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MC-12-783Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 173030 Permit Number: MC -5 -12 -783 Scheduled Inspection Date: October 10, 2012 Inspector: Perez, JanPierre Owner: WALTERS, CLIFFORD Job Address: 310 NE 99 Street Miami Shores, FL 33138- Project: <NONE> Contractor: RESIDENTIAL AIR CONDITIONING CORP Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060135580 Phone: 305 -6524040 Building Department Comments REPLACE UPSTAIRS DUCTWORK AND 3 RETURNS 1 t Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. October 09, 2012 For Inspections please call: (305)762 -4949 Page 8 of 46 tt),S RESID -1 OP ID: E0 'A�.°RL CERTIFICATE OF LIABILITY INSURANCE DA 05/01/1 Y) 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 POUCIES 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 poticy(les) 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 Dieu of such endorsement(s). PRODUCER 954 -776 -2222 Brown & Brown of Florida, Inc. 964.776.4446 1201 W Cypress Creek Rd # 130 P.O. Box 6727 Ft. Lauderdale, FL 33310 -5727 Commercial Lines House CONTACT PHONE • EXU: {A�iC, No) RLSS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A : *FFVA Mutual Insurance Co.+ 10386 INSURED Residential Air Conditioning, Corp 20250 N.E. 15th Court N. Miami Beach, FL 33178 INSURER B : Harleysville Mutual Ins. Co.+ 14168 INSURER C 11/10/12 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : $ 5,000 COVERAGES CERTIFICAT REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WV!) POLICY NUMBER POLICY EFF @AAIIDDIYYYYI POLICY EXP (MNIDDIYYYYI LNrn'S B GENERAL X LIABILITY coMMERCwL GENERAL uaeiulY GL82251 H 11/10111 11/10/12 EACH OCCURRENCE $ 1,000,000 DAMAGERENTED PREMISES S ( (Ea acaarence) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY n PFRa n LOC $ B AUTOMOBILE X X IJABILITY ANY AUTO ALL OWNED AUTOS HIRED Aims X SCHEDULED NON -OWNED AUTOS BA82252H 11/10111 11/10/12 ode) SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? LJ (Myanndatory In NH) cribe under DESCRIa TIIONN OF OPERATIONS below N I A WC84000259042011A 03/23/12 03/23/13 X I r TORYSTAA TU I i ER- EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 E.L DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space to required) Air Conditioning Contractor MIAM Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THOF, NOTICE ACCORDANCE WITH DTHE POLICY PROVISIONS. WILL BE DELIVERED IN AUTHORIZED FtEPR ���/�A © 1988-2010 ACORD CORPORATION, AU righth reserved. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING . ° Permit No. t l.( 12,---77C3 PE ' ►_ PPLICATION Master Permit No. FBC Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder)C- -0/Q 1 l4G74s Phone # dekr;— '75-V "' 44.5—a2 °2 Owner's Address 3/0 9 rj' th- 2 City YZt )/ ' z4 ( S�i�. er State o Zip 3.344 p RECEIVES MAY 02ZQZ Tenant/Lessee Name Email Phone # Job Address (where the work is being done) �. i /I / iiii' City Miami Shores Village County Miami -Dade Zip FOLIO /PARCEL# // 3 o6 0 /35:4'8© Is Building Historically Designated YES NO V Flood Zone Contractor's Company Name/ /Z,5,v t 4.t %ft__ do RP . Phone # .0-r - bSaa 6' 6 as )e® Con actor's Address` ®2.f17 A -/1 v� o-r City i 144,Q;9-in, /gat State Zip 4b' 27 Qualifier Name Ae/M1141 in //,V.&/ , ' Phone # 3c. 6.r2. -'4 c&/ C. i State Certificate or Registration No. 35-Y-8 Si Certificate of Competency No. Contact Phone Architect/Engineer's Name (if applicable) Value of Work For this Permits Type of Work: ■edition - ❑Alteration Describe Work: E -mail Phone # Square / Linear Footage Of Work: Repair/Replace ❑ Demolition ['New ***************************************pees**** * ******* ***** *** **,r* **** ******* ******* Submittal Fee $ t ID Permit Fee $ \ ki Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ CCF $ CO /CC $ Violation date: Structural Review. $ Total Fee Now Due $ *I/ See Re , de —> 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 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 such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this / The foregoing instrument was acknowledged before me this /4- day of /■ 1 g , 20 f a. , by , day of /140 , 20 /L , by who is me or who has produced identifica i9 did take an oath. it0 41.V1 NOTARY who(" personally known me or who has produced ON n and who di Sign: Print: ELll#214- a My. Commission Expires: 0 11-4,, i ,c1b/Yetru s:44 ** * * **** ** * ** * * *** * * ** ** **** *** * * ** * ** * * * * *** * *** *, rat * * * *, ***************** * * * * *** *** *** *** *,r **** * *** * * ** (:Rli) APPROVED BY l' laps Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) 13.r, /ZONING DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL ."; TA -11- AND COUNTY RULES AND REGULATI - • io"er no brit/ • Eill,/,5rAirif Out- To Re .../ 10X 1 0 .9 re r Leu. t x 1+ •■••■••■ 8X8 X'10 I j 'Lt.— /I t/ TO 1)0ar $YA/r$ . ro RervAi , r. bps r Alvs 6- r)Locr g3kAN Po le- c Arm.rers 1), we) .I r; cA■co 104 8 0 &, or r° $4144. e. ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE 0 DISCIPLINE APPLIED FOR: PLUMBING ELECTRICAL PERMIT # MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER LIGHT OUTLETS CENTRAL HEATING DISPOSAL RECEPTACLES NC (WIND) FLOOR DRAIN SERVICE TEMPORARY "' L) GREASE TRAP SERVICE SIZE IN AMPS DUCT WORK INTERCEPTOR SERVICE REPAIR/METER CHANGE �. N LAVATORY APPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP UNDERGROUND TANKS CLOTHES WASHER OVEN ABOVE GROUND TANKS SHOWER WATER HEATER U.F. PRESSURE VESSELS SINK. POT/3 COMP. i MOTORS 0 -1 HP STEAM BOILERS SINK, RESIDENCE. MOTORS OVER 1 -3 HP HOT WATER BOILERS SINK, SLOP. MOTORS OVER 3 -5 HP MECHANICAL VENTILATION TEMPORARY WATER CLOSET MOTORS OVER 5 -8 HP TRANSPORTING ASSEMBLIES URINAL { MOTORS OVER 8 -10 HP ELEVATORS/ESCALATORS WATER CLOSET MOTORS OVER 10-25 HP FIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS` OVER 25 -100 HP COOLING TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP VIOLATION A/C UNIT NC WINDOW REI SPECTION FIRE SPRINKLER AIR CONDITIONERS HEATER —NEW INST. STRIP HEATER lif 1.. ,I ea li •�; ^,, I it HEATER— REPLACE GENERATORS TRANSFORMERS ,e ; LAWN SPRINKLER —WELL GENERATORS TRANSFORMERS 4 ea, , �,M, �jM s , 6 SWIMMING POOL — GENERATORS TRANSFORMERS �. WATER SERVICE SPECIAL PURPOSE SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY —SEWER SIGN TUBES UTILITY —WATER SIGN TRANSFORMERS SEPTIC TANK SIGN TIME CLOCK RELAY FIXTURES FAINFIELD, 4" TILE/RES. ANTENNA 1 PUMP & ABANDON SEPTIC TANK TELEVISION OUTLETS SOAKAGE PIT CU. FT. VIOLATION CATCH BASIN REINSPECTION DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE _ METER SET (GAS) GAS PIPING