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MC-11-2099Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 inspection Number: INSP - 168503 Inspection Date: January 09, 2012 Inspector: Perez, JanPierre Owner: HUNTER, MARK Job Address: 1245 NE 93 Street Miami Shores, FL p-VA(5't Permit Number: MC -11 -11 -2099 Project: <NONE> Contractor: HVAC ENERGY SOLUTIONS Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Kitchen Hood Phone Number (917)604 -8328 Parcel Number 1132050270070 Phone: (954)391 -7029 Building Department Comments KITCHEN HOOD INSTALLATION V t iqi 1 Passed Inspector Comments CREATED AS REINSPECTION FOR INSP- METAL, NOT FLEXIBLE. COVER WORK HOLE. JPP 1/4/12 v 6-L5A) 166605. WITH /► "v DUCT MUST BE DRYWALL AROUND THE 't----() aseLA n I 1;14,6/ li r Failed Correction rection Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. 1A,.12.-- H-0 rr-94' � bv V until January 06, 2012 For Inspections please call: (305)762 -4949 Page 1 of 1 • 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 BUILDING PERMIT APPLICATION FBC 20 Permit No. NOV 14 2011 BY:- ------- eoeoamoo°oo Master Permit No. (LC In .140CA Permit Type: MECHANICAL e ` OWNER: Name (Fee Simple Titleholder): \-1 u.c1 c r Gi \` Phone #: Address: 4 2- Lk CD Zip: —3.3 «v City: V g Nv. UC P 6 State: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: . ?'* S 3 4 �'v-'t, City: Miami Shores County: Miami Dade Folio/Parcel #: 1 / NO �( Flood Zone: Is the Building Historically Designated: Yes Zip: 33 \9 •CONTRACTOR: Company Name: \A) A- C C pcc,, 51) t,c_n S Phone #: CSA.q - Y- 1 Address: 4y S ! c --V \ c City: ■ U\ P C//,1N Qualifier Name: 7`,i\(\ck Qc cv G\ State: CL Zip: ' \2 Phone #: C543c\I 10 aG State Certification or Registration #: CAC— Contact Phone #: k9 U 3'ti `)c-02R Email Address: Certificate of Competency #: 1,_____ ,co (n DESIGNER: Architect/Engineer: Phone #: —... Value of Work for this Permit: $ O : Square/Linear Footage of Work: Type of Work: Address OAlteration Descripti6E'af'Wdflt .. k UNew ORepair/Replace ODemolition PAP VA5 1'41,0 at ;°: ds ATOi! OW) NI 01-11,1k4 dlagoliieWNA" ******** *** * * * * * * * * * ** * * * * * * *** * * * * * * ** Fees************* * * * * * * * * * ***** * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ *Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) 1 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 iss '. In he absence of such posted notice, th� inspection will not be approved and a reinspection fee will be charged. Signature 9/761k � Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this " I The foregoing instrument was acknowledged before me this q day of r k•,►I A , 20 \\ , by \A N- ` -� r\lv\rc' c wh. 's personally known tc ine or who has produced w o is personally 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: day of r , ?OkL, by €°(Gl Sign: Print: My Commission Expire APPROVED BY 14 (Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09) MELANIE VIRELLA NOTARY PUBLIC • STATE OF LIMOS MY COMMISMON EXPMES03l27/12 *** * ** ** NOTARY PUBLIC: Plans Examiner Zoning Structural Review Clerk • IVI iami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT • C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 • COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: %OW' Firm Cow4o gA , Inc . \Ig - .e,�icr So , s. BUSINESS ADDRESS: k W 4 Iltvl✓ Nr CITY '66,16L STATE L ZIP CODE 33 ®62 BUSINESS PHONE: ( ) A'' ®� �0 FAX NUMBER ( geiNr ) " ' 0 P F7 CELL PHONE ( ®4- ) �QIl °aO /© QUALIFIER'S NAME: '12.91/8 0-PAI QUALIFIER'S LIC NUMBER: 0 lc ° If-41-7f 5 E -MAIL ADDRESS (IF APPLICABLE): or7rIlve ev►el Iraivila145 , cowl Created on 3119109 BY MLDV I RV 3126/09 MLDV BATCH NUMBER _ ` . 7 BATCH NUMBER ttti Pau* of nine= Is authorized under the provisions of to the public through a Professional Engin NS a Statutes, to offer engineering services under Chapter 471, Florida Statutes. Certificate of Authorization EXPIRATION: 2128/2013 AUDIT NO: 2282013045981 CA. LIC. No: 29476 • • COLLECTOR W FLAGLER ST. t FLOOR ANII, .FL 33430 2011 LOCAL BUSINESS TAX` RECEIPT ~` 201 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT., 30, 2012 MUST BE DISPLAYED AT PLACE OF SUSINEW PURSUANT TO COY ®'. ° PT RT 1)&1° -FIRST CLASS IJ.& POSTAGE PAID MIAMI, FL PERMIT N.O.231 600421 -2 BUSINESS NAME !LOCATION_ QUALITY ,FLOW `COMFORT' INC 45,7 4 AVE 33012 HIALEAH THIS IS NOT A BILL — DO NOT PA Y OWNER QUALITY FLOW COMFORT INC • TypeofBuslr WORKER /S ERAL MEC 1ANICAk CONTRACTOt 1 TAX RECEIPT. IT NOT PERMIT- THE H LDER To VioLATE ANy EX S'RNG REGULATORY oh ZONING ZotiNO LAWS OF THE Y' OR CITIE6.' FROMArog OTHER hT OR .IREC BY LAW. mis E . A .CERTIFFCAT/ON, , TES HOLDER'S OHALIIFIOA RENEWAL RECEIPT NO. 626470-9 4063TATE0 CMC1249713 AYMENT RECEIVED IAIII- GOUNTYT10, 09/07/2011 022100320f01 000-04 -5.00 SEE OTHER SIDE 130 NOT FORWARD QUALITY FLOW COMFORT INC ENRIQUE PASCUAL PRES 6575 W 4 AVE 406 HIALEAH FL 33012 i,Liit,llilil>;>" "iumaiL, a LiLLLu.Ji,;viii 05 -27 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 05/27/2011 EXPIRATION DATE: 05/26/2013 PASCUAL ENRIO.UE 201726189 BUSINESS NAME AND ADDRESS: QUALITY FLOW COMFORT INC 6575 W 4TH AVENUE #405 HIALEAH FL 33015 -3510 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED MECHANICAL CONTRALTO 2- ENGINEERING CONTRACTOR IMPORTANT: Pursuant to Chapter 440. 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ender this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer 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 named on the certificate to meet the requirements of this section. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 • QUESTIONS? (850) 413 -1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 05/27/2011 EXPIRATION DATE: 05/26/2013 PERSON: ENRIQUE PASCUAL FEIN: 201726189 BUSINESS NAME AND ADDRESS: QUALITY FLOW COMFORT INC 6575 W 4TH AVENUE 5406 HIALEAH, FL 33015-3510 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED MECHANICAL CONTRACTO 2- ENGINEERING CONTRACTOR IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer 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 named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. ODWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 Dec. 15. 2011 11:21AM � ` °R °® CERTIFICATE OF LIABILITY INSURANCE PRODUCER JAL INSURANCE SERVICES INC. 141 E Commercial Blvd Ft Lauderdale, FL 33334 (954)958 -0878 INSURED No. 6318 P. 1 DATE(MMIDDIYYYY) 12/13/2011 THIS CERTIFICATE IS 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 NAIL# Quality Flow Comfort, D /H /A HV A/C - Energy 6575 W 4th Ave Hialeah, FL 33012 1305- 219 -0650 COVERAGES Inc Solutions INSURER A American Vehicle INSURER D; INSURER c: INSURER D: INSURER E 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR I TR ADDL N RD Ni+P oFr M9 aN _ POLICY NUMBER POLICY EFFECTIVE DATEf MVO DIYYYYI POUCY EXPIRATION OATE(MMiDDlYYYYI UMITS A GENERAL LIABILITY GL- 0504007937 -00 9/21/11 9/21/2012 EACH OCCURRENCE $ 1,0g° 00(0 $ 100.000 X COMMERCULL GENERAL LIIBILTTY °Amu% TO Ho ccur PREMISES (_Ea ecaffence) � I CLAVASMADE rid I OCCUR MED DIP (Anyone per i) $ 5,000 PERSONAL a ACV INJURY a 1,000,000 GENERAL AGGREGATE S 2,000,000 S 1.000.000 I POLICY n jPra n LOC PRODUCTS - COMPIOP AGO �GEN'LAGGREGATELIMITAPPLIESPER X -- AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea Dcddenl) $ — BODILY INJURY (Per Pte) $ — — BODILY INJURY (Pet aecideM) $ — — PROPERTY DAMAGE (Per acddenl) $ GARAGE LIABILITY ANYAUTO AUTO ONLY-EA ACCIDENT $ R OTHER THAN EA ACC $ AUTO ONLY; AGO $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE 8 OCCUR CLAIMSMADE AGGREGATE S DEDUCTIBLE RETENTION S $ $ $ WORKERS AND EMPLOYERS ANY PROPRIEYOWPARTHERACCECUNVE OFRCERASEMBP-FL lI°RrInMO Wyse. aescribeunaer SPECIAL PROVISIONSbelew COMPENSATION LIABILITY YIN Wy�C EgTATU- rat I TORYI IMIT$ I I ER_ E.L. EACH ACCIDENT 8 OCCLUDED? EL DISEASE - EA EMPLOYEE $ E.LDISEASE - POLICYLIrMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS FICATE HOLDER Village of Miami Shores 10050 NS 2nd Ave Miami Shores, FL 33138 305 - 756 -8972 ACORD25(2009/01) The ACORD name and logo CANCELLATION SHOULD ANY OF THE ABOVE DESCIRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE DOOM INSURER WILL ENDEAVOR TO MAIL 30 DAYB NNIUTTEN NOTICE TO THE CERYIRCATE HOLOER NAUFA TO THE LEFT. BUT FAILURE TO DO SD SOUL IMPOSE NO GOUDA ..' LIABJUTY OF •, n UPON THE INSURER, ITS AOENYS OR REPRESENTA AUTHOR, ®1988- ' 09 ACOND CORPORATION. All rights reserved. e r , stared marks of ACORD