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MC-11-1810Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 165062 Permit Number: MC -10 -11 -1810 Scheduled Inspection Date: January 11, 2012 Inspector: Perez, JanPierre Owner: Job Address: 180 NW 103 Street Miami Shores, FL 33150- Project: <NONE> Contractor: AIR SUPPLY MECHANICAL SYSTEM INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)825 -7080 Parcel Number 1131010230020 Phone: (786)229 -6240 Building Department Comments INSTALL NEW SUPPLY AIR DUCTS T4 \ \ \ z, Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 10, 2012 For Inspections please call: (305)762 -4949 Page 11 of 37 Miami. Shores Village Building Department 1. 0050 NLE2nd Avenue, Mi@m Shores, Florida 33138 Tel: (305) 795,2204 Farr: (305) 756.3972 INSPECTION'S PRONE NUMBER: (305) 7614949 FLNG T APPLICATION FBC 20 Permit T : MEC NICAL Simple Titlehokler): Jo' Permit Nord ICI Master Permit Ad City: Tertant/Les.see Name: Email: Zip: Ph ne#: JOB AD D-6 / 03 R-D City; County: Fah CONTRA : Com pany Nam: Addras: City: Qualifier N State Certificatio Miami Dade Zip: on #7,(71/6/,?-Vq9 9 Certificate of Corn Contact Phonclik 2‘--C7 Email Address: 1;2- 5V,/, 1 4/ ar IGNER: Mehl Phone*: valuta Work for ibis Perit: Type of"Work: Cl Sqi/L[iear F tage of Work: LINew c3Repait/Replace molitk,n 46. cc 4 ,/ if/ I dr ,ddir 6 .‘r # Submittal Fee $ IemiL Fee Fee $ Fee $ Notary $ treat! hie Fee $ Structural Review $ .1 CO/CC DRPR $ Band $ Technology Fee $ TOTAL FEE NOW DUE $ 1 C y "s e.. f applicable) Y`s Address is Hattie (if applicable) °s Ad" Zip StatC `Z p Applicati i by obtain a permit to do the work and itzstallation as idcated, l y that no work or tnstallatirtts has commenced prior to the issuance of ,a permit S <t all work will be performed to meet the standards of all ka ixs regulating construction hi this jurisdiction, 1 understand that a separate petntit must be secured far ELECTRICAL WORK PLUMf3lN4°a, SIGNS. WEIR. POOLS. FURNACES, BOILERS, REAMS, TANKS and AIR CONDITIONERS, ETC,e... OWNER'S AFFIDAVIT: 1 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable taws regulating construction and zoning. G TO 0 R: YOUR FA -<< TO RECORD A NOTICE OF NT FOR TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN G„ CONSULT WITH YOUR _.. G YOUR NOTICE OF COMMENCEMENT." a Applietrnt'« As ondition to the iss c of a building permit is °e €it erg es Mimed value cx ding 2500. tlr applicant must gosndfaith that a copy of the rte t o tm tenement and construct a lien law brat will be deitvered to the pervon property is subject to attachment: Also. a certified copy of the recorded nonce afcornmencern nt must be pasted at the jab site shack occurs se fter the buijdtng permit is issued, In the absence of such posted notice, the owed and a refit a will he charged. Signatu The f day of tTIC tiott and did take an oath, NOTARY PUMA 411pas Si NOTARY ETC. da7 '' %,: o d• S►: # uniss,WWeao0 : ARIAN eoeismo t itnnn "" Plans Exariti t f1�1� i v My 011111160.011 Expir : O7/10107X produced_ ho did take an oath° Nan 0_,p NOTARY PUBLIC -STATE OF FLORIDA Osleivy Blanco Commission #DD773911 Expires: MAR. Q 2012 co.,>Nc. Zoning St aural Review mClerk +� s This form mug .a shr t. Multiple unit Job Address City: Miami Silo Miami Shares Village Building Department 10050 N E,2ncl Avenue Miarni Shares, Florida 33138 Tel: (305) 7962204 (305) 75& 8972 ON TONING REP C ENT DATA PER lT U R: ... ant Each unit ehan . t must be on its own data d i County: Miami Dade Zip Code: ALL CONDE N uNrrs MUST BE ON A 4 INCH SOLID CONCRETE S B MUST COMPLY MTH E.E. FLOOD ELEVATION OF KK CO CT IS REQUIRED ALL SAL M (AMR DATA E REQUIRED Ch _; >& .:: YES El WO p ARHI Sheet Attached: YES Q NO C A a YE 0 s Company Name: Phone. or R i Won N. __ Certificate of Competency Si east on Miami 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. l/ 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. v COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTIQN) 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 INFORRMATION, 4- 5 , /,/ /� ✓r /� (. BUSINESS NAME: �� BUSINESS ADDRESS: D r . - r 5-5 CITY STATE C ZIP CODE 3.9 / BUSINESS PHONE: (_1 ) ?d-q-0?--(0 FAX NUMBER ( %9 370 -Z76 CELL PHONE ( 6 QUALIFIER'S NAMES `G A-6W 7L)' QUALIFIER'S LIC NUMBER: /29T%6/7 E -MAIL ADDRESS (IF APPLICABLE): 4/P S l% L gi A-A Dc Gem' Created on 3119109 BY MLDV 1 RV 3126109 MLDV MIAMI-DADE COUNTY 2011 LOCAL BUSINESS TAX RECEIPT ' 012 FIRST -CLASS TAX COLLECTOR MIAMI -DADE COUNTY - STATE OP FLORIDA U.S. POSTAGE 140 W. FLAMER ST.: EXPIRES SEPT, 30, 2012 PAID st PL I OR FAUST" BE INSPLAYED AT PLACE OF BUSINESS MIAMI, FL �NAMI, FL X3130 PURSUANT TO COUNTY CODE CHAPTER' SA - ART a& 10 PERMIT NO, 231 639726 -9 THIS IS NOT A BILL - C C+ NOT PAY RENEWAL BU IWOWNIVRIANICAL SYSTEMS INC STATE C F 249947 13035 SW 2 TERR 33184 UNIN DADE COUNTY OWAiK SUPPLY MECHANICAL SYSTEMS IN seciWegAt CHANICAL CONTRACTOR WORKER/S THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR cmES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR UCENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUAUFICA- TIONS. PAYMENT RECENED MIAMI-DADE COUNTY TAX COLLECTOR: 07/12/2011 60120000336 000075.00 SEE OTHER SIDE 666525 -2 DO NOT FORWARD AIR SUPPLY MECHANICAL SYSTEMS INC JOSE ALAIN HERNANDEZ PRES PO BOX 941955 MIAMI FL 33194 1.1111,,11aa,,11i,1., i,,, ii 1 f,C1 4 • ACORD CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MMIDD/YYYY) 09 -29 -2011 .I.- •. i., 1: ti PRODUCER A.B.S. Insurance Consultants 11402 N W 41st Street Suite 213 Miami FL 33178 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 NAIC 8 'MUM Air Supply Mechanical Systems Inc PO Box 941955 Miami FL 33194 -1955 INSURER A.. Accident Insurance ; ;Ompany GENERAL INSURER B: Granada Insurance Company AGL9008644 INSURER C: Commerce Industry Insurance Co. 09/1212012 INSURER D: castlePoint Insurances Co 1,000,000 INSURER E. '''a' " " O RENTED COVERAGES 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. INSR I; ' .. 1.F : • .I.- •. i., 1: ti POLICY NUMBER POUCY EFFECTIVE • - . r,,,. la,. h•1 POLICY EXPI - TION a , V . la,. {AA LIMITS A X GENERAL LIABILITY COMMERCIAL GENERAL UABIUTY AGL9008644 09/12/2011 09/1212012 EACH « «« RRENCE 1,000,000 X '''a' " " O RENTED 1,000,000 CLAIMS MADE X OCUR MED EXP one . = rson 5 000 ■ PERSONAL 8, ADV INJURY 1,000,000 ■ GENERAL AGGREGATE 2 000,000 GEM. AGGREGATE LNAIT APPLIES PER: POLICY 1-1.1PM n LOC PRODUCTS - COMP/OP GO 2,000 000 X B AUTOT,KIBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS Noa, AUTOS 0110FL00003091 07/16/2011 07/16/2012 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 • ■ BODILY INJURY (Per person) $ X X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT ■ OTHER THAN EA ACC ■ AUTO ONLY: AGG C EXCESS/UMBRELLA LIABILITY EBU011055615 07/15/2011 07/15/2012 EACH OCCURRENCE 1,000,000 X OCCUR CLAIMS MADE AGGREGATE 1 000 000 DEDUCTIBLE RETENTION ■ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFeFICERIM6NBER EXCLUDED? Yes If dbe under SPECIALLPPROVISIONS below WCP760355901 07/15/2011 07/15/2012 X TWOCRY i s 0;111, E.L. EACH AccIDENT $ 1,000,000 $ 1,000,000 E.L. DISEASE - EA EMPLOYE E.L. DISEASE - POUCY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTArnES. AUTHORIZED REPRESENTATIVE <DA> ACORD 25 (2001/08) @ A RD CORPORATION 1988