MC-13-2798Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 204525 Permit Number: MC -12 -13 -2798
Inspection Date: February 10, 2014 Permit Type: Mechanical - Residential
Inspector: Perez, JanPlerre
Owner: YENNI FLORES, MATTHEW KADEN
Job Address: 935 NE 99 Street
Miami Shores, FL
Project: <NONE>
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number 1132060340251
Contractor: ALL AIR OF SOUTH DADE INC Phone: (305)247 -3443
Building Deoartment Comments
REPLACE DUCT SYSTEM SUPPLY AND RETURN
Infractio Passed Comments
INSPECTOR COMMENTS False
Passed 9t
Inspector Comments
Failed El
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
February 12, 2014 Page 1 of 1
l
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
DEC 18 2013
FBC 20
Permit No.
Master Permit No.� �$
Permit Type: ME (N CHANICALG•
JOB ADDRESS: -135 NE L10( �3 tl !�
City: Miami Shores _ County: Miami Dade Zip: J3 ) 15®
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): IY 4 Phone #:
Tena01essee Name: Phone #:
Email
CONTRACTOR:
Address:
City:
Qualifier Name: _
State Certification or Registration #: Lf l(- ,JY7
Contact Phone # s 5 7e&42i a Email Address:
DESIGNER: Architect/Engineer: Phone #:
00
Value of Work for this Permit: $ 'SU 0 0 • Square/Linear Footage of Work:
Type of Work: OAddress . OAlteration • ❑New dRepair/Replace
Description of Work:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
ODemolition
��xsmgagaKfH��gs��ag8ag ¢H+sNSIaffisbx+HageagHadsHagaga ap�$a���gejasH gt�H+eg�eg
OOCCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 qV Si
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this
day of bA , 20 L_-J, by
who is personally known to me or who has produced fl
As identification and who did take an oath.
NOTARY PUBLIC:
Print: \- .,J JAM lti
My Commission Expires:
APPROVED BY
The foregoing instrument was acknowledged before me this 0P—
day of 20 a by �9
who is personally known to me or who has produced I�
®CAA � as identification and who did take an oath.
JOANA POULOS
MY COMMISSION #EE0236 L
EXPIRES: SEP 06, 20414
Bonded through lot StO Insurance
e �� , Mans Examiner
Structural Review
Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
Print: '�—/ JUUJ
My Commission Expires: JOANA POULOS
r =O 6�c� IN COMMISSION #EEM 7b
q BORES: SEP 06, 2014
Bonded through 1st State Iasmanco
Zoning
Clerk
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From: AD-Air of South Dade Fax: (786) 466 -2883
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From: All-Air of South Dade Fax: (786) 466 -2893 To: Fax: +1 (306) 766-8972 Page 7 of 7 12/13/2013 10:22
,4co CERTIFICATE OF LIABILITY INSURANCE DATEEMMIDDNYYYJ
12/13/2013
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 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 endorsementlsli.
PRODUCER
3ateman Gordon and Sands
M50 North Federal Hwy
Jghthouse Point FL 33064
I.r ligl
INSURED ALLAI2
All Air of South Dade, Inc.
29790 Old Dbde Highway
Homestead FL 33033
INSURER B'
INSURER C:
INSURER D:
COVERAGES CERTIFICATE NUMBER: 347585408 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,
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
NN��EXCLUSIONS
LTRR
TYPE OF INSURANCE
IrygR
WVD
POLICY NUMBER
PO�LI
PAD EX
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE ITI OCCUR
OPP207617901
4AWM13
/16/2014
EACH OCCURRENCE
$1000000
PREMISES Ee occurrence
$300,000
MED EXP (Any one person)
$6,000
PERSONAL & ADV INJURY
$1,000_000
GENERAL AGGREGATE
$2,000,000
GEN1 AGGREGATE LIMIT APPLIES PER:
POLICY X PR LOC
JEL
PRODUCTS- COMP /OP AGG
$2000000
$
B
AUTOMOBILE
LIAEuLnY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
AUTOS X pUTOSWNED
0,420761780101
/16/2013
/16/2014
Ea ecddent
$1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PR PERTY DAMAGE
r Tiden
$
JXHIRED
A
B
UMBRELLA LIAR
EXCESS LIAR
X
OCCUR
CLAIMS —MADE
NIA
OU207MS0302
0207618001
/16J20 33
/16J2013
H 6/2014
/16/2014
EACH OCCURRENCE
$3,000,000
AGGREGATE
$3,000,000
DED X RETENTION$O
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OOFFIPCERMIEIv�13EOR�EXCLWEDC�� Y❑
(ManddeoryWund
If yes, describe under
X OTH-
WC STIM
�
$
E.L. EACH ACCIDENT
$1 000 000
DISEASE - EAEMPLOY
$1,000,000
A
DESCRIPTION OF OPERATIONS below
Rented & Leased Equipment
CPP207617901
/16/2013
DISEASE - POLICY LIMIT $1 oo0 000
00 Limit $1,000 Deductible
DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additlonel Remarks Schedule, If more space to required)
CFRTIFICATR unl neo
Miami Shores Village Building Department
10050 NE 2nd Avenue
Miami Shores 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
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