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MC-12-2433Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 183483 Permit Number: MC -12 -12 -2433 Scheduled Inspection Date: January 02, 2013 Inspector: Perez, JanPierre Owner: PARDINO, ANA Job Address: 94 NE 99 Street Miami Shores, FL 33138- Project <NONE> Contractor: DESIGN ENGINEERING CO Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060131040 Phone: 305 - 267 -0844 Building Department Comments LEGALIZATION OF 5 TON SPLIT SYSTEM INSTALLED Infractio Passed Comments INSPECTOR COMMENTS False z1/3 Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 28, 2012 For Inspections please call: (305)762 -4949 Page 14 of 22 "'°m,,1-.`�'"KL, CERTIFICATE OF LIABILITY INSURANCE DATE(vinvooYYYY) 12/28/12 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 ADDITIONAL INSURED, the policy(ies) must be endorsed. IT SUBROGATION IS WAIVED, subject to the terms and conditionts of the policy, Certain policies may require en endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Prime Rate Insurance 13874 SW 8 St Miami, FL 33184 Phone (305)5173737 Fax (305)517 -3736 NAMNE ARLES SUAREZ PHONE arc No > 905)5W-3737 � FAX Nor • (305)517 -3736 ADD prilnsrateins®aol.com INSURE' S AFFORDING COVERAGE NAJCE INSURERA: GRANADA INSURANCE COMPANY INSURER A : INSURED DESIGN ENGINEERING COMPANY PO Box 347225 MIAMI, FL 33234- (305) 303.2484 CAVFRALW iacay.�.ww.re .,.... ».. _ INSURERo: INSURER R: INSUtiER E: INSURER F: vrr.. ,r,vp c �yulYloCR: REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THI" 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'. LIMITS SHOWN.MAY HAVE BEEN REDUCED BY PAID CLAIMS. IADDLS VOO POLICY NUMBER POLICY GM POLICY E%P (MMfDDCYYYYL IMWDDIYYYYI A TYPE OF INSURANCE GENERAL LIABILITY • COMMERCIAL GENERAL tJAs r1 ❑ ❑/ CLAIMS -MADE ❑ OCCUR 0 0 GEN'L AGGREGATE OMIT APPLIES PER: ❑ POLICY ❑ J ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTO:?WNED ❑ OSULED AL ❑ HIRED AUTOS ❑ AUTOSWNED ❑ ❑ ❑ UMBRELLAUTAB ❑ OCCUR ❑ EXCESS !JAB OCLAIMS -MADE ❑ OED ❑ RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/P/RTNEWIMCUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandately In NH) If yes, describe uruicr DESCRIP110N OF OPERATIONS below 0185FL00035340 04/17/2012 04/17/2013 LIMITS F,ACH OCCURRENCE DAMAGE TO RENTED PREMISS jEa occurrence) MED EXP (Any one parson s 1,000,000.00 $ 100,000.00 5,000,00 PP,,RRONAL 2, ADV INJURY s 1,000,000.00 GENERAL AGGREGATE PRODUCTS . COMP /OP AGO $ 1,aao,00o.0o $ 1 ,000,000.00 COMBINED SINGLE UMIT (Ea accident) 80DILY INJURY (Per parson) $ S BODILY INJURY (Per accident, t POPERAMAGE trer EACH OCCURRENCE 5 AGGREGATE $ n NIA © wo STATI n OTH- TORY I IMiTs EL EACH ACCIDENT 5 E.L DlSEAet EA EMPLOYE 3 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD t01, Additional Remarks Schedule, If more space la required) CERTIFICATE HOLDER W.. DISEASE POLICY UMIT $ CANCELLATION CITY OF MIAMI SHORES VILLAGE 10050 NE 2nd AVE MIAMI SHORES, FL33138 ACORD 26 (2010/05) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED liMpoRH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIV ARLES SUAREZ 010 ACORD CORPORATION. All rights reserved. RD name and logo are registered marks of ACORD 4 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 r� r OWNER: Name (Fee Simple Titleholder): Y r� C Phone #: 37? Permit No. W A 272433 Master Permit No. Addres : /U City: State: Zip: Tenant/Lessee Name: Phone#: Email: A. 4 JOB ADDRESS: 1 City: Miami Shores days -nom County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Address: too 917 City: i State: Qualifier Name: Zip: Phone#: State Certification or kegistration #: 12 i9/? Certificate of Competency #: Contact Phone#: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ of Work: °Address S Type � - '°fllteration Description of Work: It/Square/Linear Footage of Work: °New °Repair/Replace °Demolition ********* * * * * * * * * * * * ** * *41 * * * * * ** * * * * * *F ************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 1 2,2-1 5 ? CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 2 -41 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 installatitsn 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the, person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first ins , lion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection \I'll n t . e approved and a reinspection fee will be charged. Owner or Agent The for oing in trument as ac • owledg fore ' e this W l.p The for • 'nstrum nt was ac : o GG Ir day of 0 �, by % ' —.._ day of 2012_, by _��7 AZ.�, .� .� s ho s personally known to me or who has produced • 1 ' �� a%. identification and who did take an oath. who 's rsojnally o t or who has produced ( tS t+t , 12'.11" � � n cation and who did take an oath. Sign: Print: My Commission Expir Commis Assn. '' pi a Through National .Notary ****** * * **** **** *** *** ****** ***** ** *7* ***** *********************************** *** ** **** *****$****** * ******4'* /i APPROVED BY \2 / X I -16 ` 2P1ans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06/10/2009XRevised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI).DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO 0 Contract Attached: YES 0 UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS AHU CU PKG 1) M.C.A AHU CU PKG . AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4 °CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name. Phone: State Certificate or Registration N. Certificate of Competency N. Signature Date: (Qualifier's signature only) 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 Permit Type: MECHANICAL JOB ADDRESS: 94 NE 99 ST DEC mgii,-7zuzTri lla 1 x 2612 9_ BY: o0 0- ®- 000000mo°omo, FBC 20 Permit No. MC2005 -104 Master Permit No. BP2005 -1045 City: Miami Shores Folio/Parcel #: 11- 3206 - 013 -1040 Is the Building Historically Designated: Yes County: Miami Dade Zip: 33138 NO Flood Zone: OWNER: Name (Fee Simple Titleholder): ANA PARDINO Phone #: 305 - 775 -4093 Address: 94 NE 99 ST City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: ESSIG POOLS, INC phone#: 305 - 949 -0000 Address: 1800 NE 151 ST City: NORTH MIAMI State: FL Zip: 33162 Qualifier Name: DANIEL ESSIG State Certification or Registration #: CPC052505 Certificate of Competency #: Contact Phone #: 305 - 949 -0000 EXT 213 Email Address: PERMITS @ESSIGPOOLS.COM Phone #: 305 - 949 -0000 DESIGNER: Architect/Engineer: PFEIFFER ENGINEERING Phone #: 786- 235 -2435 Value of Work for this Permit: $ 2,500 Square/Linear Footage of Work: Type of Work: Address DAlteration New DRepair/Replace ODemolition Description of Work: RENEWAL OF PERMIT # MC2005 -104 - POOL HEATER #2.4,(_ ***************************************Fees** Submittal Fee $ Permit Fee $ T 1 �l CCF $ CO /CC $ Scanning Fee $ "' Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE$ 105' co 1,4/14 • 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 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 comme# - t must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. t absence o . uch posted notice, the inspection will b 'd roved and a reinspection fee will be charged. Signature Owner or Agent The for oing instrument was ac owledgedlI fore e this -_1-- day of , 20 1.49,„ by / vtliitll who is . rsonall known to me or who has produced entification and who did take an oath. NOT " Y ' UBLIC: , Sign: Print: My Commission Expires: Signatur Contractor The foregoing '. ` trument was acknowledged before me this • day o 20 by ✓ 'i c I all known to me or who has produced as identifica and who did take an oath. X05 " "I" - - -1- LA I I 1.1 I rO/!� LOS IA V. CUBIL ,.zv. - „ ,. NotCao. m, ExP ses e 12BB10... �':'Qr -r,,0 ° Bonded 1 sough Natiotiai•WO( NO [ i LIC: 11 1 It%,L11114 Sign: Prin My Co nrleny M, ' ernandez emminion #DD904411 pi�'es; Sl P, 27, 2013 1F#ltti ATI 1 ' C BONDING CO., INC. ***** ********************* **** - ******* 'bask*** APPROVED BY Pi* ************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Structural Review Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk