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MC-10-1050Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 145727 Permit Number: MC -6 -10 -1450 Scheduled Inspection Date: February 07, 2011 Permit Type: Inspector: Perez, JanPierre Owner: LEARY, KIMBERLY Job Address: 72 NE 104 Street Miami Shores, FL 33138- Project: <NONE> Contractor: MC&C SERVICES LLC idential Inspection Type: Fi Work Classification: Phone Number 305 - 759 -1808 Parcel Number 1121360130870 Phone: (305)663 -2870 Building Department Comments INSTALLATION OF RANGE HOOD EXHAUST DUCT IN A RESIDENCE assed Failed 1/4 Inspector Comments Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 04, 2011 For Inspections please call: (305)762 -4949 Page 1 of 34 BUILD/ N -PERMIT APPLICATION FBC 2.0 Permit Type MECHANICAL Zores V 1' l age adding Department 10.050 N.E 2udAAenuve, Miami•S•hores, F°l,)rida 313$ • Tel': (305) 795.2204 Fax (305) 756.$972 INSPEC.FION''S-PHONE NUM EER: (305) 7:62:494.'9 Owner•'s Naine (Fee,Sim - -j le' Titleholder.')' ` Owner's ddrei$:. N r L` 1 i City IA S-S State Zip Tenant/Lessee Name :. . Phone Enaail Permit No • j 082010 ..... i-o Master Permit No. gc . - 3 - / 0 - 2 2 Phone # C) 7. 7 1 )>a :Job - Address .(where the work is beingr• 1i ne City . 1Ia• Shores Viliae:::. FOLIO /;PARCEL # :Is Building Historically Designated. YE'S:. Flood Zone Contractor':s .Cornpany Name C k C 5.a . Contractor's Address 'S-b0: 50 14114` i'14 City .1 - _ 1tatP F'+L�. Zip '3`3 Qualifier Name L. -I j` S Phone g g � 55 State Certificate :or Registration No M'`C '1.x:4 411 (n1 Certificate of Competency No Contact Phone l 4 z U` Architeet/Engineer's Name (iapplicable) :Value of Work For this Permit $ E mail.. r*ccse'v . ne+ P hotac 11 'Type of Work: []'Addition Al <aerati!on Describe Work b4 t. Q,,d aftf ,e,,E" $.qu$re %Linear Footage Of Work: New �® Re ririRc P� p lace 111 llenncxlihon f soiD .Elc. tus� ._ D i Iw ! - /.Z f 51126--)k, c' E • ******* * * * * ** * * * * * * * ** * *** * *.* * * *i * *** **Fees, *; **c *: * *, ** Submittal : Fee 8.:.;. Notary $ Scanning *k"F' * *.* bk�;: A"k ,: r -k k� ..;xk Permit Fee S. �. Yi U:. CCF $:. Trai'ninglEd:ti:cation Fee $ Radon $ :: . DP'B'R $. CO /CC $ Technology Fee S Bond $ Double Fee $ ..: Violation date Structural Review. $ �- � : � �•� � ��� Total Fee Now Due $ See Reverse side > 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 Permit No. SCEIIN/ZI JUN 0 8 1010 050 Master Permit No. /C- 3 -10 l'3 - k 1t '✓ s".cr7s Owner's Name (Fee Simple Titleholder) A t f r(e 1 Phone # Owner's Address 72 r v" E 4 t o G 1 City 14(4/(r .=-S--7't State Zip 3U Tenant/Lessee Name Email Phone # Job Address (where the work is being done) .72 E - 10 `-II gribeblr City Miami Shores Village County Miami -Dade Zip '33/ 3e FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name NO ' / Flood Zone M c CN iG Contractor's Address SIC, 1 5g$ `7°-�Y" CT 1G'� P h o n e # ( " 2 : ) c & - 0 (-,96 2,97 City M t • State Zip 331 55 Qualifier Name L,L i er S +..•4t S Phone # (3e ) f; 3 ` r Q /0 State Certificate or Registration No. CM C 12.1 4 i(' (v7 Certificate of Competency No. Contact Phone 074 GaC.s • Z `7 V E -mail a ll a'I & :ri CC say . fl e+ Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ C "C Square / Linear Footage Of Work: Type of Work: ❑Addition [V Alteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: i.osq- tr-if57oni OF 164 L 14c00 Exifilimi J V T ! v 4 Iliwp 7ve E * x*,**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * *** * ** *x * * * * * *, * * ** ** * * * ** * * * * * * ** * * * *** 50i OQ CCF $ 0• CO /CC $ Submittal Fee $ Permit Fee $ Notary $ Scanning $ .00 Radon $ Double Fee $ Violation date: Training/Education Fee $ ' 90 ) Technology Fee $ ! , DPBR $ Bond $ Structural Review. $ Total Fee Now Due $ 04{0. See Reverse side -- 61( Bonding Company's Name (if applicable) Bonding Company's Address City ! State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City f 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, WEL.S, 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 wh/ h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be app ri ved and a reinspection fee will be charged. Signature Signature 0 4er or Agent Contractor The .. e + oing instrument was acknowledged before me this f 7 "` The foregoing instrument was acknowledged before me this days , 20/ by day of 1-1,4H e...-, , 20 L; , by r , who._0 pers ally known 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. My Commission Expires: APPROVED BY mer Engineer (Revised 07 /10 /07)(Revised 06/1012009) NOTARY PUBLIC: Sign:�f Print: tie(S S /97 /-4? My Co ssion Expires: 6 MOISES ABADI MY COMMISSION #DD775285 * *IVPM * 1M ** an!!fir "' - 'It State Insurance * * * * * * * * * * ** 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 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. t7 COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. V COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) F 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 BUSINESS NAME: PI C 6. COMPLETE CONTRACTOR'S INFORMATION BUSINESS ADDRESS: 506i 5. L'. 7f, a. '6e CITY /1 '- STATE ZIP CODE 7 3 (Ss BUSINESS PHONE: ( 365 ) 663 - ,2670 FAX NUMBER (305 ) • 21 CELL PHONE ( ) QUALIFIER'S NAME: 11:0 4- Ste. (mss QUALIFIER'S LIC NUMBER: C 722J E -MAIL ADDRESS (IF APPLICABLE): .re. I^ i- Created on 3119109 BY MLDV I RV 3126109 MLDV S1A1t ur rIuruvf+ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 SALAS ELLIOT MC & C SERVICES LLC 8360 SW 151 ST PALMETTO BAY FL 33158 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our boxers to barbeque restaurants, and they keep Florida's eco economy strong. from Every day we work to Improve the way we do business in order to serve you better. For information about our services, please log onto www.myttoridalicense.com. impact you, , can find �ibbe to department newsletters and lean more regulations that impact you, s Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! • DETACH HERE DATE BATCH N.W. 0 20.09 48 9 3 4 cMC1'249•`9 • Under t "0: xi0VAsi010 0 Chapte ExpipItta# date: .AUG 31 2 0 escoinsdtute P.O. Box 521 • Mount Prospect, IL - 60056-052I Enclosed are the results of the test you have taken for E.P.A. certification. A passing score of 70% is required per Test Section taken. All technicians must achieve a pass- ing score in Section "A" (CORE QUESTIONS) to be certified in any of the other three Sections. Your test results are indicated in the bottom right hand portion of this form. If you have successfully completed Section "A ", along with any other of the three sections of the Test, it is reflected on the attached Certification Card. If you wish to retake the Certification Test, you need only complete the Section(s) in which you failed to achieve a score of 70% or better: r ELLIOT SALAS 5001 SW 74 CT 104 MIAMI, FL. 33155 PLEASE REPORT ANY CHANGE OF ADDRESS BY CALLING 1- 800 - 726 -9696 esco insdtute Program EPA Approved December 28, 1993 CERTIFICATE NO. 540011376110 NAME: ELLIOT SALAS has been certified as a UNIVERSAL technician as required by 40CFR part 82 subpart F Section A 88 Section I 96 Section II 92 Section III 92 SCORES ANT1 TE_{1FFLORIDA? ,.. , 2010, CE OF BUSINESS lC1�TEI #• &A ART, 94 10 DO NOT FORWARD MC & C SERVICES LLC GUSTAVO L MARTINEZ PRES 5001 SW 74 CT 108 MIAMI FL 33155 iii,ullmiiiti,i„ iii Ai,i,dLidLmhi,fiiudatii SEE OTHER SIDE AC D Policy Number. GL -35272 Date Entered: 11/1/2006 RATS IRINDnlYYWY) 6/8/2010 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE 15 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 POLICES SEL. ©W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder -WI as M /MORAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subJect to the terms and conditions of the policy, cartliin policies may require an endoraemNlt. A statement on thle certificate does not confer rights to the compete hoiden in ilea of such endorse el. PR1n1eCER T 201011LE 1 E INSURANCE, ENC. 9101 -C S. R. 19TH PLACE FORT LADDERDALE , PL. 33324 ammo M C& C Services, LLC. 5001 SE 74TE COURT, SUITE 108 MTAMJ, FL 33155 . 1(954)382 -5259 Lt 954) 302 -0000 E-MAIL FCes►knawlirnsS mei . aom IIRMD CCfe'+'OMOt ro e: u4SuRER(5 AFi aEDIN a CDVERAOE NAiC1 « A ASCRACININt GQISIR@CGia1 Insurance, too. INSURER B • INSURE! C IMS41RN1 D: mamma: COVERAGES CERTIFICATE NUMBER: INSURER - _ REVISION NUMBER: THISISIOCERTIFyTHATTNEFDLEIESOFINSURANCELISTEDBELOWHAVESEENISSUEDIOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED. NOTWRHSAANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OT EA DOCUMENT WITH RESPECT TO WHICH THIS OERTEIWEMAYBEELSUEDORNIAYPWAIKTHEINSURANCEAPPONOEDIEYTHEFOLICWGDESCRIBEYNEREINISSUELIEMTTOALLTNETERMS, EX LU$IC INS AND CONDMON$ OF SUCH POLIQIES. LOMTS SHOWN MAY HAVE BEEN RF,DUCED BY PAID CLAIMS. R L7�R :Y PL° CP IIRANCi' �� „ , , -ift POLICY UP POLEV NUMBER POLICY EXP IMM/UDNYYYj UMfl A CNNERAL MAIM COMMERCIAL GENERAL LIABILITY OCCUR __.....IMMIDDerffr) GL -35272 "/9/2010 '/9/2011 EACH OCCURRENCE s3- ,OOO,COO .AMAX + RENTED 2100,000 CLAIMS -MADE OIL .I:Bh�tl;IEsiEaaaeuxai,„oi MED EJiP ona raga) 551000 PERSONAL aADVINJURY V1 ,000,000 op eva.A$eREeATE s3.,000,000 OEN% AGGREGATE LIMIT APPLIES PER: i LOC PRODUCTS - COMPIOPAGO $1,000,000 POUOY PRO- $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUT OS SGHEOULED AVM HIRED ANTOS NON -OWNED AUTOS COMBINED autumn* ( aGddtxlt) $ SLIMLY INJURY (Per pease) $ WAS MI RY (Nor 7 PROPERTY (Poracd AGE S $ $ umlaut MAO EXCESS , Vet OCCUR CLAIMS-MADE YIN n wow III= N 1 A N/A EACH OCCURRENCE S AGGREGATE $ DEDUCTIBLE RETENTION $ $ A U ■[� + ti ■aa $ WORK= COMPENSATION XNO EMPLOYERS' USSIUTY ANY PROPRIETCRIPARTNERIEXECIJTI1fE OFFICERIMEMBER EXCLUDE(}? (Mandstowy in N ESC DRIPTION OF OPERATIONS E L EACH ACCIDENT E.L DISEASE - EA EMPLOYE E.L. DISEASE . Polio, ' LIMIT bSBCRr nde OF OPERAIIQN$1 LOCATIONS, VEISOLES puma Ammo is , Additittnal Resod* S4iltins* Bums awn I1 moon) PLCHBING,AIRGONDITIONINC AND PSS`FtXOE +PANT SERVICES CONTRACTOR; OC$iERCIAL,INDOSTRWAL AND RESIDENT >4L Sa g vII 211M __ AVrrQE SHOULD ANY OF THE ABOVE DESCRIBED POucisS BE CANCELLED REFo E: 1115 EXPUNCTION CATE THEREOF, RIME WU, EE DELIERED IN ACCCRDAN0F, i(VI H THE POUCY PROVER . /CAW aeons, I L. $3138 �AIItn1 mienREP p$B�rTicayEs�vry1 -5..--4;',.....,*. AYAL'S / A. .}�' AL9,AG . �.. 6- .,'4 -.7 ! -,y i 198E -2009 ACORD CORPORATION. All rights reserved. ACORD 2S (2009109) The ACORD name and Iona are registered marks of ACORD Pmultazi using Forms Bass Pius aottw9t6. anvw.Fntms2oss.cam: impressive Publishing 80420$ -1977 TO /T0 39Vd SNI 30Q31MON>1 13)1 0800Z8Et'56 L6 :t 0TOZ/80/90 Jun 80 2016 15:57:52 Via Fax -> The Hartford Fax Page 903 Of 083 ACORD, CERTIFICATE OF LIABILITY INSURANCE 17022 06-08-2010 PRODUCER PAYCHEX INSURANCE AGENCY INC 210705 P:()- F:(888)443 -6112 PC BOX 33015 SAN ANTONIO TX 78265 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 MSURED MCC SERVICES LLC 5001 SW 74TH CT STE 108 MIAMI FL 33155 COVERAGES WffURERA:Twin City Fire In Co INSURER U: INSURER CI INSURER D: INSURER E: THE POUCIES 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 POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR TYPE OPEVMMANGE POLICY NUMBER Y �7E ww y I wv Li4fIT3 GENERALLIARBJTY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 4 FIRE DAMAGE (Any one Orel 4 CLAIMS MADE Li OCCUR MED EXP (Any one parson/ 4 _ PERSONAL & ADV INJURY 4 GENERAL AGGREGATE $ GENT- AGGREGATE LIMIT APPLIES PEA: POLICY n� 1LOC PRODUCTS - COMP /DP AGG * AUTOMOIR. _ — _ — ELIABIL Y ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMB IN ED SINGLE LIMIT (Ea aeaident) 8 BODILY INJURY (Fm person BODILY WJURY (Per aemdant) PROPERTY DAMAGE Per aaoident) e GARAGELJAMLUTY ANY AUTO AUTO ONLY - EA ACCIDENT 4 OTHER THAN EA ACC 4 AUTO ONLY: AGG 4 EXCESSLIALIS/TY _ OCCUR _ CLAIMS MADE DEDUCTIBLE RETENTION 4 EACH OCCURRENCE $ AGGREGATE 9 4 * $ A WORKERS COMFENSA77ONAND EMPLOYERS'LMABRITY 76 WEG TY9783 10/30 /09 10/30/10 X TD Y LP ITS 9P EL. spew ACCIDENT 41, 000, 000 E.L, DISEASE - EA EMPLOYEE 411000,000 E.L. DISEASE - POLICYUMIT *1,000,000 0771 ER DESCMPTION OP OPERATIONEVAOCA770AWMAIZEGEXCLUNONS ADDEDCY ENDOREEMMITAFECIAL A40W GAIL Those usual to the Insured's Operations. CERTIFICATE HOLDER ADDITIONAL M URED,• !Y&URIALETTER: _ MIAMI SHORES VILLAGE BUILDING DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 CANCELLATION 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 (1O DAYS FOR NON-PAYMENT) TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. ACORD 26 -S (7167( A AWN 0-.L.L 6 ACORD CORPORATION 1988