MC-13-1663Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 195871 Permit Number: MC -7 -13 -1663
Scheduled Inspection Date: March 12, 2014
Inspector: Perez, JanPierre
Owner: MARINAS, ANGELA
Job Address: 118 NW 104 Street
Miami Shores, FL 33150 -1240
Project: <NONE>
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number 1121360131440
Contractor: ALFRESCO AIR INC Phone: (305)541 -3827
Building Department Comments
INSTALLATION OF 4 SUPPLY DUCT Infractlo Passed Comments
INSPECTOR COMMENTS False
W3 1Z11q
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 11, 2014 For Inspections please call: (305)762 -4949 Page 4 of 34
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
Permit Type: MECHANICAL
OWNER: Name (Fee Simple
JUL 252 63
PY., 00000Jmeoo-- --- -o.
Permit No.
Master Permit No.
Q,l c', M c, ) i Mod
City: elLIA1 51�160�1 State:
TenangL.essee Name: Phone#:
Email:
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: -;) V/ J °'
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name:
Address: _T
City:
Qualifier Name:
State Certificati(
Contact Phone#:
DESIGNER: Architect/Engineer. Phone #:
Value of Work for this Permit: $ &ec) SquareAAnear Footage of Work:
Type of Work: OAddresS °Alteration ONew ORepair/Replace ODemolition
Submittal Fee $ Permit Fee $ n r OV CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
X31 4
y
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 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
CONMIENCEMENT 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 reinspectton fee will be charged _
Signature Xf/ ` ° Signature e' )/ / v
Owner or Agent
Contractor
The foregoing instrument was acknowledged before me this 11 The foregoing instrument was acknowledged before me this 1)
day of , 20 a, by _ L k3e � h an . day of 20 , by �1 �/ � ;
who is personally known to me or who has produced '� who is personally known to me or who has produced
As identification and who did take an oath.
NOT
I � Y
Ott +
Sign: * »
Print: 0 1� Y L 0 S�
My Commission Expires:
APPROVED BY
OUVIASTELLAVIVM
* MY COMMISSION # EE 089749
EXPIRES: May 6, 2015
It
(Revised 07 /10/07)(Revised 06/1=009XRevised 3/15/09)
Plans Examiner
Structural Review
ideh * *on and wh oath.
of o OLMASTELLAaM
NOTARY * MY COMMISSION # EE 089749
EXPIRES: May 6, 2015
BOW Tbu W N" Sffftu
Sign:
�,l
Print: __ �iV Vf+l%'In N
My Commission Expires:
Zoning
Clerk
To: 3057568972 From: 8 -06 -13 10:58am p, 2 of 8
® GlrC 1'�'�i�9TE OF LIABILITY INSURANCE DATEritAMfDDMfY1*"
�N CERTIFICATE _ _ _ _ 08/06/13
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.
_.._... h_ _... -- __...-...__..._— ............._.-._..........._....__ .— ......._......- ._...._. "''N.* 1 .. ..._.., --
IMPORTANT: ff the aertiAaate holder Is a" ADDITIONAL INSURED, the poiicy(tes} must he endorsed. li SUBROt3ATlON !S WAIVED, sect to
the term and conditions of the policy, cartel" policies -may require an endorsement. A statement on this certificate does not confer fights to the
certificate holder In ileu of such- 8ndorsemangs)
PRODUCER CONTACT - -- _ .................._..
Pinnacle Insurance Group Inc. PHONE . - -.- --. Marcia C Alvarez
ttuc_t (305)$54 -9898-
29 Ponce De Leon Blvd E-MAIL O:
t ADDRESS: pinnacteins(�comcast.net.• -
Coral Gables.. FL 33135 PRODUCER
Phone (305) 8549898 Fast (3Q5)' 98119 cusTOenER tD _. _ _ ..............
-..
DISLIKED su�A :.AscendantOommerciallrisuranca Inc.
Alfresco 21 SE Air, Inc.. SURER B Ascendant Commercial Insurance, Inc
421 SE 8th AVE I•• INSURER
Hialeah, FL 33010 INSURER D__ —
INSURER E
INSURER F .
COVERAGES _ CERTIFICATE NUMBER: REVISI . ON NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE US`f'ED-BEI.bW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERRA 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 TERiiM
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLATMS.
GENERAL LIA1311M Y
® COMMERCIAL GENERAL UA U rY
A . ❑ ❑ CLAw -MADE Ea OCCUR
® $500 deductible
GSRL AGGREGATE UKTAPPLES PER:
_ =C POLICY
.T LOC
AUTOMOBILE L A5AYff —
�/ ANYAUTO
j ❑ ALLOWNED AUTOS
B ❑ SCHEDUUM AUTOS
HIRED AUTOS
'
A !ON-OW W AUTOS'
❑ .UMBRELLA IJAS .0 OCR
Excess LU1B
El CLAIMS DEDMT93LE__
XERS COMPENSATION
EMPLOYERS' UABIUTY
C
I GL38914
Y Y
Y ; 10527655&8
N /iii Y ! WC62492 2
07)28/2013 ! 07!28/2014
PERSOWLBADVNARY... -.
.GENERALAGOREGATE
$ 1,000,00(
$ 2,000,OOG
PROOUCTS- COMP10PAG.9
$ 1000,OOC
COMBINED'SINGLE LW
$
BODILY OILY (PerpNlBOr<)
$ 10,000
j04l02013 ! 10!2013 s . BOILY NdURY (Perr�I`IantY
$ 20,000
$. 10,000
PROPERTYDAMAGE
(Per scolded)
..�
09423/2012109123 /2013 ` EL, EACH ACCIDENT
DESCRIFTiON OF OPERATwn I LoCATlt)NS % VEH{Ct E8 (at�oh AcoRD 101, Addtaonar Ram ke hadule. q more Spy is mod)
Air ConditToning Contractor
CERTIFICATE HOLDER
City Of Miami Shares
10050 NE 2nd Ave
'Miami Shores, FL 33138
Fax:(305)758-8972
ACORD 28 (2009/08) QF
SHOULD ANY'OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Marla C_ Alvarez
����/��1�.�
® 9988-2009 ACORD CORPORAfflOW Afriihij n
The ACORD name and logo are registered' marks of
To: 3057568972 From: 8-06-13 10:58am p. 3 of 8
12-10-2012'
JEFF ATWATER STATE-OF FLORIDA.
CHIEF FINANC1AL-0Fi:x;ER DEPARTMENT OF FINANCIAL 9ERV[dE§
DIVISION OF WORKERS' COMPENSATION
CERTIFICATE OF ELECTION TO BE EXEMPT FROU FLORIDA. WORKERS" CbW9111SATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This c0ftifift that the -individual listed beldW has :eledted -th-be exempt' from Florida Workee Compensation low,
e-PECtivE DATE: 02/15/2613 ..EXPIRATION DATE: -VV11512615
'PERSON; -ALVAREZ AGUSTIN
FEIN .:352198463
BUSINESS NAME AND ADDRESS:
'ALFRESCO AIR -INC
'1442 NW 2NO sT
mrAmi FIL Uills,
�WOPES -OF WSINEtS- OR TRADE"
'1-'! HEATING, VENTILATION" AIR —COND
1MpoRT"ff- Put$"= to CbOW 40 TR, so wil= from this chapter by filing 9 I*Wlbifii of election .adder this
SOCIM11,108Y ant recover benefits or compensation (mabr.thls chapter. poragent to chapter 4,40.11*12), FAR, Certificates of atection to be 6"MPL.. apply. . only witblo• the
SCOPO Of 08 bW§GU• of trade listed ow the notice of election to be 6JEwilti V&SUant to Chapter 440.05(1*, F.t., Notices of election to be orompi and corijileates of
'41"deff to be Oxompt "I be SONOM to rGifft9ticil' It, :at • any Afmb after the filing of so.solieg. or
Iti lawillcil of the tamed on the notice or
.9offiflem Ito loner Monte the requirements of this section for Issuance of a comficM., 11110 d0partfifeW ,melt revoke -a tortifignis, -4 any time for failure of the person
Parsed an We certificate to weet the requirsomits. of this section. CLUESnONST • •
(950) 41''
-MYIFICATE OF MEMON To 95 O(Wpt REVISED .01-11.
-t1kt CA'k6ttL6
. * OR FUTIJ'ki -RE'k-REN-CE
STATE OF FLORIDA
tiEPARTMUM OF FRIANOML SIERVICES-
DIVISION OF WORKERS'.COUPENMTM
,CONSTRUCTION INI1WRY
CERTMAT90FELECTWNT*BEEXEMPTVROM'KZFtIDA
WORKERS COMPENSATION LAW 9
EFFECTIVE 02/I3/2013 EXPIRATION DATE.- 02i115/2015
PERSON: Arausmrol ALvAREZ
FEIN: 3112199463
BUSINESS NAME AND ADDRESS.
ALFRESCO AIR WC
1442 MW VO ST
MIAMI FL 33125
SCOPC- OF 18USINESS 014 _TRADE:-
i* WATft Y&MLATUM AM-COND
..
F IMPORTANT
Pursuant. to - Chapter 440.05(14), FA, on .officer :of a corporation who
aeledts exemption from this cliapter by filing a Certificate of election
L •imder this section may not recover benefits Or compensation under th
chapter.
H'I'tirsualft -to Chapter 440.05(121,- F.S:, Certificates of -election to be
exempt. -801Y only within the scope of the business or trade listed
-
Ethe notice• of election to be exempt.
R
E IMuot to Chapter 44M06(131,•F.&, Notices of election to be ex6ffip
aid .certificates of election to be exbmprt shall• be subject to obvocati•
It, at any time after the filiffli of the notieg or the, issuance of the
Certificate, the person named an -twitotice or certificate no fowr if
the requireowts of this -section for lsswmci •f 8.
certlffcetq. The
dePliftment -shall tevdke a certificate at any time for fidhwe of the
person named on the certif1cft to meet ft requiremelfts of . this_
Section.
- auEmahw 195n)
CUT HERE
Carry bottom Powill6w oniifiejob, keep upper portion -for your records:
..
.6ft.:252 jd bt-.i
To: 3057568972 From: 8-06-13 10:58am p. 4 of 8
U.-JU
;OP FLORIDA'
n ON
,a
5l02l —+9 .1HIS-0-N OT A-13ILL,!-.E)o -NOT PAY -
MUE/WCAlft.. itENENAL
ALFRESCO AIR INC
TATE0
1442 KW 2 ST ..CAC 490
:33125 MIAMI
ALF91ESCO Alit INC
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iditkiR . / S FSPErftECHANICJi oik�d`
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4
DO �7'i'�iiVAAD
ALFlW'tCd* A***I'R" INC
:AGUSTINE ALVAREZ #*ES
1442 -NW 2 ST
:14IANI FL 33125
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