MC-13-2624V
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 203327
Scheduled Inspection Date: December 30, 2013
Inspector: Perez, JanPierre
Owner: KOHEN, MARCELO
Job Address: 1177 NE 100 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: DADE COUNTY AIR CONDITIONING CORP
C L-'�_
Permit Number: MC -11 -13 -2624
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
�T1'i T 1Inii7:t:�'i
Parcel Number 1132050190350
Phone: (786)999 -2301
5unaing Department comments
NEW Exhaust FAN Infractio Passed Comments
INSPECTOR COMMENTS False
<VA Izl3D[l3
December 27, 2013 For Inspections please call: (305)762 -4949 Page 8 of 28
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
December 27, 2013 For Inspections please call: (305)762 -4949 Page 8 of 28
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
FBC 20 tO
Permit Type:�
NGV 1 2013
Permit NoAci `3 - o� u2i
Master Permit No. 13 -D3 11
OWNER: Name (Fee Simple Titleholder): MAELE-W KOt R-k! Phone#•
Address: 1111 ME 100 SE
City: MIAMI SttO W State: I f(- 3� 1 —
F(— zip:
Tenanul essee Name• MI /A Phone#:
Bnail: rn:orcelo E, M'I'nChofe-L corn
e
JOB ADDRESS: % N `I 00 S
City: Miami Shores County: Miami Dade Zi p
3 1�5 13
Folio/Parcel# 1- 3ZQ5- ci�-o-
Is
'
the Building Historically Designated: Yes NO x Flood Zone:
CONTRACTOR: Company Name: 2 Q D? II®U Y% T !� A/C 60 hone#A 9G - 9 9 9 - ,,b O
Address: d w c 3r
City: VN
Qualifier
N
Zip: -33 l -SS'
426 - q 4 9- 1301
State Cirrtifi6tioh or Registration #: CZAC 19 l �Q C Certificate of Competency #:
Contact Phone#: - q 99 ® �ilQ S Email Address:
DESIGNO." AichitecUEngineer. Phone#:
Value of Work for this Permit: $ � = C?� SquareUnear Footage of Work:
Type of Work: DAddress OAlteration
- Deseripgon -of Work: _ V) P (AJ P i
./ sp ..-r 1 Cz--1 h3 LPL. 'N t..p P7'
ONew ORepair/ /Reeplace ODemolition
Submittal Fee $ Permit Fee $ _ 1 t7—& �"�� •CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
1 , s
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 lip
r;
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 or ELECTRICAL WO* 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be-delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the jolt site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved arg reirwectionfee will be charged.
Signature Sipaill 11,11A
VA'W'ner or Agent C for
The foregoing instrument was ac)mpw)cdged before me this The foregoing instrument was acknowledged before me this
day ofQ� 20!�—J by day of 1 .20 by
who is personally known to me or who has produced who is personally known to rue or who has prodqced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC« ,
Sign: Sign: ��--
print: VVyX -,- Print:
My Commission Expires: "l M Commission
4 Fir MARIA GONZALEZ � a Y _
MY GOMMISWN # EE 1554S1 i ::� y °: �U id2� �IiiL Vat2Fy 'ut i .Grua ;.tl£et3
EXPIRES: Dammber 27, 2015
Wad Tluu Notary Pubhc Underwvlters i
�kds@ t, g* q�ede {i *ip+�>k *+6+k *+R�k�B�k #+k>g ` • ��kk�R�RB�Mt+k�kA+k' &P�F+ Air' itls�e�kd+ lk�k+ A�iB*`$ �3M�&**> i�Pik+dF�k' &4i�k8s$��ffid�>BtM�+B
APPROVED BY an Examiner Zoning
Structural Review
(Revised 07 /10107)(Revind 06/104009)(Revised 3/15/09)
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
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 JEITHER CERTIFICATE OR EXCEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
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 WORKERS 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: 2611 COW 114 A j C-
BUSINESS ADDRESS: 6 2�q I SW 20 S CITY Aj!LAA
STATE ZIP CODE 6
BUSINESS PHONE:(. � )_11-1q.2,-b01 FAX NUMBER(__)
CELL PHONE ( ��• 1 q99 .2-5o 9 QUALIFIER'S NAME: ,JOff- E k4 W-0 -
QUALIFIER'S LIC NUMBER: d®�,el E- 6�ZQcttf_� a CA, C� 821'700 -,
E -MAIL ADDRESS OF APPLICABLE):
Created on 3119109 BY MLDV I RV 3126109 MLDV I RV 6127111 AS
THlS:D.Q�UI47ENT({ASA COLO,ALD BhCK�ROUNq • MICfiQRA11dTING •;IING`M�R:K"'PATlnNTED PAPGfi
1 6184459 OF a ;I
r :. : r � . F w t &Mr RU . r •
P -• L12.070400243
MINES LICENSE
07 04 2t11 1284.Q2132 CiC1817067
The CiMS B AIR CONDITIONING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter *W re.
Expiration cite: AUC3 31, 2014
BROCHE PERBZ JORGB Y
DADE COUNTY 1IR . CONDITIONING CORP
6371 SW 20 STREET FL 33155
RICK SCOTT
GOVERNOR
DISPLAY AS REQUIRED BY LAW
003146
Local Business Tax Receipt
Miami -Dade County, State of .Florida .
4Hls lS NOT A 9%t - DO NOT PAY
6959804
BUSINESS NAPAWI:OCATION RECEIPT NO.
DAW COUNTY AIR.CONDMONINIc CORP RIENM4L .
6171 SW 20 St 67691.02
WEST MIAMI Fl. 33155
ZEN WWN
SECRETARY
EXPIRES
SEPTEMBER 30.2074
Must be displayed et place of business
Pursuant to C6upty Code
Chapter.BA - Art. 9 & 10
OWNER SEC. "PE OF 90 NVESO :
DADE:COUM AIR CONDITI(1NING 196 SPEC MECHANICAL CONTRACTOR . ®v E oRECEENE
CORP. CAC1 160-
Worker(s) 1 $45.00 07109/2013
.. TXHSI —.13 -019145
Tbb local Business Tags Receipt only cooftm pnvntM at Ow Lanai Business Tax. The Recolld is im a Deem.
per t,
wag i ' 'an of dw haldar "s gaalilicatiem (040 bastaese holder t .coarpl9 wttc goverawaONi er
reongovammeMal reBeiNory laws and re0ravteats whieb apply a fe hasiIiew
Tire RECEWT N0. above Mob@ di h*W as all coenetercial neldef" - WaW -Dada Code Sec lla-m ' ,
For mom ialmmadoa.v➢sa
: 1,
9
03 -29 -2012
JEFF ATWATER STATE OF FLORIDA
afFlNaNCIAtc?FFfcER DIVISION OF WORKERS' nCOMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 83/29/2012
PERSON: BROCHE
FEIN: 493327007
BUSINESS NAME AND ADDRESS:
DADE COUNTY AIR CONDITIONING CORP
0371 W 20 STREET
MIAMI FL 33155
SCOPES OF BUSINESS OR TRADE:
1- HEATING, VENTILATION, AIR -COND
EXPIRATION DATE: 03/29/2014
JORGE Y
IMPORTANT. Poraoam to Cbsptar 440 . 061141. F.S., as officer of a corporation who elects exemption from ibis chapter br filing a certificate of election under this
section may oat recover benefits or compeosetioa under this chapter. Pursuant to Chapter 440.1151121. F.S., Certificates of election to be exempt... apply WV within the
scope of the .boisiaess or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.061131. F.S., Notices at electing to be exempt and certificates of
election to be exempt .shall he subject to revocmian fl, at aoy time after the 'filing of the notice or the issuance of the certificate, the person named ag the notice ar
certificate no ioager meets the 'requirements of this section for issuance of a . certificate. The department shell revoke a Certificate ar any time for failure of the person
named on the certificate to meet. the requirements of this section. QUESTIONS? (850) 413-1609
OWC -25Z CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS COAIIFENSATION
CQNSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS COMPENSATION -LAW
EFFECTIVE: 03/29/2012 EXPIRATION DATE: 03/28/2014
PERSON: JORGE if BROCHE
FEIN. 4$3327007
BUSINESS NAME AND ADDRESS.
DADE COUNT" AIR .CONDITIONING CORP
6371 SW 20 STREET
MIAMI, Fl. 33155
SCOPE OF BUSINESS OR TRADE:
I- HEATim. VENTILATION, AiR -COND
IMPORTANT
F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
0 elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
H exempt.. apply only within the scope of the business or trade fisted on
E the notice of election to be exempt
R
E Pursuant to Chatter 440.05031. F.S., Notices of election to be exempt
and certificates of election to be exempt shall be subject to revocation
if, at arty time after the filing of the notice or the issuance of the
certificate, the person named an the notice or certificate no longer mee
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.
CUT HERE
QUESTIONS? (850) 413 -1609
• Carry bottom portion on the job, keep upper portion for your records.
OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
CERTIFICATE OF LIABILITY INSURANCE Dx its
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
SELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(8), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
MPORTANT: B the cofflicaft holder Is an ADDITIONAL. INSURED, the polley(ies) mum be endorsed. tf SUBROISATION IS WAIVED, subject io
the tonne and condemns of Dire policy, certa[n pollofes may require an endorsemeaL A statement on Oft cortiente does not confler rights to the
certificate holder In Hsu of such endoreslnerA(sI
PRODUCER AC I Luds Estrella
ACCUmte (305)228-8727 No. (305)228-8787
8300 West FMgler Suite 114 I at
Miami; FL 33144 MMMAIWORMNOOMMM NAIca
Phone (305 5-8727 Fax ( 305) 228 -8787 aR A: Acederd lmusamre Company
MaRED v9suRER s
Dade County Air Conditioning Corp
8371 SW 20 Street INSUWR 0:
Miami, FL 33156- 786-999 -2301
CERTIFICATE 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 CONTRACTOR 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.
it
TYPE @I>UIRANCE
ADM
SM
POLa:Y EFF
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A
OENERALLIABILITY
® COMMERCIAL GENERAL LIASILRY
❑ ❑ mms-mE ® Occult
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GEN'LAQMGATELWffAPPUESPER:
® POLICY ❑ M ❑ LOC
C13120001188.01
02128f2013
02128/2014
EACH OGt21RRENCE
1 000 000.00
lS TDEaR�D
MED Exv Ift are
S 100,000.00
s 5,000.00
PERSONAL & ADV INJURY
83 1,000,000.00
GENERALAGGREGATE
$ 1,000,000.00
PRODUCTS - COMPIOPAM
S 1,OW,000.00
3
AUTONOBLE LABILITY
❑ ANYAUTO
❑ ALLOWIM ❑ AUTOS
El K ED AUTOS ❑
❑
INQLE LIMIT
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BODLY INJURY ( P—n)
ODDLY ODDLY ONJURY (Per adinift
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❑ 7UMBRELLALIAB ❑ OCCUR
❑ ExcEssu B ❑'CLANSMADE
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AGGRECOITE
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El DED -E] RETENTIONS
0
WINUUM COMMS ATION
AND EIftPLOIRW UJUM iY YIN
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OFFIC MmY EXCLUDED? � C N
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DESCRIPTI� ON OF OPERATIONS below
NIA
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DESCftlP'RQN OF OPERATIONS I LOCATIONS 1 VENICLES (AUaoh ACORD 101, Addhhuml Rarmdm Soheduft, It mina space to m*&eQ
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village Bldg Dept.
10050 NE 2Avenue
Miami Shores,Fl 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DEWERED IN
ACCORDANCO•j'H TIDE POLICY PROVISIONS.
Lucia Estrella
819AS -2b18 ACORD r-nRAARATInLI A11.4 kf- — ,,..ew
ACORD 25 (20101M OF The ACORD trams and logo are registered nmrks of ACORD