MC-11-1832Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 165173
(HV25
Permit Number: MC -10 -11 -1832
Scheduled Inspection Date: February 22, 2012
Inspector: Bruhn, Norman
Owner: MCCREADY, JAMES
Job Address: 1399 NE 103 Street
Miami Shores, FL
Project: <NONE>
Contractor: UMC MECHANICAL CONTRACTOR
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number 1132050300190
Phone: (786)715 -1447
Building Department Comments
BATHROON EXHAUST FANS & KITCHEN HOOD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
February 21, 2012
For Inspections please call: (305)762 -4949
Page 10 of 52
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 Type: MECHANICAL
OWNER: Name (Fee Simple �Titlleeholder): J hva r ivi G c r. �` °S Phone #: 3 9 S s S 6,- g 4 6 F.
Address: .31, v' . (�( / / .l C 3 57".
o.J
Pte, „o MGII-IgbZ
Master Permit No. ? C - 11 - 14 2 S
City: 0-1 . J ti .e e.--5 State: F( Zip: 3 1 3 g
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 3 41 1 /Q L 0 3 5 f.
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: 0 RC- (N1C.(tAO ■ CAL Cb N i 'jt, C bZ Phone #: slots - `447
Address: 1142,9 SUJ C., Z S T Z- L 0 Cie
City: Ht A 141 State: F L
Qualifier Name: MANUtL 14‘31.1-0 Z
Phone#:
-33 Ics 3
-7313.715-14,47
State Certification or Registration #: CAC I 2.1 OOO7 Certificate of Competency #: 1
Contact Phone #: %8(p -7 (S' 14641 Email Address: yr i ROZOwt c e. o \ • CAIA
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Q-• Square/Linear Footage of Work:
Type of Work: ❑Address Id(-llteration ❑ URepair/Replace Demolition
Description of Work: 5�?. "` +` ^� _ X e� � t 3.4-1,.
******** ******** **m**** * * * ***** *** ** *** ees+r a��xx��x.x*a �x x�x� �r u�* r �x+x �x�x�x x �x.x�x�x.a x�x�
\ 74O
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)
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 A}'r'IDAVIT: 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement mus be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. the ' . sence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
L• ntractor
The f d 's • • ;e. oing instrument was . knowled ed before me 's akder
day o �/ _ 1 _ d .• : � NI€
, 20
, by "lG/ �y� a—D 4r
Sign
IVO& A AMR&
g'
Owner or Agent
o : •� m instrument was knowle ) .e
, 20 11 ,by
onall 1 me or who has produce
II. fl .yientification and who did take an oath.
NOTA
9
!'
re m
•
PUBLIC:
I
h
f
who is
y
rsonally known to me or who has produced
as identification and who did take an oath.
Sign:
Print:
My Commission Expires:
aka * * ** * *****•x•x**+x+xu: ******
APPROVED BY
NOTARf lc - STATE OF FLORIDA
disis Y. Rivas
'scion # DD620574
"'•< ais►
res. ,, 06, 2010
Sign: t.�� = — - �.v .. .
Print:
rcr NOTARY rum- STATE OF FLORIDA
Comm• {�aQ ��.uu.�i
n m�sst0� tiot►atNotatY My Commis' . j ,.. ir1.1diS1S Y. Rivas
Sptou9 :—.
:Commission #DD620574.
4.,„ n,,.•$ Expires: DEC. 06, 2010
BONDED THEW ATLANTIC BONDING CO,INC.
*********************** * * ** * * * * * * * * * * * ** * * * * ** * ** * * *** *sass * * * * * ** * * **
4!J
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Zoning
Clerk
STATE OF FLORIDA AC# 5 510 5 5 i
DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
CMC1250007 04/22/11 100425522
CERTIFIED MECHANICAL CONTRACTOR
MUNOZ, MANUEL
UMC /MECHANICAL CONTRACTOR CO
IS CERTIFIED under the provisions of Ch.489 Ed
Expiration date: AUG 31, 2012 W1042201005
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ# L110422010
DATE BATCH NUMBER
LICENSE NBR
04/22/2011 100425522 CMC1250007
The MECHANICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2012
MUNOZ MANUEL
UM/MECHANICAL 4 L CONTRACTOR CO
MIAMI FL 33183
RICK SCOTT
GOVERNOR
DISPLAY AS REQUIRED BY LAW
CHARLIE LIEM
SECRETARY
IMPORTANT
F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
O 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
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 meal
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 an the certificate to meet the requirements of this
section.
a
05 -12 -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:
05/12/2011 EXPIRATION DATE: 05111/2013
MUNOZ MANUEL SR
264550233
BUSINESS NAME AND ADDRESS:
UMC /MECHANICAL CONTRACTOR CO
13428 SW 82 ST
1 -104
MIAMI FL 33183
SCOPES OF BUSINESS OR TRADE:
1- CERTIFIED MECHANICAL CONTRACT°
**
IMPORTANT: Pursuant to Chapter 440. 05114 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 440.051121, F.S., Cettilicates of election to be exempt... apply only within the
scope of the business er 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
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
certittcate eo longer meats the requirments at this section fat issuance of a certificate. The department shalt revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-11
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
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 05/12/2011 EXPIRATION DATE: 05/11/2013
PERSON: MANUEL MUNOZ SR
FEIN: 264550233
BUSINESS NAME AND ADDRESS:
UMC /MECHANICAL CONTRACTOR CO
13428 SW 62 ST
I -104
MIAMI, FL 33183
SCOPE OF BUSINESS OR TRADE
1- CERTIFIED MECHANICAL CONTRACT°
H
E
R
E
QUESTIONS? (8501 413 -1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
Oct 04 11 10:28a InsuranceNOWAgency, Inc.
786- 573 -4486 p.1
'� R CERTIFICATE OF
LIABILITY INSURANCE I DATE (14101°°""""
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY .AND CONFERS 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 BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDMONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and condItlons 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 endorsements .
PRODUCER 786- 573 -4485
Insurance NOW Agency 786-573 -4486
12915 SW 132 Street suite 4 -B
Miami, FL 33186
INSURED
UMC Mechanical Contractor Co.
13428 SW 62 Street
Miami, FL 33183
NAME: Mavleen Blandon
PHOIYE
I . eat 786- 573 -4485
&DDRESS:
PRODUCER
CUSTOMER ID#:
I (FM. Nor 786- 573 -4486
COVERAGES CERTIFICATE NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR R. THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIT 1 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
L�?3 TYPE OF INSURANCE iNBB Iv0 POLICY NUMBER 1 ip LICY EF 1 D/YYYYI
GENERAL. LABILITY
A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
CLAIMS-MADE 1I) OCCUR DAMAGE PREMISES Mee merrDe an $ 100,000
lNSURER(S) AFFORDING COVERAGE
INSURER A: Western Heritage Insurance Co.
INSURER B :
INSURER C:
INSURER D :
NAIC 8
INSURER E :
INSURER F •
LIMITS
$ 1.000.000
GEM_ AGGREGATE LIMIT APPLIES PER:
71 POLICY n 1F I we
AUTOMOBILE tudatuT•
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
UMBRELLA [JAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNEPJ C(ITIV.0
OFFICER,MEYIBER EXCLUDED?
(Mlyyendatory In NI)
DESCRIIPTIO OF OPERATIONS flow
0608111C
06/06/2011
06/0812012
NED EXP (Arty a'Ie person)
PERSONAL 8 ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMPIOP AGG
COMBINED SINGLE LIMIT
(Ea accident)
s 5.000
$ 1,000.000
s 2.000.000
$ 1,000.000
$
3
BODILY INJURY (Per person)
S
BODILY INJURY (Pet aocI sni
PROPERTY DAMAGE
(Per occident)
EACH OCCURRENCE
AGGREGATE
NIA
1 TORY LINERS I 11:6-
EL EACH ACCIDENT
5
S
EL. DISEASE - EA EMPLOYEE
$
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Atteoh ACORD 101, Additional Remarks Schedule,11 more space is rsgWnsdt
CERTIFICATE HOLDER
E.L DISEASE - POLICY LIMIT
$
Miami Shores Village
10050 NE 2nd Ave.
Miami Shores, FL 33138
Fax: 305 - 756 -8972
ACORD 25 (2009/09)
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Mayleen Blandon
The ACORD name and logo are registered marks
1988-2009 RpORD CORPORA ON. All
.,10 1
"''erne •