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MC-12-2152 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-181529 Permit Number: MC-11-12-2152 Scheduled Inspection Date: August 26,2013 Permit Type: Mechanical- Commercial Inspector: Perez,JanPierre Inspection Type: Final Owner: MIAMI,ARCHDIOCESE OF Work Classification: Addition/Alteration Job Address:9401 BISCAYNE Boulevard Miami Shores, FL Phone Number (305)762-1033 Parcel Number 1132060490010 Project: <NONE> Contractor: PARKS&THOMPSON INC Phone: (305)698-7722 Building Department Comments REPLACE VARIOUS HVAC EQUIPMENT,VAV BOXES Infractio Passed Comments AND CONTROL SYSTERMS. REPAIR VARIOUS AIR INSPECTOR COMMENTS False HANDLERS.ALL WORK AS PER PLANS Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 23,2013 For Inspections please call: (305)762-4949 Page 1 of 24 � �Z1 Miami Shores Village NOV 1 1. got J Building Department eo--------- 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 1 di ERs-Sit- FBC 20 B ILDING Permit No. PERMIT APPLICATION Master Permit No. Permit Type: MECHANICAL JOB ADDRESS: 9401 Biscayne Boulevard City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206-049-0010 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder):Archbishop Thomas Wenski Phone#:305-762-1032 Address:9401 Biscayne Boulevard City: Miami Shores State: Florida Zip: 33138 Tenant/Lessee Name: N/A Phone#:N/A Email: jrancano @theadom.org I CONTRACTOR:Company Name: Parks&Thompson, Inc Phone#: 305-698-7722 Address: PO BOX 160518/2340 W 77th Street. City: Hialeah State. FL Zip: 33016 Qualifier Name: Joseph F Gorski Phone#: 305-698-7722 State Certification or Registration#: CACO20193 Certificate of Competency#: Contact Phone#: 305-986-4016 Email Address: 1g @parksandthompson.com DESIGNER:Architect/Engineer: DeRose Design Consultants Phone#: 954-942-7703 Value of Work for this Permit:$ 4 a 0DO.00 Square/Linear Footage of Work: Type of Work: ❑Address DAlteration ONew bRepair/Replace ODemolition Description of Work: Replace various HVAC equipment,VAV boxes and control systems. Repair various air handlers. All work per plans Submittal Fee$ Permit Fee$ 0 o60CCF$ 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 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 Signa O er or Agent Contractor /y', ► The foreg in i�strrJument was ac owledg befor m this The foregoing instrument was acknowledged before me thisig day of�k5W,201-k,by t day of ,20 ,by�g2 nTr �81 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: I Si � Sign r �7 mn-Arguello print: J/,�� IV Expires:J5/:1*/ .STATE OF FLORIE A My Commissi dsr MY COMMISSION#EE006289 �� Comm#EE095931 %; EXPIRES August 16,2014 �acplr®S 5/28/2015 (407)358-0163 FlorideNotaryServiee.com APPROVED BY vin q moans Examiner Zoning Structural Review Clerk Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the most Reverend Thomas Wenski,as Archbishop of the Archdiocese of Miami,his successors in office,a corporation sole,has made,constituted and appointed, and by these presents does hereby make, constitute and appoint Sister Elizabeth A. Worley,C.O.O., his true and lawful attorney for him and in his name,place, and stead Giving and granting unto Sister Elizabeth A.Worley,C.O.O.,his said attorney full power and authority to do and perform all and every act and thing whatsoever requisite an necessary to be done in and about the premises as fully,to all intents and purposes, as he might or could do if personally present,with full power of substitution and revocation,hereby ratifying and confirming all that Sister Elizabeth A.Worley, C.O.O.,his said attorney or his substitute shall lawfully do or cause to be done by virtue hereof. In Witness Whereof,I have hereunto set my hand and seal this 1$ day of A.D.,2011 Signed, sealed and delivered in presence of: Witness: — Witness SignatureZ The Most Reverend Thomas Wenski /Y-4F-4A -E, -rA)y Lo as Archbishop of the Archdiocese of Miami his Printed Nanpy successors in office,a corporation sole W' ess( ture ted Name / STATE OF FLORIDA ) SS: COUNTY OF DADE ) I hereby certify that on this day,before me,an officer duly authorized to administer oaths and take acknowledgements,personally appeared The Most Reverend Thomas Wenski,as Archbishop of the Archdiocese of Miami,his successors in office,a corporation sole,known to me to be the person described in and who executed the forgoing instrument,who acknowledged before me that he executed the same,and an oath was not taken._X Said person is personally known to me Said person provided the following type of identification: Witness my hand and official seal in the County and State last aforesaid this day of A.D.2011. My Commission Expires: YAYM MUM RMM My C�I■b�6MIM JIIL iT,111i i PERMIT# CONTRACTOR: 4"` "of 1 SUBMITTAL DATE: I �� ADDRESS. JL4 pi NAME: ) }} � RESUBMITAL DATES: PROJECT TYPE: ZONING FIRE STRUCT RAL IMPACT FEES ELECTRICAL � �y- HRS/DERM PLUMBING - ---- NOC Lv �r MECHANICAL BLDG gtt.c, n .n. Miami Shores Village Building Department RiAA' 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$30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: PARKS & THOMPSON, INC. BUSINESS ADDRESS: PO BOX 160518 CITY HIALEAH STATE FLORIDA ZIP CODE 33016 BUSINESS PHONE: 3( 05 ) 698-7722 FAX NUMBER 3[ 05 ) 698-7733 CELL PHONE 3( 05 986-4016 QUALIFIER'S NAME: Joseph F Gorski QUALIFIER'S LIC NUMBER: CACO20193 E-MAIL ADDRESS(IF APPLICABLE): JG @PARKSANDTHOMPSON.COM Created on 3119109 BY MLDV 1 RV 3126109 MLDV C# 1 Z STATE Q� FLORIDA, v. DEPARTMENT OF BIISINESS AND PROFESSIONAL REGULATION CON$TRT�CTIObT INDUSTRY :IiICENSIG BOARD. SEQ#L1206°29110396 l LICENSE' NBR 06 29;` 2012 118214.52 CA002019 ,.. , ; . . °` .. 'I'he.: CLASS ''A 'AIR �ONDIT�ONI:NG CONTRAC TOR Named;below IS CERTIFIED a ,�t 'Under the provisions of ehapt r #89 "S Expiration date: AUG 31, : 3 1 GORSKI, :J03EPH FRANK PARRS `&'THDMPSON ;LN 77 7 P 0 BOX 160518 HIALEAH FL. .33016 RICK SCOTT i..� ti KEN LAWSON GOiTERNOR SECRETARY DISPLAY AS REQUIRED BY LAIN MU1M1 L1ADE COUNTY 201 LOCAL BUSINESS TAX RECHPT 2Qt3 FIRST-CLASS TAX COLLECTOR U.S.POSTAGE I MIAMI-DADE-COUtM•STATE OF FLORIDA r 940, FI Aral E1�ST EXPIRES SEPT.30„2Q1$,; PAID k let FCOO t MUST BE DISPLAYED AT PLACE'OF SUSINE55 MIAMI,FL MIAMI?FI.33130 PU�iSUANT TO GOUNTY CODE CHAPTER$A AfR7;9 S 10 PERMIT NO.231 026162-8 THIS IS NOT A BILL—DO NOT PAY RENEWAL BuPXMFMEf OWN INC STATE79MM193 026162-8 2340 W 77 ST 33016 HIALEAH *11WKS & THOMPSON INC u 'eclW MnXCHANICAL CONTRACTOR WORK 1E0 THIS IS ONLY A LOCAL BUSINESS TAX HECEU+T.IT DOES NOT PERiIIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR DO NOT FORWARD ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERW OR LICENSE REQUIRED BY LAW.THIS IS PARKS & THOMPSON INC NOT A THE HOLDS OOUUAOLIFICA- JOSEPH F GORSKI PRES T1ONS, P 0 BOX 160518 PAYMENTRECEIVED` HIALEAH FL 33016 COLLECTOR:pL LINTY TAX 08/29/2012 000045 0083 {}l�tlil�i lli!{ii{ {il�fill!{111ti}�{1!}�}�i}}}li��lii}ii�}iy5 SEE OTHER SIDE PART9-2 OP ID: MA CERTIFICATE OF LIABILITY INSURANCE DATE(MDn�YYY) 05/224/12 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 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 endomement(s). PRODUCER 305-262-0086 cAOMEACT STEPHEN M. DENKERT BUTLER,BUCKLEY,DEETS INC. 6161 BLUE LAGOON DR.,STE 420 PAtcoNNo ;305-262-1016 FAX,No;350-262-0187 MIAMI,FL 33126 E-MAIL Stephen M.Denkert ADDRESS:MARIANA@BBDINS.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FCCI Insurance CO INSURED PARKS&THOMPSON,INC. INSURER B:SENTINEL INSURANCE COMPANY 11000 W. 77TH STREET HIA LEAH, FL 33016 INSURER C:National Trust Ins Co 20141 HIA 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. LLTR TYPE OF INSURANCE POLICY NUMBER MMIDDCDY EFF MPMNDI EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. A X COMMERCIAL GENERAL LIABILITY CPP0011125 3 05/26/12 06125113 PREMISES Ee occurrence $ 100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,0 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 11000,00 POLICY PRO- LOC $ AUTOMOBILE LIABILITY EeMakxi EDitSINGLE LIMIT $ 500,000 B X ANY AUTo 21 UECPP1416 05125112 05/26/13 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE X HIRED AUTOS X NON-OWNED $ AUTOS Per accident X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000, C EXCESS LIAB CLAIMS-MADE UMB0010615 3 06/26/12 06125113 AGGREGATE $ 1,000,00 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY X TRY LIMITS X ER A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N 001 WC12A-55369 05/25/12 05/26/13 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? El NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yy,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 12 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION VILLAMS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF MIAMI SHORES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPT. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVENUE AUTHORIZED REPRESENTATIVE MIAMI SHORES,FL 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD II111111 Hill 11111111111111111111111111111IIN CF N 2012RDS71 71.1. NOTICE OF COMMENCEMENT OR Bk 2835 09 2033; tlaa! A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION RECORDED 12/05/2012 10 51:59 HARVEY RUVINr CLERK OF COURT t1IAIII-DARE COUNTY? FLORIDA PERMIT NO.WC-11-12 7W r.7- TAX FOLIO NO. LAST PAGE STATE OF FLORIDA COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,the following information t is,provided in this Notice of Commencement. - - 1. Legal description of property and street/address: ARCHDIOCESE OF MIAMI SUB PLATBOOK 11627 TRACT A LOT SIZE 187270 SOFT. 8401 BISCAYNE BLVD„MIAMI,FL 33138 j G 2. Description of improvement: HVAC repels and replacements 3. Owner(s)name and address: THE MOST REVEREND THOMAS WENSIG ��( R S f1 Ic 0141A® n O Q l 3�{3lt v Interest m properly. Name and address of fee simple titleholder �aers god S �Y O & 4. Contractor's name and address: Parks&Thompson,Ina-2340 W 77th Suet/PO BOX 16D518-Hialeah,FL 33018 5. Surety:(Payment bond required by owner from contractor,if any) Name and Address, �N11 Amount of bond$ ra 6. Lender's nanle and address: o a, 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as o provided by Section 713.13(1)(a)7.,Florida Statutes. Name and Address: .e CIS 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: 9. Expiration date of this Notice of Commencement:(the expiration date is 1 year from the date of recording unless a different date is s cified) Signature W601per E P Owner'sNameSiAef 7,I beNI,\ I, or le-j Prepared by � k Sworn to and subscribed before me this day of AVM&_r 20 . Notary Public: - Address: Print Notary' am o My commiss it No '� - Expires 5/21WO15 -