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DEMO-12-22Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 RQ- Il- 21 LA Inspection Number: INSP- 168485 Permit Number: DEMO- 1 -12 -22 Scheduled Inspection Date: July 16, 2012 Inspector: Inspector, Default Owner: SFARA, VERONIQUE Job Address: 1080 NE 105 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ALTMAN AIR INC Building Department Comments DEMOLITION OF SOME MECHANICAL ITO RECEIVE NEW REMODEL & ADDITION Permit Type: Demolition Inspection Type: Final Work Classification: Mechanical Phone Number (305)799 -2006 Parcel Number 1122320280090 Phone: (305)235 -6095 Inspector Comments Passed Failed pv� Correction ,❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 16, 2012 For Inspections please call: (305)762-4949 Page 3 of 35 Miami Shores Village g 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 Permit Type: MECHANICAL 5 2U d JAN 0 2. Permit No.WO I Master Permit No. 1 I — U4t a' OWNER: Name (Fee Simple Titleholder): (yrlL� {°11 ,� i kl~ JestraJe Phone #: � � �1 �® Address:00tO N E I nS St M City: 1 1 1 A ti 'l State: FL Zip: k 3 Tenant Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: /4/4h 4 ^,, fi ) /z, C. Phone #: (?®S -) a,7 S--60 g r Address: i.1 JL 7 3 s. w o 3 1 Ci ty: 1 f= Zip: ?? %ye �►� I ei •1 State: Qualifier Name: Lj , 1 \ 1 r4 /a N Phone #: State Certification or Registration #: 0 C4 t 1 1(. d, + Certificate of Competency #: Contact Phone #: Email Address: �a e �� C') k m 1f 10� /'� I & -Z N C. C 6 VV- DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ ` ::SZU Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ONew ORepair/Replace ODemolition Description of Work: Submittal Fee Scanning Fee $ Permit Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF CO /CC $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $_ c. c�,' V 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 rn 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 / ° Signature,�� J..i Owner or Age % Contractor The foregoing instrument was acknowledged before me this day of A(AA , 20 IZ , by V�� qve S� MA , who is is personally known to me or who has produced iii um -,.-L As identification and who did take an oath. The foregoing instrument was acknowledged before me this day of ,20JZ,by W( Iitwr f� �LT^^�►N who is personally known to me or who has producedL ,ly if- %Arl a-S identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: OJ Sign: Putdic State of Flodda Iarisea Egana Print: SSA Notary Pubic State °f Flows Print: Commisabn DDS40681 +� MY Cmnmisa DD940081 q ao Expires 11!1812013 My Commission Expires: �i�a Expires t1/1eJ2p13 My Commissio ►I�I�P(2o 13 00zoa APPROVED BY ef J LrExaminer Zoning T-T Structural Review Clerk (Revised 07 /10 /07XRevised 06/10 /2009 )(Revised 3/15/09) ..1 1 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 ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: State Certificate or Registration N. Certificate of Competency Signature (Quallfler's signature only) Phone: Date: 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 / / PKG UNIT 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 (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: State Certificate or Registration N. Certificate of Competency Signature (Quallfler's signature only) Phone: Date: Miami shores Village Building Department 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. V COPY OF QUALIFIER'S STATE LIC CARD B. \/""' COPY OF LOCAL BUSINESS TAX RECEIPT C. y, 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: Altman Ai-r- Tnr BUSINESS ADDRESS: 12273 SW 132nd Court CITY Miami STATE FL ZIP CODE 33186 BUSINESS PHONE: (--105 ) 235 -6095 FAX NUMBER 305 251 -1271 CELL PHONE L_786 ) 229 -7476 QUALIFIER'S NAME: William D. Altman QUALIFIER'S LIC NUMBER: CAC1816271 E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV I RV 3!209 MLDV Dave @altmanairinc.com OP ID: DT ACORRiX `Iill ,.,,.� CERTIFICATE OF LIABILITY INSURANCE DATE (MM E11YYYY) . 01/03/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICM*E 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 policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and condi °tons 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 endorsement(s). PRODUCER 305- 270 -2100 CO NAME: FILER INSURANCE, INC. 305 - 270 -2195 9440 S.W. 77 Avenue Miami„ FL 33156 Mark A. Bluh PHONE FAX Arc No Exit: AC. No): ADDRESS: PRODUCER CUSTOMER ID #: ALTMA01 INSURER(S) AFFORDING COVERAGE NAIC # $ 1,000,00 INSURED Altman Air, Inc. INSURER A:FCCI Insurance Company 10178 INSURERS: PERSONAL B ADV INJURY 12273 -75 SW 132nd Court Miami, FL 33188 INSURERC: INSURER D $ 2,000,00 GEITL AGGREGATE LIMIT APPLIES PER: PRO- LOC POLICY INSURER E $ 1,000,000 INSURER F; A A A AUTOMOBILE COVERAGES CERTIFICATE NUMRER! 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. TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Building & g POLICY NUMBER MNIIDD P LICY P LIMITS rA GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR CPP0004905 07101111 07101112 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEITL AGGREGATE LIMIT APPLIES PER: PRO- LOC POLICY PRODUCTS - COMP/OP AGG $ 1,000,000 $ A A A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON- OWNEDAUTOS CA0006921 07/01/11 07101112 COMBINED SINGLE LIMIT $ 50000 (Ea accident) BODILY INJURY (Per person, X BODILY INJURY (Per accident) $ PROPERTY (Per accident) DAMAGE $ X X $ EACH OCCURRENCE $ $ _ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? F (Mandatory in NH) styyes describe under DESG�RIPTION OF OPERATIONS below NIA 59870 05/28/11 05/28/12 X TOY LIMITS LATUS OTH- ER E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required) CERTIFICATE HOLDER CANCELLATION MIAM109 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Building & g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Zoning 10050 N.E. 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE DARYL TORRES - A2M51 ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009109) The ACORD name and logy are registered marks of ACORD �. e.