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RC-13-174Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 189951 Permit Number: RC -1 -13 -174 Scheduled Inspection Date: April 25, 2013 Inspector: Rodriguez, Jorge Owner: Job Address: 118 NW 97 Street Miami Shores, FL 33150- Project: <NONE> Contractor: ORONI INC Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number (305)978 -4715 Parcel Number 1131010250070 Phone: (305)685 -0412 Building Department Comments REMODEL 1 BATH & CLOSET Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 25, 2013 For Inspections please call: (305)762 -4949 Page 30 of 49 Miami Shores Village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 LD NG PERMIT APPLICATION JAN 3 0 N13 FBC 20 1-0 Permit No. Master Permit No. geA 3 — 171 Permit Type. BUILDING ROOFING JOB ADDRESS: J' `° u SS A-( L- (1 O MAJ Miami Dade Zip: 33/32K City: Miami Shores Folio/Parcel #: II '3 to/ ' 02-1:007-0 Is the Building Historically Designated: Yes County: NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Phon .3 v T-7 6_=_� v Address: � ' ( City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: OROIJ t ( /L4) C Phone#: (5°r) 1C - `f Address: l' k t-k 3 LP 6 c.r--- City: 1 State: Zip: l b b Qualifier Name: (NZ-40-ft . t(€`L5 State Certification or Registration #:CGI '? ( brit Certificate of Competency #: Contact Phone #: Eppail Address: DESIGNER: Architect/Engineer: , f 6 L-- Phone #: Value of Work for this Permit: $ d Type of Work: UAddition ❑Alteration Description of Work:. Lit Phone #: Square/Linear Footage of Work: New ❑Repair/Replace ❑Demolition Color thru tile: ** *** *�xYx **** * * *** * * ** *** *** ********* Fees******************************************** Submittal Fee $ £'UL- r Permit Fee $ 1 2 i CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 AE1HllAVIT: 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 /j` " Signature, Owner or ent Contractor The fore oing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this I ) day of d , 20 _ b ' t� i�-� (Z ` lC L day of , 20 13., by who is personally known to me or who has produced r-(--1 1) who is personally known to me or who has produced As identification and who did take an oath. 04S el- t as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: My Commission Expires: 001111111111,01/4 * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY C s ••• . SA ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Sign: Print: ****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) HOW 1111111111 RHINO MO 1111111111111 NOTICE OF COMMENCEMENT CFN 2013R0195331 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECT104IR Bk 28528 P9 3619; (1 P RECORDED 03/13/2013 14:43:17 HARVU RUVINF CLERK OF COURT :TANI-DADE F PERMIT NO. 13 -171( I/7r 18,3 TAX FOU0 NO. 11-3101'020'0070 COUNTY FLORIDA - S T A T E O F F " e i LAcouNST PTyAGEOF LADE / k STATE OF FLORIDA HEREBY CER7IFY original Med In 6* alv (*.the COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be mad property, and in accordance with Chapter 713, Florida Statutes, the follcmqngi is provided in this Notice of Commencement. 1. Legal description of property and bLret / address: RESUB OF MK 3 OF BONMAR PARK PB 42-60 LOT 7 011( 3, LOT SIZE 75.000 X 115, OR 12838-2889 0386 1, COC 26468-2872 06 2008 3 118 NW 97th Street, Miami Shores, FL 33150 2. Description of improvement: Expansion of master bathroom and closet construction 3. Owner(s) name and address: Christopher Moussally 118 NW 97th street, Miami Shores, FL 33150 Interest in property: 100% Owner Name and address of fee simple titleholder: Christopher Moussally 118 NW 97th street, Miami Shores, FL 33150 4. Contractor's name and address: Omni, Inc. 14040 NW 6th Court, North Miami, FL 33168 5. Surety: (Payment bond required by owner from contractor, if any) Name and Address: N/A Amount of bond $ N/A 6. Lender's name and address: N/A 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: Larry Hershman, Esq. 11420 N. Kendall Drive, Sults 110, Miami, FL 33176 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: N/A 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date is specified) 2013 11(.1'41413kt,- fca Prepared by CstoPher MoussanY day o1 ti a&h ,20 / 5 Address: Lf.) PERMIT # 12c. 1 17,4 ®' CONTRACTOR: 0 �i SUBMITTAL DATE: 6 Z i ) ADDRESS: 1 CK IQ 4/l e -°-� ) 91 e� 1 NAME: 0 U S L ut RESUBMITAL DATES: PROJECT TYPE: , A 4- C ,(, ZONING FIRE STRUCTURAL IMPACT FEES ELECTRICAL ,ZesP 9 HRSIDERM nK- ii / „lit-i9 PLUMBING i I______ ME I.I AL_ A c BLDG - l �— Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 189708 Permit Number: EL -1 -13 -183 Scheduled Inspection Date: April 22, 2013 Inspector: Devaney, Michael Owner: Job Address: 118 NW 97 Street Miami Shores, FL 33150- Project: <NONE> Contractor: ATLANTIS ELECTRICAL CORP Permit Type: Electrical - Residential Inspection Type:. Final Work Classification: Alteration Phone Number (305)978 -4715 Parcel Number 1131010250070 Phone: (305) 551 -4043 Building Department Comments repalce outlet in bathroom and closet Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 2- /9-/7/2_ April 19, 2013 For Inspections please call: (305)762 -4949 Page 34 of 38 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: Electrical JOB ADDRESS: City: Miami Shores County: Folio/Parcel #: ( ,4g (1::=4 I e 0� Is the Building Historically Designated: Yes NO FBC 20 { 0 Permit No. LI 3 - I Master Permit No. - C 13 Miami Dade Zip: T-1, (' Y Flood Zone: OWNER: Name (Fee Simple Titleholder):C r2-t S t "` ° d'Ac3o5 Phone#: CJS- Y4( -iy77. Address: A M -C City: State: Zip: Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: 0-603 ' L.3 rk' ` State: State Certification or Registration #: EC- 3 o6 ( t1/44 Contact Phone #: — 39T- al ' 0 Address: City: TLA 71. Phone #: 75G`3S' - (075'0 Qualifier Name: Zip: 3 3 1 s- Phone #: 7 3‘ ' r- co-7 s'o Certificate of Competency #: eiRcke) 1ZSQ 4 , con Email Address: DESIGNER: Architect /Engineer: Phone #: Value of Work for this Permit: $ ° ` Square/Linear Footage of Work: 400 Type of Work: ❑Address ❑Alteration J❑New ❑Repair/Replace Demolition Description of Work: , r trir R6 ° am, tilt " e .fs i +a1 oyG `1�"'3 6 * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * ** * *** *** ***** **** * * * *** * ** Submittal Fee $ Permit Fee $ /f P ti'd CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 niade 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. Owner or /1 The foregoing instrument was acknowledged before me this l The foregoing instrument was acknowledged before me�his 1� day of , 201 3, by C J 7 CR'l if. th( t5 ly of , 20(3, by/-fz, „t 'sec) f z; who is personally known to me or who has produced \ O who is personally known > nown to me or who has produced C. - -- As identification and who did take an oath. ON Pt : - kn as identification and who did take an oath. NOTARY PUBLIC: °o����tUi���lt►ttte��io NOTARY PUBLIC: Signature Contractor .`ate 6. 1 Sign: = : o ; Sig Print: • q��e� 44 o`'Q'' _a Pri •• .....•••• C:) •••••• My My Commission Expires: APPROVED BY Plans Examiner Zoning Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk 01/07/2005 09:58 3056434410 JOS PAGE 01 'STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 PEREZ, FRANCISCO JULIO ATLANTIS ELECTRICAL CORP MIAMI I SW 20 TERR FL 33175 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong, 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.mytlnridaiicenae.com. There you can find more information about our divisions and the regulations that ; ..: impact you, subscribe to department newsletters and learn more about pie 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 far doing business in Florida, and congratulations on your new license! AC# 6139507 DETACH HERE STATE ow'Ft.ORw,r • AC# P 11.3 9 5 Q 7 'APARTMENT OF BUSINESS AND PROFESSION', REGULATION EC13601914. 4', '2 1.2 110398967 CERTIFIED ' ,;:`CRIBL ' CONTRACTOR PEREZ, F . s '4 : LIO • ATLANTIS 'F, .CORD IA CERTIFIED under the proaiainrla a Ch.489 FS epe4ratiffi data. AUG 314 2014 L12052401181 THIS DOCUMENT HAS A COLORE=S 5ACKGROUNb , MICROFRINTING . LINEMARK:•: PATENTED FADER STATE OF FLORIDA DEPAR R OF,:ai 08 PROF$$SSICINAL R$t3VLATION ELECTRICAL TRS T,ICEr+1'S•IN•s BOARD SEQ# L12052401181 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter Expiration date: AUG 31, 2014 PEREZ, FRANCISCO JULIA • ATLANTIS ELECTRICAL CORD": 12803 SW 20 TERR MIAMI FL 33175 RIK 'G©VERNORT • DISPLAY AS REQUIRED BY LAW SECRETARY 161/ U l/ 2bbb b`j: btl dbbb4d4410 Imo JUb rAtat eIl FlISTT CLA$$ u.8. POSTAOE I PAID MIAMI, FL PERMIT NO. 221 372675- 0 THIS IS NOT A BILL - DO NOT PAY BUSINESS NAME / LOCA RENEWAL ATLANTIS ELECTRICAL CORP STATE RECEIPT 3001914 389164-6 12803 SW 20 TERR 33175 UNIN DADE COUNTY OWNER ATLANTIS ELECTRICAL CORP See. 96 ELEC ICAL CONTRACTOR WORKER/S QM.Y A L % EialiatriG MVO LAWS O, Te on mi5. DO NOT FORWARD r t ffAUIRets ow LAW. TIN la ur ►fasq PAYINNT MEWED rammOADII touem Tnx COLLECTOft 60140000262 000075.00 SEE OTHER SIDE ATLANTIS ELECTRICAL CORP FRANCISCO J PEREZ PRES 12803 SW 20 TERR MIAMI FL 33175 ! „ # #,,,1i ►„ ►iii,,, #, #, # ►,,, # # „ ## „� :i # : #, #, # #,.,,, # #,�� #,i ACORD. CERTIFICATE OF LIABILITY INSURANCE I DATE �SDNY) PRODUCER BUTLER, BUCKLEY & DEETS 6161 BLUE LAGOON DRIVE MIAMI, FL 33126 Phone: (305)262 -0086 Fax: (305)262 -0187 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER. This CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED ATLANTIS ELECTRICAL CORP 12803 SW 20TH TERRACE MIAMI, FL 33175 Phone: (786) 395 -6790 INSURER A: North Pointe Insurance Company INSURERS: INSURER C: INSURER D: INSURER E: COVERAGE THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED ro THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTHMTHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYY) POLICY EXPIRATION DATE (MMIDDIYY) LIMITS A GENERAL LIABILITY 7 COMMERCIAL GENERAL LIABILITY CLAIMS MADE L OCCUR GEN'L AGGREGATE LIMIT APPLIES EXTPOLICY PROJECT LOC 8090020508 02/10/2013 02/10/2014 EACH OCCURANCE $ 1,000,000 DAMAGE TO PREMISES LIMIT(Any One Occurrence) $ 100, 000 MED EXP(Any one person) $ 5,000 PERSONALANDADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY _ ANY AUTO ALL OWNED AUTOS — SCHEDULED AUTOS — HIRED AUTOS — — NON -OWNED AUTOS — COMBINED SINGLE LIMIT (ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY 1 ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY 7 OCCUR 0 CLAIMS MADE 1 DEDUCTIBLE RETENTION EACH OCCURANCE $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY JWC STATUTORY LIMITS n OTHER EL.. EACH ACCIDENT $ ELDISEASE-EA EMPLOYEE $ ELDISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES!EXCLUSIONS ADDED BY ENDROUSMENTISPECIAL PROVISIONS Electrical work within buildings; CERTIFICATE HOLDER 1 IADDmONAL INSURED:INSURED LETrER: I !CANCELLATION ,VILLAGE OF MIAMI SHORES /BUILDING & ZONING 10050 NE 2 AVENUE MIAMI SHORES, FL 33138 Mailed to: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION ON LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORRFAREPRESENTATIVE ,....4,,,9„,;_o ACCORD 26-S (7/97) ACORD CORPORATION 1988 ATLEL -1 OP ID: DA AL r3P. L .,.- - CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 02126/13 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. 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 305- 262 -0086 BUTLER, BUCKLEY, DEETS INC. 8161 BLUE LAGOON DR., STE 420 MIAMI, FL 33126 Mariana Gonzalez CT DAMARIS ALVAREZ PHONE FAX (NC. No. Ext): 786-216-1760 (Arc, No): 305- 262 -0187 Lam, DAMARIS@BBDINS.COM INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A : FLORIDA CITRUS, BUSINESS & LIABILITY COMMERCIAL GENERAL LIABILITY INSURED ATLANTIS ELECTRICAL CORP. 12803 SW 20TH TERRACE MIAMI, FL 33175 INSURER B : INSURER C : INSURER D : $ INSURER E : $ INSURER F : $ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MISR LL1R TYPE OF INSURANCE �R � WVD POLICY NUMBER (MMIDD IYYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GEN'L AGGREGATE 7 POLICY LIMIT APPLIES JET PER: LOC $ AUTOMOBILE UABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED NON -OWNED AUTOS OBMaCOMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA MB EXCESS LUIS OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Mow Y / N N / A 106 -50846 10/30/12 10/30/13 X WC STATU TORY LIMITS X OTH- ER EL EACH ACCIDENT $ 500,000 EL DISEASE - EA EMPLOYEE $ 500,000 EL DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION MIASHVI VILLAGE OF MIAMI SHORES BUILDING & ZONING 10050 N E 2 AVE. MIAMI SHORES, FL 33138 i 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 ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo am registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INS P- 184987 Permit Number: MC -1 -13 -184 Scheduled Inspection Date: April 17, 2013 Inspector: Perez, JanPierre Owner: Job Address: 118 NW 97 Street Miami Shores, FL 33150- Project: <NONE> Contractor: ALL AIR SOLUTIONS INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)978 -4715 Parcel Number 1131010250070 Building Department Comments ADD EXHAUST FAN Infractio Passed Comments INSPECTOR COMMENTS False 4 (r-1 2/ Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 16, 2013 For Inspections please call: (305)762 -4949 Page 7 of 32 From: Maximo Dopazo Fax: (866) 647 -9673 To: +13057668972 Fax: +13067668972 Page 3 of 4 2127/2013 3:58 accmkt CERTIFICATE OF LIABILITY INSURANCE �- DATE (MM/ DD/YYYY) 10/10/2012 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 pollcy(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 lieu of such endorsement(s). PRODUCER Dopazo and Associates 3900 NW 79th Ave Suite 700 Miami FL 33166 NAME: Alexander Dopazo CIC PHCNN . Exf: (305) 470 -8500 FAX No): (SOS)470 -0111 ADDRESS: eio @dopazo.cama INSURERS) AFFORDING COVERAGE NAIC S INSURER Essex Ins Co 39020 INSURED All Air Solutions Inc 20429 NE 10th CT RD Miami FL 33179 INSURER B :Phoenix Insurance Co 25623 INSURER C Mount Vernon Fire Insurance Co 26522 INSURER DBusiness First Insurance Co. 11697 INSURER E : 100 000 S , INSURER F : COVERAGES CERTIFICATE NUMBER:CL12101003906 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE NSR WVD POLICY NUMBER tg at/DDI ( ) (MM D/YYYY) LIMITS A GENERAL $ LIABILITY COMMERCIAL GENERAL LIAeaLITY /111300 010571 3/27/2012 3/27 /2013 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTtD PREMISES (Ea ocamence) 100 000 S , CLAIMS -MADE X OCCUR PDT, (Any one person) S 5,000 PERSONAL &ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEML X AGGREGATE POLICY LIMIT APPLIES � PER: LOC PRODUCTS - COMP/OP AGG S 2,000,000 S B AUTOMOBILE X — LIABILITY ANY AUTO �0OWNED HIRED AUTOS SCHEDULED NON-OWNED BA7349X697 3/27/2012 3/27/2013 COMBINED SINGLE OMIT (Ea accident) S 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accidertt) S PROPERTY accident) S PIP S 10,000 c X UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE 21 21 182 3 9A 3/27/2012 3/27/2013 EACH OCCURRENCE S 5,000,000 AGGREGATE g 5,000,000 DED RETENTIONS s D WORKERS AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yyees describe under DESCRIPTION OF OPERATIONS below Y / N X N / A 0521 -04444 9/23/2012 9/23/2013 WC STATU- TORY LIMITS 011-l- ER EL. EACH ACCIDENT S 100 , 000 EL. DISEASE- EA EMPLOYEE S 100 , 000 EL. DISEASE - POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Air conditioning sales, intallation and repair. CERTIFICATE HOLDER CANCELLATION (305) 756-8972 City of Miami Shores Building Department 10050 NE 2 Avenue Miami, FL 33138 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 M Dopazo CPIA/MAD ACORD 25 (2010/05) INS025 n01(10R01 O 1988 -2010 ACORD CORPORATION. All rights reserved. Tha arnio 1 Hama anti Irwin Ara raniatararl marlta of AC'ARIl From: Maximo Dopazo Fax: (866) 647 -9673 To: +13057568972 Fax: +13067668872 Page 4 of 4 2/27/2013 3:58 A °0 CERTIFICATE OF LIABILITY INSURANCE 10/10/2012) 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. If SUBROGATION IS WANED, 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 Dopazo & Associates 3900 NW 79th Avenue Suite 700 Miami, FL 33166 N TACT Alexander Dopazo (7,2 No Ext): (305) 470 -8500 r,,","c, No): (305) 470 -0111 E-MAIL E33: INSURERS) AFFORDING COVERAGE NAIC # INSURERA: BusinessFirst Insurance Company 11697 INSURED All Air Solutions, Inc. 20429 N.E. 10th Court Road Miami, FL 33179 -2523 INSURER B INSURER C: INSURERD: $ INSURER E : $ INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL INSR SUBR ULR/D POLICY NUMBER POLICY EFF (MM/DD/YYYY) Policy EXP (MMOD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO TED PREMISES (EaRENoccurrence) $ CLAIMS -MADE OCCUR MED EXP (My one person) $ PERSONAL EL ADV INJURY $ GEN'L GENERAL AGGREGATE $ AGGREGATE POLICY LIMIT APPLIES PER J� LOC PRODUCTS - COMP /OP AGO $ $ AUTOMOBILE LIABIUTIf ANY AUTO ALL OWNED HIRED AUTOS SCHEDULED NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA !JAB EXCESSLIAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY CN=FICERPR ET ER /EXCLUER CUTS (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 0521 -04444 09/23/2012 09/23/2013 X I TORYSLIIMIITTS I I ERR- E.L. EACH ACCIDENT $ 1 OO,000 E . DISEASE - EA EMPLOYEE $ 1 00,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Item 3. A.: Workers Compensation Insurance applies to the Workers Compensation Law of the states listed here: Florida CERTIFICATE HOLDER CANCELLATION City of Miami Shores Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 -2304 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISION& AUTHORIZED REPRESENTATIVE Carol Sipe ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 q� JOB ADDRESS: FBC 20 l C Permit No. 016 i 3 I Master Permit No. c- t 3° I 1 Li City: Miami Shores County: Miami Dade Folio/Parcel #: I t :SR) I ° O eXR Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): ))J `wss��'�Y Phone#: 30s -76/ -/ �' f) Address: City: State: Zip: Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: M\ NN:ce- 5a4,A ev1 Phone#: 9 s'- Sqz 6 845 Address: k‘O ■ 1Jty too, c ' 4ot City: 0-- �.;,ft.it--a,; State: ' L Zip: 3'7rd'1 el Qualifier Name: �jvr-q i.Z ea kw] elm. a- Phone #: State Certification or Registration #: GA L. 1$1. S i%2 Certificate of Competency #: Contact Phone #: Vito - to $ - $ o VL Email Address: '4vn.e.'4OQ14 Q. SvAiNo++- .. ih 4_4) DESIGNER: Architect/Engineer: Phone #: i Value of Work for this Permit: $ Square/Linear Footage of Work: LIDO 0 Type of Work: Address Alteration 2INew ❑Repair/ReplaFc-e� ❑Demolition Description of Work: z`p�, . 1� P O` li P') L S ifi vt (aii) * * * * * * * * ** ,i **** * ** * * * ** * ******** * ** Fees * * ** * *** * * * * ** * *** * *** * **** ** ** * *** Submittal Fee $ � ' Permit Fee $ 601 670 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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, BOIT .FRS, 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 po ted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such po : < notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this I day of � , 20 (3 byCA-(rZ lY'lam ((d Ytc L1 who is personally known to me or who has produced As identification and who did take an oath. �►► ,`,■‘ 1u111t //tit // NOTARY PUBLIC: Sign: Print: My Commission Expires: s C� 'ttn„S TP∎I'C' �\\. Signature Contractor The foregoing instrument was acknowledged before me this I f Oday of J , 20 ' , by a 5 it z who is personally known to me or who has produced 11— Ctu F as identification and who did take an oath. NOTARY PUBLIC: ****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * ** ********************************** * *** *** * * **** * *** *** *** *** * **** APPROVED BY —Flans Examiner Zoning Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk 02/27/2013 15 :01 3056513900 ALL AIR SOLUTIONS PAGE 01/02 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 - 1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 SANCHEZ, SERGIO ENRIQUE 1101ANE SOLUTIONS SEET N 408 MIAMI FL 33179 -2523 Congratulations! With this License you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to•serve you bette For information about our services, please log onto www.myfloridaiicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the 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! kC #62.91 DETACH HERE STATE OF FLORIDA • ACS` • 6 2 el & S 6 "MPAlt' ttikk° O 'r ESINESS M .,P.ROFES S TlONATAAIEGULATTON CAC18l Y#112 2 •i.28046034 ALL AIR �:•SO a •e' INC : IS'.IPERTIFISD :iadex':L>ieprcviaiaaa ; oP 152:489 .•:244r4tiaa flat* :' F.+10 3' .: 2. ©� ,110S22'112014 • • THIS DOCUMENT HAS A COLORED BACKGROUND - rIAICROPRINTING . LINEMARKT'' PATENTED'PAPEP STATg.OF FLORIDA. .�. f• Irv: i� ,.�.« .. ♦ ♦:• .• • °♦ °.. •••'• ' AR E111T:ry{3F'''HgS3NSSS 'AND PROFF9S AL.114EatiLATioN :' ONsT' geTroN • NDQSTRY' :.LIGEN ING 40zaZU DATE BATCH NUMBER :d b.,. 22 SEQ# L12082202014 FALL AIR,'SOL'UR•fiTIo s: • c • 11i� 1 191.` 'STREET j•j# :•.'4 0 8 •• : • FL , X3179 • GO Y$.RNok ° "' DISPLAY AS REQUIRED BY LAW ' • KEN LAWSON SECRETARY • • II 597964-7 RuI 5Ai R � b% e 1101 NE 191 ST 33179 UNIN DADE COUNTY - «.�`y�..k.. -i i -. :- t:;.;::._t '• j -_.- :.g- -r o -'_+'- ' ' •_ -- - . -.�:'' '�"` -:jam`' 4d1`A 191t9S !AX#�CiIIPi y' = -ti8f: , ,,� ,.Ei !iRISEPT ?JOB Q: ixottlial 48/1 THIS IS NOT A BILL -- DO NOT PAY RENEWAL NS INC STATEIEOC€A�3M5118 OIVNER ALL AIR SOLUTIONS INC Sec. 19 -6 all PECnMECHANICAL CONTRACTOR BUSINESS TAX RAPT IT ODES NOT PERMIT TEE WILDER TO VIOLATE ARV MEETING REGULATORY OR ZONING LAWS OP THE ODIIIITV ON CITIES. NOR GOES IT EXEMPT THE ROWER PEEPER' SCR ARV OTHER REQUIRED NY LACY. THIS IS NOT A TEE HOLDERS DECOUNTDYTAX COLLECTOR: 09/14/2012 02280012001 000075.00 SEE OTHER SIDE WORKER /S 1 DO NOT FORWARD ALL AIR SOLUTIONS INC SERGIO SANCHEZ PRES 1101 NE 191 ST MIAMI FL 33179 i 1I111,r1l31EIIliiiIi/IlII►iJIi JCIIhli7411'IkbA11IIYd FIRST-CLASS U.S. POSTAGE -PAID MIAMI, FL PERMIT NO 231 623822 -4 a EIOZ /LZf30 006EI9950E SNOIlf1l0S ZIIV 11V 30/Z0 39 d 18/89/21,112 18:12 JUbbh18808 ALL A1R bULUI1UNS HAUL 88/88 • 597964-1 'THISIgNOTAOLL-DONOTPAY.::::.ii,'%. :.... . -..— rfiribrintin INC . STATECadg.2".:444.:i...**'•':'*: '1': 4 E • : :***1..."*".......::: ! 1101 NE 191 ST 33179 OM DADE COUNTY OWNER ALL AIR sommas INC • . w4gq4' seliniireacHAtucAt. aiNTwroi: illitILA2cmaJLY.S.4 At7174"vng INNAER, 10 AMAIN ANY % Etanne.REGUIATORY OR • qatele. LAYia ' OF ing ' DO NOT : AxANIT AR MEM NCO nary __I:W 41Ern 1,11N2 ALL AIR SOLUTIONS INC ; am' cA AA 1:31PANC: !iflE SERGIO SANCHEZ PRES 1101 NE 191 ST p MIAMI FL 33179 1 VAIWADERENSIAX .., !!AMMMAIft 00/14/2012 00007S.00 aimil.a.lidmIAL,himmujj.44 , 02200012001 h 1____ISEVYMERSME ,—.•••••■•■•••*.....-••••■-,-.--..--n--..—..—. -,—,•,-.• ANN-roma... •••••■••—■—■ 10/09/2012 18:12 3056513900 ALL AIR SOLUTIONS PAGE 01/03 STATE OF FLORIDA DEPARTMENT or BUSINESS AND PROFESSIONAL REGULATION coNSTRUCTIoN.imusTRy LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 SANCHEZ, SERGIO ENRIQUE ALL AIR SOLUTxONS INc 1101 NE 191 STREIST, # 408 Rama xer.1 3317 9 -2523 Csogratuistions! With ibis limn= you become Me of the nearly one milfloo Floridians licensed by the Department of Business end Professional Regulation. Our pmfessio' nate and buttresses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy Wong. Every day we vvork to improve the way we do business in order to serve you bather' For intonation about our services, please log onto wvrw.yoridalicense,coni There you can find more information about our divisions a the regulations that impact you subscrthe to department newsletters and learn more about the Oepartment's Our mission at the Department is License Ma:lenity, Regulate Fairly. We constantly strive to serve you better so that you can MVO your customers. - Thank you for doing business in Florida, and congratulate= on your new license! DETACH HERE 4; CAC181.51. "3E. • 11,P *-54.#044; cit'OP Sii•':1•6.1f tL4 *••.A. . • . . •••• •. ••, tW4,47," .246' fat • . • k r ' 04'4 4 Cge ".kf." ..4.,;;;# ;4* 'iRORP744. THJS DOC‘AIENT HAS A COLORED .3ACKGROLIND MCROPRN7N (3 LINEMARK,'" PATE'NTEL'?.,P,'APai • , STATE i OJ FLORIOA • • , . 3..:•• • • • .!.;;-' • •'. • • • • • • • • PIRbititthlitedivi4:161174itioir.. • •• • • „. .2=9351Wragr4ilgkibig ,==.1aCTION, STIZT714CPWW TOW • SEM ii120a2b2014: . , . • •••.• •• . BATCH NUMBER, TOTCRNSE NBICe:0;...1rtA : • . 'lb /b9/2U12 1U:12 dUbbb139Ui ALL AIR LULUIJUNS HAUL U2 /I A IJ CERTIFICATE OF LIABILITY INSURANCE DATE UD ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOFMUMON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Tim 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 cartificate holder is an ADDITIONAL INSURED, the poli0y(ies) most be endosed. if SUBROGATION .16 WANED, subject10 . the terms and conditions of the policy, certain policies may requires an endorsement A statement on this certificate dens not confer Vas to the certificate holder in lieu of such omdememani(s). aaoimrna$e Dopa.so and Associates 3900 NW 79th Ave Suite 700 Miami FL 33166 POLICY POLICY NUMBER NFL pinseCONTACT 141:4 °" DO,paZO CIC PHO (305) 470 -8500 , wit TIM ago -6113 pp- inio5dopazo. c c @M ns gS)AFFORDINGCOVERAGE CAICr! ME= A Eases. DVS . CO .... -._ .... 39020 . 25623 INSURED All Air. Solutions Inc 20429 NE 10th CT RD Mend FL .33179 immERA:Phoo+x Insurance Co eseerecNoimt Vernon Fire Insurance Co 26522 amomeoBusiness First Insurance Co. 11697 INSIBER E: INSURER P: M00 (AeM°Ae 1 COVERAGES CERTIFICATE NUMBER{ L124403231 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDt11ON 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. tvPROFRISURANGE VW POLICY POLICY NUMBER NFL . POLICY EV DOYYTYN„ A GENERAL X LIAINLITY CONLIERCIAL GENERAL UALNIUTY NS00010571 3/21/2022 $/27/2073 EACH OCCURRENCE $ 1,000,000 DAMAGE TO 2D PREMISES(Ea.Nla;aareme)... 100,000 I CLAW-MADE j1 OCCUR M00 (AeM°Ae 1 $ 5, 000 PERSONAL aArm INJURY $ 1, 000, 000 ommummummos s 2,000,000 OEM AGMEGATE LIMIT APPMES PER: �GIPOLICY n ;LAG PRODUCTS - COMP/QPAGO $ 2,000,000 $ 1 H AI TBMOreLa X _ _ L/ABB PTY ANY AUTO ALLOWED HIRED AL,TTOS _ � AUIESULED AUTOS S� BA7349X 97 3/27/2012 3/27/2013 60MOINEC SINGLE LIMIT raulsaNTS 1 1,_000,000 $ _ SOCILY INJURY (F'spersa$ gp�pppgY�iNy3UpRpY�L {ppyraaidesN $ ^tP�aaxaderd) $ PI?-B Ic $ 10.000 g II6BRELLA LIAR MOMS UM X OCCUR CLAIMSBADE sL,21111230A 0/27/2012 3/27/2013 EACH OCCURRENCE $ 5,000,000 AGGREGATE s 5,000,000 DED I I RETENTIONS D WORXERSIDOMMRSATION ANY PROPRIETORIPARTNERn FIVE �v! N CFRCERIMEMBER EXCLUDED? l.:..I If DESCIRPI,ON OF OPERATIONS;dem N!A 0521 -04444 P/83/20ii 9/23/2012 X I T�LUU SI I R EL EACH ACCIDENT $ 100,000 EL DISEASE -EA EMPLOYEES 100, 000 E.L. DBEASE- POLICY LIMIT $ 500.000 DE CRIPTIONOFOPERATIONS/LOCATrOM$ /VEHICLE§ (AtlshACORD16%A ftT na, Rem arksSt;edure,Nmaespatererequired) Air conditioning salon, intallation and repair. CERTIFICATE HOLDER CANCELLATION N+i roly21210aol . corn City of Miami Beath Building Department 1.700 Convention Center Dr 2nd hoar Miami Beach, FL 33139 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WRH THE POLICY PROVISIONS. AUIHOIEZED REPRESEETATIYE N D CPIS /MAD ■ ACORD 25 (2010105) INSQ$R rm4mro 111 0 1988 -2010 ACORD CORPORATION. All rights marred. Th. Artfilaf earns Sand Nunn sans ,aniataeorl nnrrlra of Anna; Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 184965 Permit Number: PL -1 -13 -178 Scheduled Inspection Date: April 17, 2013 Inspector: Hernandez, Rafael Owner: Job Address: 118 NW 97 Street Miami Shores, FL 33150- Project: <NONE> Contractor: A & C PORTELA PLUMBING Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)978 -4715 Parcel Number 1131010250070 Phone: 305/343 -2115 Building Department Comments REMOVE AND REPLACE EXISTING SINK AT BATHROOM Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 16, 2013 For Inspections please call: (305)762 -4949 Page 6 of 32 °.c 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 Pwrsat Permit Type: JOB ADDRESS: I 1 v (I City: 11 Miami Shores County: Folio/Parcel #: It ` tb ` ° 02-c° 039-0 Is the Building Historically Designated: Yes FBC20 0 Permit No. -�1 Master Permit No. 12--c-r6 fl ROOFING Miami Dade Zip: i r NO Flood Zone: OWNER: Name (Fee Simple Titleholder): (+fzkS ` i\ S5 -`1 Phone#: 3 0 5 - r - /7 9 Address: City: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Ci ¶ (��� k'IU � V 1 Address: ,. S' � S � 33 � City: J" A'►"'t1 State: Qualifier Name: 1),A-A/ i FO I� �' .d State Certification or Registration #: C FG I Ada- 01' 17 Contact Phone#: 305— �%S �p 7-5 Email Address: Phone#: 3oS— %r —o77S Zip: 33 ) 3 3 DESIGNER: Architect/Engineer: Ce ' ! Phone#: 3Os- �kiS' -�Zis rtificate of Competency #: pllln4i ( i G014,4- ` c Phone#: Value of Work for this Permit: $ 100 Q Square/Linear Footage of Work: /100 4a Type of Work: DAdditi�on OAlteration ONew ORepair/Replace ODemolition v ^ ,_ Description of Work: 0\00sr i PV-6-5/7 4I4 S! W 1 him tks, Color thru tile: *****:x************* ******** :*** Fees****************** ** * * ** ******* ************* Submittal Fee Permit Fee $ /6e' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ l CT (o i 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 FT.ECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOIT.RRS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AIi'lh'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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose properly is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is sued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Contractor The foregoing instrument was acknowledged before me this 6"-- The foregoing instrument was acknowledged before me this day of , 2013, byO' —8 4Y ( j3ay of to4.4,J , 20 a by '2 -�— rr, who is personally known to me or who has produced "CI-- I who is personally known to me or who has producedPt. As identification and who did take an oath. !lab ` T `17 as identification and who did take an oath. NOTARY PUBLIC: `o1�Y�!' Sign: Print: My Commission Expires: APPROVED BY i$c NOTARY PUBLIC: Sign: My / /l!144INFt�� ********** **** ****** ********Ho***:k*****:k****** k******ik****Ek***:kAs:k***** ****N=**:k********** Plans Examiner Zoning Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Clerk FEB -27 -2013 06:17A FROM:AB.0 PORTELA PLUMBING 3054427947 MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 TO:305756B972 P.1 2912 LOCAL BUSINESS TAX RECEIPT 2013 FIRST -C S MIAMI -DADE COUNTY - STATE OF FLORIDA U.S. PO GE EXPIRES SEPT. 30, 2013 PAID MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI, PURSUANT TO COUNTY CODE CHAPTER SA • ART. 9 at 10 PERMIT N • 231 5219 92-9 t/ pOCCpp THIS IS NOT A BILL - DO NOT PAYFF��TTRENEWAL BUSINESS C PORTELA PLUMBING INC STATEw CFC1428617 545552 -2 2655 SW 33 AVE 33133 MIAMI OWNER A &Cff PORTELA PLUMBING INC Se196 PLUMBG CONTRACTOR mils IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT TOES NOT PERMIT THE WOLDBR TO VIOLATE ANY BIESTMO REGULATORY OR TORINO LAWS OP THE AUNTY OR CITIES. NOR 7OE9 IT EXEMPT THE {OLDER PROM ANY OTHER WONT OR LICENSE VEOtER® BY LAW. THIS IS VOT A CERTIFICATION OP rilE QUALD9CA- WZNT RECEWED :c,6 COUNTY TAK 07/16/2012 02240004001 000045.00 SEE OTHER SIDE WORKER /S 2 DO NOT FORWARD A & C PORTELA PLUMBING INC DAVID PORTELA PRES 2655 SW 33 AVE MIAMI FL 33133 kdhunnnHuiludLuLHuMuLhJduhLAU FEB -27 -2013 06:15A FROM:A &C PORTELA PLUMBING 3054427947 TO:3057568972 P.1 TErmviraf s teem PTorwu T C k9- .0E-Es idrTo , TO Awi(Ja?IYa" lE�'aaEtAiw sie,E AC# 6130396 STATE OF FLORIDA DEPARTMENT INDUSTRYPROFESSIONAL LICENSING BOARD EQ#L12051700651 DATE BATCH NUMBER LICENSE NBR 05/17/2012 117055937 CFC1428617 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 PORTELA, DAVID A &C PORTELA PLUMBING, INC. 2655 SW 33 AVE MIAMI FL 33133 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY ABC D CERTIFICATE OF LIABILITY INSURANCE 02/27/2013 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(Ios) 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 endorsements PRODUCER MUTUAL INTEREST ASSURANCE 1295 CORAL WAY SUITE 3 MIAMI, FL 33145 DATE 0111NOD/YYYY) INSURED A & C PORTELA PLUMBING, INC 2655 SW 33 AVENUE MIAMI, FL 33133 COVERAGES CERTIFICATE NUMBER: NAmEt ESTHER VIDAL _ o(); 305 -860 -2003 "�RL ..MUTUALAS@AOL.COM iNSURSR(s) AFFORDING COVERAGE INSURER A: GRANADA INSURANCE CO. INSURER a; ASCENDANT UNDERWRITERS LLC INSURER a : ASCENDANT INSURANCE INSURER 0: INSURER E : INSURER F I f.em:305 -$60 -0907 NAIL tl REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTIMTHSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L TrPE OP INSURANCE ADDC$D a QLICY PFi PCtI Y GENERAL POLICY fMWSDMrYY) I (gMMIOD4YrrY) CASTS A GL- 113937 -3 1/20/2013 1/20/2014 EACH OCCURRENCE $ x COMMERCIAL GENERAL LIABILITY -1j/gp , .try 0- CLAIMS -MADE [ J OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY p�Or n LOC AUTOMOIELE LLABII-ITY ANY AUTO ALL pOSWNED SCHEDULED AUTOS AUT AUTOS HIRED AUTOS UMBRELLA LIAR OCCUR EXCESS LIAO _CLAIMS.NADE DEb • 1 I RETENTION $ n WORKERSCOAMPENSATION AND EMPLOYERS' LIAOIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE YfN OFFICERNEMBER EXCLUDED? N I A ( Mandatory In NH ayIPN F DESCRIPY p O QPERATIOHS bolow 0110FL00002952 WC- 802624 7/03/2012 1000,000 •a a r _ 50,900 MED EXP IAny ono perm) & 5 000 PERSONAL & ACV INJURY S 1,000,000 GENERAL AGGREGATE $ 1 000 000 . PRODUCTS - COMP/OP AGO $ 1,000 000 07/13/2013 f pccidenSl g BODILY INJURY (Porperann) 9{ BODILY INJURY (Pnr.dacldant) $ FFFOAEII"TY DAIG UtT CPerscltldnnd 100,000 7 _ 300,Q0 $ 100,000 _ 1/13/201 1/13/2014 DESCRIPTION OF OPERATION l LOCATIONS / VEHICIJEE (Atlanh A OND lOt Additional Remarks Schedule If man, opaeo in roguing') PLUMBING CONTRACTOR CERTIFICATE HOLDER CITY OF MIAMI SHORES 10050 NE 2 AVE MIAMI SHORES, FL ACORD 25 (2090/05) TO /T0 3EVd EACH OCCURRENCE AGGREGATE $ g q TS I S { Tr LI I [ YR _ E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 500 000 E.L. DISEASE • PQLIOY LIMIT $ 100,000 CANCELLATION SHOULD ANY OF THE ABOVE DES ' Is POLICIES BE CANCELLED BEFORE THE EXPIRATION DARE T OF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLI PRO SIONS. AUTHORIZED REPRESSNTA L 01988-2010 ACORD CORPORATION. All rights reserved, The ACORD name and loan are realStered marks of ACORD 1S3i•131NI1VillilH L060098506 TE :bt ET0Z /LZ /Z0