MC-13-2444Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 203468 Permit Number: MC -10 -13 -2444
Scheduled Inspection Date: November 25, 2013
Inspector: Perez, JanPierre
Owner: EDELMAN, ALEX
Job Address: 9999 NE 2 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Permit Type: Mechanical - Commercial
Inspection Type: Final
Work Classification: Fire Suppression System
Phone Number ()_
Parcel Number 1132060134490
Contractor: MARMICH AIR CONDITIONING INC Phone: (786)416 -4=491
Building Department Comments
INSTALLATION OF NEW FIRE DAMPER Infractio Passed Comments
INSPECTOR COMMENTS False
f
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP- 202076. install screws as per
plans 6" oc
Failed
Correction ❑
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
November 22, 2013 For Inspections please call: (305)762 -4949 Page 24 of 33
Miami Shares Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (3055) 762.4949
BUILDING
PERMIT APPLICATION
OCT 2 9 2013
FBC ?6
IV zi
Permit No. M(, / 3
Master Permit No. O C- J
Permit Type: MECHANICAL
JOB ADDRESS: 47 93 11 V e_ 2
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): AIe_7L F4, enetG° Phone #:7 s 9,7 _ 03 �S'
Address: F / s 2 % IV r:! z Ave
City: r A C �� ®6�5 State: Zip: �?3l ? p
Tenant/Lessee N
Email: 1 col
.S d
CONTRACTOR: Company Name: / Aam i c-h Alit, 4)/017-10M MM M Phone #: 7d yl10 W`V1
Address: , /72 'S GJ 3 2 A "sle-
City: t 1,r,,141gLj State: Zip: ;3 12-
Qualifier Name: (L' A/49/e.67 '91)d AZ4 6,09F-r— Phone #: 305' X04' V 0' L1
State Certification or Registration #:
Contact Phone #:
DESIGNER: Architect/Engineer:
8 14 i 4- Certificate of Competency #:
Email Address: lY14 rl)" ! C k 61 i a ella /too. E O 10,
Value of Work for this Permit: $ a7- `0 0a �e-_- Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ONew ORepair/Replace ODemolition
Description of Work: -i' A4TA -t (ATLVvi OF NCB 7=1;2-e PAM Ug r^
Submittal Fee $ Permit Fee $ 1,159 o CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE 45- V
VVJ
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
zip
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
The foregoing instrument was acknowledged before me this
day of , 20 _, by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPROVED BY ��
Signature (�:, ?
Contractor
The foregoing instrument was acknowledged before me this 2V
day of 000�. , 20 t?3, by 0.�.A't 45 c2o 4Y1GW
who is parsonally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC: � WSAHMW
* * MY COMMISSION # EE 021558
EXPIRES: September 10, 2014
al ,. N ovr Bonded Thru Budget N* q Services
Sign:
Print: 2A I 1 t1 via K JA
NJ
My Commission Expires: 10 t p— i L/
Plans Examiner zoning
Structural Review Clerk
Revised 3/12 /2012 )(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Miami Shores village
Building Department
90050 N.E.2nd Avenue
Miami Shores, Florida 33938
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 ❑ Contract Attached: YES ❑
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
I I
PKG UNIT
I I
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 (Wre 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
(Qualifier's signature only)
Date:
Local Business Tax Receipt
Miami-Dade County, State of Florida
11 '1
') W
8
BUSINESS NAME/LOCATION
,MARMIC-H AIR CONDMONING INC
25 �,V 32 ST
HIALEAH., FL 33012
RECEIPT NO, EXPIRES
RENEWAL SEPTEMBER 307 201
6917126 MU-st be PlaCe Of
Pur,,tuw)l to (�'ouf)TY COd-?
OWWR SEC, TYPE OF BUSINESS PAYMENT RECEIVED
7ON'l N C, A i 'E C M, E CHAN I 0 1_ BY TAX COLLECTOR
0DN1R-\C70R
41950 10/1!
C14 C
This L*cal Busimess Tax Rtc*01 only confirms payment of the Local Bilsiness Tax The Receipt is not a licenser
# e ruit, or a C#46cation of the holder's qualifications, to do business, Holder must CONFIV WA ANY
or son,# -,je tna#ntal r&jgIAt#ry laws and reqviromentS Which aPPIY to the "Sill "s,
Tire RECEIPT N 0 above 0"t b# displayed 60 an co aearcial vehicles — M1,401—u4st tAge b0c *a—,c
For more is4ruatJOR, vir,1t',N`Nw ""An"A"
A.r**#
:6.350121.
-DZPA
STATE T. QF FLORIDA
niM OF � '
US1 SS AND PROFESSIONAL` R13
G.0
MRSTMC TION I RY: LTCENSTN7 BOARD
109/09./20 112:867449(6 CAC181479
5
The CLASS A..'AIR c
k
Named below 10 C-RITIFT'On'
prov i.*ons
r the st
Unde hi
of "Chapt
Expiration date: AuG 31, 1014'
-T
�c
RODRIGUE Z 'ES
-
X&RKICH' AIR:' CONDITIONING INC
725 WEST 32ND STREET.-
HIALEAH FL 3301i"-2"%�-
GOVERNOR
DISPLAY AS REQUIRED BY LAW,
N
SEW L1209090012
KEN LAWSON
SECRETARY
R
01 -18 -2013
JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
ATIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW
ION INDUSTRY EXEMPTION
that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
DATE: 01/18/2013 EXPIRATION DATE: 01/18/2015
RODRIGUEZ CHARLES
203051329
3 NAME AND ADDRESS:
4IR CONDITIONING INC
ST
FL 33012
i OF BUSINESS OR TRADE:
ING, VENTILATION, AIR —COND
IMPORTANT: Pursuant to Chapter 440 . 05041, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05031, F.S., Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or
certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -161
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11
CERTIFICATE OF LIABILITY INSURANCE F °A-M("""'�°'�"""' --
1 10/29/13
THIS �C�RTIFICATE IS ISSUED AS A
W-- ATTER OF INFoRIVIA TION ONLY AND CONFERS NO RIQHTS UPON THE Ct?RTIFfCATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEQATIVEI;Y AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT t JONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICA'11E HOLDER. _
IMPC>� NT: If pre cerElBCate holder Is en ADDITIONAL INSURED, I Ile pdiey(tee) mutt be endorsed. If SUBROtiATION 13 WANED, subject to
the terms and conditions of the policy, certain policies may require in endorsement. A statement on this eRM11100e does not confer rights to the
certificate holder In lieu of such andorsement(a).
PRODUCER .. —• • -- N�E�T•. —. -- ... —.a. - ,I
South pacific Professional Iris. PHONE �_(30S)825 -3535 — �iur�„ Nol:_— (300)825 - 5884 --
500 K W. 49th Street p" SI?ETs lance{ hatrnail.cxrm
Hialeah, FL 33012 — tNSURB) A oRDINa tRAVe — — ,• NUC a
Phone (305)825-3535, —. .— Fax (306)825.5894 — — INSURER A I GRANADA INSURANCE COMP_ — -
- —. — — i
NWIREP INSUREk IS — —• — — —. —.
.I
MARMICH AIR CONDITIONING, INC. e48URER C
725 West 32 St ��� � • - .-- .--.. --. .— —. '. —' I
Hialeah, FL 33012 305 INSURER E:
L INSURNA L-_
i
COVt:RAGES — —_ CERTIFICATE NUMBER _ _ REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF IN5URANGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FUR I HE POLICY PERIOD
INDICATED, NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERT151CATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANC E AFTORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHCI' HAVE BEIlN REDUCED BY PAID CLAIMS. —
UK - TYPE OF INSURANCE_ — — P �LICY NUMBE'!t POLICY OFF (M Y _ —, — LIMITS. ! i
GENERAL L.IASILITY EACH O CgU—R $ 1,000 =OCQ.W
DAMAGE TO R[=NTED S 1 DO_000.00 —_
L,1 COMMERCIAL GENERAL LIABILITY REMti+SS LF8 . M-- `
�] Ll CLAIMS -MADE [� OCCUR GL -0186F L00030778 MED EXP Imo— POET) $ 5,000.00 i
A Ll — — — — 10127/2013 10/27/201 PERSONAL &ADVINJURY $ �.1000,ow•00
❑ — — — — OENSRAL AGGREGATE s 2,000,000.00
OWL AG13RtGATE LIMIT APPLIES PGR PRODUCTS - COMP /OP AGG ¢ 2,0001000.00
U POLICY
.. Cppq ®iIVED 8ING6.� LuND ,
AUTOMOBILv LIABILITY Ee aSnt•) -- I
U ANY AUTO BODILY INJURY (Per POM-) S _ T-
1--� ALL OWNED r i SCHEDULEP BODILY INJURY (Par ecddsnt s
LI AUTOS U AUTOS PRR0 �AWIAOE
❑
HIRE �,J AUTp WNED — — —
❑ _ _
C-1. -- — — . —.. — . -_ — __. — — — S . —.
umBRELLA LIA6 ]OCCUR EACH OCCURRENCE .— i-
❑
EXCESS Lt" — n GMM -MADE
L
L DED u RfiT@N'I ION• —,
WORKERS COMPENSAVOIN
AND EMPLOYERS' LIMILITY YIN
ANY PROPRIErORIPARTNERIFXECUTIVE MIA
O ICERIMRMBER EXCLUDED?
(eatery in NMI .�
B x, �rlbe under'
U SCRIPTiON OF QECRA rM§ below
AGGRILGATE
If &SSTAL
jjjj��jjpp p
E1. EACH ACC=M- T
_ E.L•, DISEASE " PLOYE S —
E.L_D�SUSE- POLICY LIMIT $.. „—
J_ _ _ 1 L l— _ _ _ I — —. .L —. I -- —• — • —• —..
DESCRIPTION OF OPEkATIONS I LOCATIONS / VEHICLES (%+Nch ACORD • Al, AdfiBenal Remarlas Schedule, It mars epe0a Is requimd)
CERTIFICATE HOLDER — — —_ — — — — CANCELLATION —
CITY OF MIAMI SHORES
100 NE 2 AVE
MIAMI SHORES, F1.33138
SHOULD ANY OF THE A
THE EXPIRATION DATE
ACCORDANCE WITH Th
AUTHORIMD 1WRESE
_ —1300- 756-8972
01988 -20'
ACORD 26 (201 0106) OF The ACORD
Td Wd8S:tiT RTOZ 6Z '1.00 t769SSZ8S02: 'ON XUJ
I CIES 13E CANCELLED 13EPC V.
lL BE pELtVi;R6D IN
IS. r
— — — �-
i
PORATION—All fights rose 1,10d-
are reglstwed marks of At I I:)RD
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Miami shores Village
Building Department
RECEIPT
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
PERMIT #: 0 e- (3 — c0 DATE: / ®�� /��
W 71A
o Contractor
o Owner
o Architect
Picked up 2 sets of plans and (other)
Address: ff F rG - '2-,+ Vic �� o -3//"
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE:
PERMIT CLERK INITIAI
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
October 30, 2013
Permit No: CC13 -2444
Mechanical Critique — Jan Pierre Perez
need Miami Dade Fire approval
Plan review is not complete, when all Items above are corrected, we will do a complete
plan review.
If any sheets are voided, remove them from plans . replace with new revised
sheets and Include one set of voided sheets In the re-submittal drawings.