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MC-11-215
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 \v\ LIV\ Inspection Number: INSP - 155836 Permit Number: MC -2 -11 -215 Scheduled Inspection Date: October 05, 2011 Inspector: Perez, JanPierre Owner: HUTCHINSON, MARK Job Address: 1041 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: JORDA MECHANICAL Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060143720 Phone: (305)262 -0095 Building Department Comments RELOCATE AIR HANDLER 36" (3 -0 ") TO THE SOUTH AND RE CONNECT PLENUM T-6) Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments October 04, 2011 For Inspections please call: (305)762 -4949 Page 5 of 49 Miami Shores Village Building Department 100501;.1= = n l .!venue, Miami lhorca. I. Vrida 33138 1 ci: r ,lip, ')5..2204'Fax: (3U .5 } .E;Gj'; 72 • INSPE[:T1O7:'s PHONE NUMBER,: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL r1A ' 2011 : Permit No. MO Master Permit No. Owner's Name (Fee Simple Titleholder) f` 2,7M,7%.. %"C' ik ( , Phone # Owner's: Address /OW /VV 94 &'i City Aim nu .S tee ES State f L. zip 33136 Phone # Tenant/Lessee Name Email Job Address (where the work is being done) v41 ie City . Miami Shores. Village County FOLIO / PARCEL # add: Zip Is Building Historically Designated YES NO Flood Zone Contractor's Company Name 66t bi/q Aft /1 Aif C it7 4._ Phone # 5-) --*770 R Contractor's Address .')i \ l,..) LA, 14* 5 City S> Q Re2)L State -ROIL l b q Zip 3312(p Qualifier Name J li ‘ SA`�Jf I J�- l' Phone # . ( o'��, Se `�} — ' 70 S^ State Certificate or Registration No. C,m C C' t]-.�gCI Certificates of Competency No. V C600) Jai - T1 Cl*Q E-mail. Q .b Xt n i Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 FM-LORE 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 COMMENC *MENT 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 s posted notice, the inspection will not be approv ins ctton fee Will be charged. Signature er or Agent The foregoing instrument was acknowledged before me. this 1/ day of ; e 1 , 20 : / , by ' ',-Pri.,yyz, f %ter, ) who is personally known to me or who has produced)''Yseiftr /t, As identification and who did take an oath. NOTARY PUBLIC: Print: (e hot Ct PJI fl_ b cJf My Commission Expires: APPROVED BY JJDEZ Nolary Pt,b1R:. Sts„E. of Florida my Comrniniof E Aires gab 4, 2012 -* *m•/gr., B9p :.. a,: grik ia*7k* *i: B mr h Na ti a, Notary Assn. (Revised 07 /10 /07)(Revised 06/10/2009) Signa Con actor The foregoing instrument was acknowledged before me this, 11111 day of ` , 20 , by SOf 4 �`x ,50i Pt who is j)ersonail� known to me or who has produced as identification and who did take an oath.,i NOTARY PUBLIC: nine. Engineer Sign: Print: c IRNA CORTEZ u � %lon DD 741416 Expires January 6; 2012 Bonded Thor Troy Fan Insurance 8n-m -7919 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 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No.IVIC) El-2)1 Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): illikek 7eg/4/S0/1./ Address: ir City: Al/Am/ Tenant/Lessee Name: Email: .Z(' rc phone#:95-V-Wc—Pro--- S State: FE.- 511wb Aef AL( 0A/ JOB ADDRESS: YA /l4 4 egaiiiE City: Folio/Parcel#: of , Co Zip: 33/SP Phone#: Miami Shores 0( 3 County: Miami Dade Is the Building Historically Designated: Yes NO CONTRACTOR: Company Name: 70 gpA, Atamhydat. Phone#: S ZCZ 04195 ??)& ,o40 /440/ State: re 76K6.5 e-air.s4se.)4A Zip: Flood Zone: Address: City: Qualifier Name: State Certification or Registration #: CMC. ooltiqg Contact Phone#: ZCZ. 0075 DESIGNER: Architect/Engineer: Zip: Phone#: Certificate of Co7etency #: CC i Email Address: 1 Phone#: J3/z� Value of Work for this Permit: $ Square/Linear Footage of Work: ONew ORepair/Replace 3, # Type of Work: °Address Description of Work: ilAlteration A? Ad/A °Demolition 7b nic *************************************** ******************************************** Submittal Fee $ Permit Fee $ I t 60CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ TrainingJEducation Fee $ Technology Fee $ Double Fee $ Structural Review $ CO/CC $ Bond $ TOTAL FEE NOW DUE $ 1541 - 10 Bonding Company's Name (if applicable) 4/,9 Bonding Company's Address /1%s41 City State Zip Mortgage Lender's Name (if applicable) 4/4 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 properly is subject to attachment. Also. a certified copy of the recorded notice of commencement must he 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 Jed notice, the inspection will not be ap + roved and a reinspertion fee will he charged. Signature ff./ ?,M r; Owner or Agent nd The foregoing instrument was acknowledged before me this 2 The foregoing instrument was ackno !edged before me this , r day of feib. . 20 .1_, by Orli o 't4. kitOtTkil (). Oft. day of �Mt,btri , 20 .L. by z-ort6e ( i _vise 4: who is personall_ v k_ nom to me or who has produced who 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: Sign: Print: %molt& My Commission Expires: NOTARY PUBLIC: Sign: BRE AE.FERNANDEZ Print: 1•4 ULNA Ccs(++e'Z. Notary Public - State of Florida My Commission Expires Feb 4, 2012 My Commissio 0, ��o� Commission # DD 754950 '''a.Q; ;a4+`� Banded Through National Notary Assn. Plans Examiner Structural Review (Revi.ed 07 /10/07)(Revised 06/10/2009 )(Revised 3/15/09) Zoning Clerk CERTIFICATE OF LIABILITY INSURANCE Pm- PO 12/21/2010 THI8 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BAN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED, the pollcyr(Ies} must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such ntis). PACCUMB Brown & grown of FL, Inc, - Fort Myers 3820 Colonial Boulevard Suite 200 Fort Myere FL 33912 WCTStephanie Wi110.nnon 3.9- 274 -1430 l ,NOI239 -278 -5306 lkinson5bbftmyerrs.Cant m>f INSURERMAFFORDING COVERAGEE NAIC# INSURED Jorda Enterprises, Inc. DBA Jorda NeclxaniCal Contractor's 8011 NW 14th St. Miami FL 33126 INSURERA:National Trust Ins Co INSURERS: INSURER C: INSURER III: INSURERS: INSURER F : COVERAGES CERTIFICATE NUMBER: 107920640 REVISION NUMBER: THIS i5 TO CERTIFY .PST 1TE.RCLICIE OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED ABOVE FOR THE POLICY PERIOD H TH INDICATED. FICATErt11UI MAY BEp� OR MAY PERTAIN 'TH INSURANCE IATFFFOORDED Sy EN p�}C CONTRACTOR OTHER SORO HEREIN IS BJECT TO ALL THETERMS, EXCLUSIONS AND CONDmONS OF'SUCH POLICIES. LIMITS SHOWN MAY HAVE EIS =I:NN REDUCED by RAID CLAIMS, INSR A TYIEOF INS1 LANCE GENERAL LULIEEITY R COMEROIAL "GENERAL. LIABILITY CLAIN ADE x OCCUR ADDI. SUBS lo LT.V0 CMAIV K W, L% GEN'L AGGREGATE LIMITAPP�LIESPEW POLICY l JECT I� I LSD' AUTomos LEUABIUT , Jt AWAtITO ALL OWNED AUTOS SCHE ?I LFDAAUTQS HIREOAUTOS NON CANNED AUTOS 01,00096 22 12/334 010 12/ 011 went EAC1HA•• CUI RENCE PREMISE: Eac *sreltee) 1,'000,000 00, 000 MED E P (A y me person) $5 , Doi PERSONAL a Aov INJURY $3,000 GENERAL AGGREGATE $' 00,000 PRODUCTS - COMPJOPAGQ $2, 000, 000 S /00150331 12/3:1/201 1,000,000 PROPERTY DAMAGE (PAT 014001X) $ UMRRELI A LIAR ExceIS LUA9. OCCUR CLAIMS -MADE DEDUCTIBLE RETENTION $10,060 WORKERSCOMPENSATION AND ISSPLOYERV LLASLITY ANY PROJ'RSTORJPARTNERlOXECUTNE (�-1�"� DESCE MONO OPERATIONS NIA 12/31/2010 /31/201.1 FAOI0CGUI1 AGGREGATE 000.,000 43,000,090 E.L. EACHAC E1.,, DISEASE - EA EMPLOYEE $ EL DISEASE- POLY LIMIT $ P1ToaoF OPERATIONS/ LOCATIONS/ ' CtES (Attach A 101, . RemarksSchedWe, e, ei9I q*e ) 30 days notice Of cancellation except 10 days notice for non- payment CERTIFICATE HOLDER CANCELLATION Miami Shores Building & Zoning 10050 NE 2nd Avenue. Miami Shores FL 33138 -2304 SHOULD ANY OF THE BEFORE THE TCER TIONAiEH SF WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISID AUni l7ATFE ACORD 26 (2009/09) ®1988 -2009 ACORD CORPORATION. All rug The ACORD name and logo are registered marks of ACORD Acc?R J Policy Number: CERTIFICATE OF LIABILITY INSURANCE Date Entered: 10/5/2010 DATE IMM/DDN YYY) 10./5/2010 THIS CERTIFICATE IS ISSUED AS A.it ATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGEAFFORPED EY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUR:ER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT! If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed: If SUBROGATION IS WAIVED, subject to. the terms and conditions of the policy, certain policies may require an. endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTAMT Neighborhood Insvraaoe Ooapany nun tfo. EMI (3p5) 597,-4)502 FA X Max (305) 597 -4547 > : 2t'ei ghborhood_i nsuranae@yaboo. coin PRODUCER 4755 SW 8th Stmt Miami., Florida 33134 INSURED Jorda Enterprises, Inc. $Sirna Cortez 8011 NW 14th Street Same As Above Waal , FL 33126 CUSTOMER ID, INSURER�S)AFFORDING COVERAGE INSURER A: eGhflo109 Insurance CO INSURER B: INSURER c: INSURER D,: INSUI INSURER F COVERAGES CERTIFICATE NUMBER: REVISION ND'. THIS t5 TO CERTIFY THAT THE POLISIES OF INSURANCE LISPED BELOW HAVE PEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDIN REQUIREMENT. TERM OR:CONDfnOH OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED- INS I._..a= + -1 �.: s3- alt AD ^ia0s.- .17._. L -...v. TH TERM •a U oi[. ANA s: IONS eF sa.PO LI. JrS 91a,:... w:Y MA _ "1.0 +.mss' .�a �Y PAID CIA! LTR S POLIOT EFF POLICY EXP TYPE OFINSURANCE UASIU'TY OMMERCLAL GENERAL LIABILITY CLAIMS -MADE Tin POLICY NUMBER 4 I3EWLAGGREGATE L@ArrAPPLIES PER IPODGY SECT I i tO AUTOMOBILE-LABUTY ANY AUTO ALL OWNED AUTOS SCHECA/LEDAUTOS HIRESAUTOS. NON-OWNED AUTOS EACH OCCURRENCE. DAMAGETORENTED PREMISES (Ea occurrence) MBA ENFIRWOM ppison) PERSONAL AADVINJURY GENERAL± iRESATE PRQDUCM COMPfOPAGO aotiaNED SINGLE LIMIT tel secktere) BODILY INJURY (Pei patter)) BODILY INJURY {PerScctdent) PROF (Para GE $ UMBRELLA LAB EXCESS LIAR OCCUR CLAIMS -MADE DEDUCTIBLE EACH OCCURRENCE AGGREGATE $ WORKERS COMPENSADON AND EiPPLOYERS' LIABILITY AAIYin?PetrrQRIPARTNttutxEt THE O K RftaEMBER exCLueem in p1>e utudr ON OP OPERAT(om scam TIaTCS251507 10/7/2010 10/7/2011 I TORY LIMITS I 1 ER E.L. EACH ACCIDENT EL DISEASE- EA EMPLOYEE E.L DISEASE- POLICY LIMIT $500 000 $jai ,0a0 $500,000 >MI P31i IF AT LOATIM1 VEHMAttabrACORD 1111, Additional Remarks Schedule, Smoot space is required)'. "$O dayys notice of cancellation, except 10 days notice for no payment" CERTIFICATE" HOLDER' CANCELLATION Miami Shozera Building 5 Zoning 1005O NB 2tid Avenue Miami Shores, S. 13e -2304 S05 785 2204 - SHO0t0 ANY OF-THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP1RAT)ON DATE THEREOF, NOTICE WILL BE DELIVERED IN Ae NCEwiTH THE POLICY PROVISIONS. TWEAma A ACORD 25 (2009109) u "IB*B ". UUS Xa.vrvr u6f6F�,VaVSa.va�• rya a,yPaao acaa�ar . rw. The ACORD name and logo are registered marks of ACCORD Produced wring Forms Soo Plus software. veme.F©tmsBess.cnnn lmmresleva Publishing 8o0- 208=1977