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MC-13-1362 IPT / 3 117-5- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-204063 Permit Number: MC-6-13-1362 Scheduled Inspection Date: December 09,2013 Permit Type: Mechanical- Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: RICHARDS, RANDALL Work Classification: A/C Replacement Job Address:10666 NE 11 Avenue Miami Shores, FL Phone Number (305)335-4848 Parcel Number 1122320280690 Project: <NONE> Contractor: DJ METZELAR A/C Phone: (305)491-1995 Building Department Comments A/C OUTLET FOR EXHAUST FAN IN THE BATHROOM Infractio Passed Comments INSPECTOR COMMENTS False i Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 09,2013 For Inspections please call: (305)762.4949 Page 26 of 29 Miami Shores Village Building Department JUN 18 20a 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fast: (305)756.8972 6 Yo INSPECTION'S PHONE NUMBER:(305)762.4949 FMC 2 BUILDING Permit No. �� ' k_ PERMIT APPLICATION Master Permit No. Permit Type: MECHANICAL JOB ADDRESS: -IG(,-. /' .,u Q City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): e�+�1 Phone#: Address: /0(:P 6 (V &A—) City: fl. 0 k State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: J e- /T Phone#: Address: `Z- 2 city: ,/ . VA I State: �' C_ zip: 3 / Qualifier Name: _ rn E "V _G— t;/4 Phone#: !�10S^ L f Qi / —1 !3 9S- State Certification or Registration#: G A-G 0 �[ °1 Certificate of Competency#:C A it® Sir 0- Contact Phone#: 3OC=4R 1 t CI 9 Email Address: L DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ 4MO Square/Linear Footage of Work: Type of Work. OAddress Alteration ONew C]Repair/Replace ODemolition Description of Work: _ A Submittal Fee$ Permit°Fee$ G 60'DCCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Educadon Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ �j G r 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 MPROVEMENTS 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 ' ood faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose p ope is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the rst pection which ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspect' n ll not be approv and a reinspection fee will be charged. c Signatur Signature :��— --- VA9�e Lltt Owner or Agent Contractor The foregoing instrument was acknowledged owledged before me this The fore ing instrument was acknowledged before me this ky day ,20(3 rr ,by �" 961 , day of 2Ck,'7—,by !r.�.ta-+oC �• *..w� who is personally 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. NOTARY PUBLIC: NOTARY PUBLIC: Si v a04 Sign: Print' Notary ZV11 State of Fwc;, PriIIt' Sandra !+14• My Commissio MY Comm, --m FF 010644 MY C �o@ es: i~art o►�o Expires rr6'. .2017 4mr•,rgt:..rt•F 010844 Noftry Public Ste My Commission FF 010844 APPROVED BY E ner or � Expires 04/21/2017 Zoning Structural Review Clerk Revised 3/1212012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) + ' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD1YY) 0=1/13 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(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 endomement(s). PRODUCER CONTACT AcelaRate(A DIVISION OF)All Risks,LTD NAME: AcelaRate Team 300 ARBORETUM PLACE,SUITE 410 PHONE FAX RICHMOND,VA-23236 (A/C,No,Ext): 877-275.9578 (A/C,No): 866-285-8651 E-MAIL ADDRESS: quickcommemlal@allrtsks.com PRODUCER CUSTOMER 10: INSURERS)AFFORDING COVERAGE NAIC d INSURED INSURER A:Canoplus US Insurance Inc 12981 DJ METZELAR AIR CONDTIONING INSURER B: D.J.METZELAR INSURER c: 225 NE 108 STREET INSURER D NORTH MIAMI BEACH FL 33161 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 ADDL WVD POLICY EFF POLICY EXP L.TR TYPE OF INSURANCE INSR SUER POLICY NUMBER (MM/DDIYYYI`) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY N N ACE-0008217.1 02/27/2013 02/27/2014 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $100,000 0 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) m CLAIMS-MADE IM OCCUR MED EXP(Any one person) $5,000 ❑ PERSONAL&ADV INJURY $1,000,000 ❑ GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 1 IM POLICY❑PROJECT❑LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ❑ANY AUTO BODILY INJURY(Per person) $ ❑ALL OWNED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS PROPERTY DAMAGE $ (Per accident) ❑NON-OWNED AUTOS $ ❑ $ ❑UMBRELLALULB❑OCCUR EACH OCCURRENCE $ ❑EXCESS LIAB❑CLAIMS-MADE AGGREGATE $ ❑DEDUCTIBLE $ ❑RETENTION$ $ WORKERS COMPENSATION ❑WC STATU- ❑OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 no 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores,Fl.33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE 9 ' (CHRIS MCGOVERN) ©1988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD AC# 620127:4 ... STATE of FLORIDA bEpAR'1'M �VT Off" RUSNESS Alb P1OFE3SggZONAL REGULATION EON$T 17ETION IIWTY. RY LICENSING SOARD SEQ#L120713007 !q 07 13 2012 , 9:1041554.'5 CAC054tk90 „r > The CLASS. .A AIR CONDITTONNG ed r Named below IS CERTIF'IEb t ��R Under the provisions of:'C hap t�� wd ,S 7 Expiration date: AUG 31, 2014 # `y�.,- METZEI,;AR, I? CIC:;J UJ ME'i' .ELA�t` AG LLC 225 NE' 10$Tti` ST MIAMI FL 33161 RICK .SCOTT t- RN6R KEN LAWSON GO SECRETARY DISPLAY AS REOUIRED`BY LAW WADE 1" I.00AI�-6U IBS TAX F-4IMIPT pnt FIRST-CLASS OFFill y F� U.S.POSTAGE E$ +:ZrJ9 � PAID A�VH, � hd� OZ�EO # PILOE OiIESS MIAMI,FL #fSJ TO Ct31�11Y,;O©t3 O1IAl� `pA AiT,8a3i0 PERMIT NO.231 575488-3 THIS IS NOT A BILL-DO NOT PAY RENEWAL M LLC STAT&TE-894090. 279414-8 225 NE 108 ST 33161 UNIN DADE COUNTY 11YE5 METZELAR AC LLC Seal'4yge gift enI €CHANICAL CONTRACTOR WORKEi/S THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT.IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR CONING LAWS of THE DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT LICENSE REQUIRED BYRLAW.THIS IS D J METZELAR AC LLC NOT A THE HOLDER'S QUALOIFICAF DICK J METZELAR TINS. 225 NE 108 ST PAYMENT RECEIVED MIAMI FL 33161 MIAMI•DADE COUNTY TAX COLLECTOR: 10/10/2012 60010000173 nnnnag rn t l l l i t I I I 11 1 1 1 t PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION O Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA s L under this Section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW `^� D chapter. EFFECTIVE: 02/08/2012 EXPIRATION DATE: 02/05/2014 H Pursuant to Chapter 440.05112). F.S., Certificates of election to be PERSON: DICK %J METZELAR exempt... apply only within the scope of the business or trade listed on FEIN: 579747$43 R the notice of election to be exempt BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt 22 METZELAR A/C LLC and certificates of election to be exempt shall be subject to revocation 225 N E 108TH sr if, at any time after the filing of the notice or the issuance of the MIAMI. FL 33161 certificate the person named on the notice or certificate n sc p care o longer meet the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE person named on the certificate to meet the requirements of this 1- AIR CONDITIONING 2- MECHANICAL CONTRACT section. QUESTIONS? (850) 413-1609