6030 SW 22 ST
MIAMI FL 33155
111111 111111111111111 ►11►► ►1till I1 III ► ►I► ill ►1111119CH1
08 -30 -2010
STATE OF FLORIDA
OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
ERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW *
ION INDUSTRY EXEMPTION
that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
DATE:
08/30/2010 EXPIRATION DATE: 08/29/2012
ARCE JOSE . M
651112177
TAME AND ADDRESS:
1VICE INC
iT
FL 33155
BUSINESS OR TRADE:
ACTOR 2- OAS MAIN / METER INSTALLATION
*
►t to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this
ver benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the
s or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of
It shell be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the persod named on the notice or
meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
:ate to meet the requirements of this section. QUESTIONS? (8501 413-1609
OF ELECTION TO BE EXEMPT REVISED 09 -06