MC-13-2157Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 199750 Permit Number: MC -9 -13 -2157
Scheduled Inspection Date: January 15, 2014 Permit Type: Mechanical - Residential
Inspector: Perez JanPlerre
Inspection Type: Final
Owner: SILVERMAN, SCOTT Work Classification: Addition /Alteration
Job Address: 1321 NE 103 Street
Miami Shores, FL Phone Number
Parcel Number 1132050300120
Project: <NONE>
Contractor: NEIGHBORS A/C INC Phone: (754)222 -6347
Building Department comments
EXTEND EXHAUST VENT AND RELOCATE SUPPLY
DUCT
INSPECTOR COMMENTS False
4 � �s �
January 14, 2014 For Inspections please call: (305)762 -4949 Page 10 of 36
Inspector Comments
Passed Za
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 14, 2014 For Inspections please call: (305)762 -4949 Page 10 of 36
Miami Shores Village
Building Department I SEP 2 4 2013
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 ���
INSPECTION'S PHONE NUMBER: (3055) 762.4949
FBC 20
BUILDING _ Permit No.
PERMIT APPLICATION Master Permit No.
Permit Type: MECH4NCAL
JOB ADDRESS: 3a / �� iO3 5Z -Ae 7`
City: Miami Shores County: Miami Davie Zip: 3 138
Folio/Parcel# r 3.20 s®3 co lac
Is the Buckling Historically Dedgnated: Yes NO L'-"" Flood Zone:
OWNER: Name (Fee Simple Titleholder): %&-& % \yF.�g& POt Phone#k 3 V '�; Z - 0 q U O
Address: \ 3 24 1 No-3""c' S -1.reer
City: X11 o- m i SX�s State: -- Zip: 733135!
TenangLessee Name:
Email��� i��le�rn�m Ot VrXJ�i • C-t9m
CONTRACTOR: Company Name: 4��� 1�
Address:/ �� �� /�,�1/%L Syl'7`�e_ ,315
75-7/-,Z;2.,7--d35"7
City: /
ftigkv�x��i state: �/ zip: 3306
Qualifier Name: /+. "" / /,y-. Phone#: 9'�l- $��
State Certification or Registration Certificate of Competency #
Contact Phone# -. Email Address:
DESIGNER: Architect/Fngineer: Phone##:
Value of Work for this Permit: Square/Linear Footage of Work:
Type of Work: OAddress > to on ONew ORepair/Replace ODemolition
Description of Work: Oxfmi/ aZ Y �ie�%� 1l�s�s74 PG�
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
CCF $ CO/CC $
DBPR $ Bond $
Notary $ Trainhtg/Education Fee $ Technology Fee $
Double Fee $ Struckual Review $
TOTAL FEE NOW DUE $
Bing Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
O
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,
WEI -IS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate scud 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 building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of caownniencentent 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 niust be pasted 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 approvgd and a reinspection fee will be charged f-` r J ?
day of
who has produced
and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: �l
My Commission Expires:
APPROVED BY
ALEXANDRIA CAMPBELL
MY OOMNISSON # EE 843913
EXPIRES: QeMber is, 2016
Examiner
Structural Review
' RevLd3 /121MI2)( Revised t}7 /1o/07)(Revised06110/20D9
)(Revised 3115A)4}
who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Print:
My Commission Expirpme - -
i.
Clerk
ALL CONTRACTORS MUST PROVIDE COPIES OF
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE
A. N COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. PY OF LIABILITY INSURANCE CE TIFIC
D. COPY OF WORKERS COMPENSATION (Ell
A COPY OF CERTIFICE OF COMPETENCY OF
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Rorlda 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
XS AND INSURANCES EACH TIME A PERMIT IS
YOUR INFORMATION FOR A $30.00 FEE PER YEAR.
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE
D. COPY OF WORKER COMP INSURANCE
MIAMI SHORES VI GE BLDG DEPT
10050 NE ND AVE
MIAMI SHO , FL 33138
sssssssssss.■ ss Nunn man sssassssas■ �sssYss�ssss��ssr�s_ ssrssssssssssssssssssss monsoons ssssss
BUSINESS NAME: NtUMUCA 3 "U
BUSINESS ADDRESS: �b i` �U ` 1 AAn
STATE ZIP CODE '�90 Wq
BUSINESS PHONE: ( - ),-O - tU 3 41 FAX
CELL PHONE 3(d Q -�30 5 QUALIRERVS
QUALIFIER'S LIC NUMBER: 0.4 C
E-MAIL ADDRESS OF APPLICABLE):
CredW an 3MM BY MLDV I RV340M ALDV
CITY
:e � 3lnfo - 31 W
sU Luc
I
CERTIFICATE OF LIABILITY INSURANCE ° 'D0N""
PRODUCER THIS CERTIFICATE IS ISSUED AS A NATTER OF INFORMATION
API Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 93+126 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Margab FL 33093 _ INSURERS AFFORDING COVERAGE NAIC #
M45URED NEIGHBORS AIC, INC INSURggA STARR INDEMNITY 8r LABUM COMPANY `
1TIM NW 15TH AVE #366 INSURERS: ASCENDANT INS CO _ ..
POMPANO BEACH, FL 3= INSURERC:
INSURER D:
THEPOLICIESOFINSURANCELISTEDBELOW HAVESEENISSUEDTOTHEINS UREDNAMEDABOVEFORTHEPOLICYPERIODINDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THEINSURANCEAFFORDEDBYTHEPOLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHETERMS, EXCLUSIONSAND CONDITIONS OFSUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
10050 HE 2ND AVENUE
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO MALL
INSR _ POLICY NUMBER TFIMM
LIMITS
MIAMI SHORES, FL 33138
NiENERAI LIABILITY
EACH OCCURRENCE
$ 1.000,000.00
A X COMMERCIAL GENERAL LIABILITY 1000051737131
( CLAIMS MADE OCCUR •
W12=3 0811212014
DAMAGE TO RENTED � -
MED EXP LAny are,pason
$ 60,O".00
$ 00.00
PERSONAL 8 ADM INJURY
S NOM0.00
$ 2,0 ;Or —00
qph RAL AGGREGATE • •
..GEN'L 7E LI ITAPPLIESPER•
;PRODUCTS- 9PWJlOPAGG
PRO oc
M
i AUTQMOWA LUUmm
COMBINED SINGLE LIMIT
$
_^ ANY AUTO
(Easoddeid)
_ ALL OWNED AUTOS
BODILYINJURY
SCHEDULED AUTOS
(Par Pmm)
$ _ --
:._ HIREDALIT09
INJURY
NON -OWNED AUTOS
AIL)
$
DAMAGE
: s
(pmP
CAMBA LIABILITY
AUTO ONLY - EA ACCfDENT
$ _
; ANY AUTO
OTHER THAN EAACC
s
S
AUTO ONLY: G
EXCESS I UMBRELLA LIABILITY
EACH OCCURRENCE
S
_ OCCUR CLAIMS MADE
AGGREGATE
$ _
DEDUCTIBLE
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LI BLLITY '
X I WC STATU OTH-
100 000.00
r `
YIN
B • ANY PROPRIETOR�PARTNERmcuT WC804202 08123/2013 .0612312014
P-L. EACH .. _ IDAC E� NT
$ 500,00p pQ
OFFICERIMEMBER EXCLUDED?
(MmdaMry In NH)
EL. DISEASE - EA EMPLOYES
$ 1001000.00
N . describe ands
•
-
belav
E.L. DISEASE - POLICY LMNiT
$
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS
AIR CONDmONING CONTRACTOR
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2809/01) ®1988 -2009 A CORPORATION. All rights reserved.
The ACORD rmm and logo are registered works of ACORD
SHOULDANYOFTHEABOVE DESCWBEO POUCIESSECANCELLED BEFORE THE EXPIRATION
CITY OF MIAMI SHORES
DATE THEREOF, THE issume INSURER WILL ENDEAVOR TD MAIL . " DAYS WRITTEN
10050 HE 2ND AVENUE
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO MALL
IMPOSE NO OBLIGATION OR LIABILI F ANY HIND UPON THE INSURER, ITS AGENTS OR
MIAMI SHORES, FL 33138
REPRESENTATIVES.
ACORD 25 (2809/01) ®1988 -2009 A CORPORATION. All rights reserved.
The ACORD rmm and logo are registered works of ACORD
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