MC-14-579Miami 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
RECEIVED 1
MAR 2 4 2014
FBC 20 ``�
Permit No. in G 1L-4 ®S1 c9
Master Permit loo, .° / /Q--/61
Permit Type: MECHANICAL
JOB ADDRESS: 4L0 , '
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#•
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): —4`51"" OC 7 20c S Phone #: . "7
Address• hei-0 nE 90
City: ifi/M-11
State:
Zip:
Tenant/Lessee Name: Phone# ' `71:' J'
Email.
CONTRACTOR: Company Name: ekle1"--1 5%/%% Phone #: ^ –07‘91
%
Address. QQ110 ��1/ ►
City: `e t -drc- State:
Qualifier Name: ,,92.,A P Phone#: cgof -2/f IRP
Zip: 5 -3/6g
State Certification or Registration #: (2,4/ e-e? v Certificate of Competency #:
Contact Phone#: jA – /� "�� / / Email Address: &- .,) / e_ tMA) es e #614 a e.oro
DESIGNER: Architect/Engineer: Phone #:
Value , WoC t�or this Permit:
Type o ' , "k: otIAddress " "f
Descri i oirqf Work: - , R
Square/Lin
ONew
Works. _r ..1- 2
�
•
, /R eplace o n
---17
*** ***a **** *** ** ** ************* ****** *Fees * t ***************u************* **** * * ***
Submittal Fee $ Permit Fee $ 5-0 c CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ D
3J tQ4
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
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 valve exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law b4)chure 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 a ence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was ackno edged before me this
day of 20
w is p onally known to , h-arwho has produced
As identification and who did take an oath.
NOTARY PUBLIC:
% N 'ry ' u lic - State OT
•3 My Comm. Expires Feb 7, 2017
:70 Commission N EE 872359
*Bonded Through Nahori al Notary Assn.
Signature
The foregoing
day of
who'..
Contractor
ent vas acknowled
20y�
efore me this
J ,
q me or who has produced
as identification and who did take an oath.
NOT
Si
Print:
YoPIIBIJ :_ — - -- .
SARA GARCIA
Notar lic - State of Rortda
547, 2017
My Commission Expires:
ant**** ** **** i ***** r *********t ****** ***** ***** t, **** * ** **** *** ** ** *****+trr,�,rdF****,t ****** *,ter **** * * * **** ***
APPROVED BY ;3
-Z1t1 Mans Examiner Zoning
Structural Review Clerk
(Revised 3 /12/20I2XRevised 07 /10 /07XRevised 06 /10R009XRevised 3/15/09)
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
C�
Inspection Number: INSP- 209590
Permit Number: MC -3 -14 -579
Scheduled Inspection Date: June 02, 2014
Inspector: Perez, JanPierre
Owner: ROSS, IAN
Job Address: 640 NE 98 Street
Miami Shores, FL 33138-
Project <NONE>
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Contractor: CANE AIR CONDITIONING AND INSTALLATION, INC.
Phone Number (305)979 -3879
Parcel Number 1132060171820
Phone: 305 - 266 -7800
Building Department Comments
NEW EXHAUST FAN VENTILATION FOR BATHROOM
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
May 30, 2014
For Inspections please call: (305)762 -4949
Page 5 of 28
MAR -24 -2014 10:11 From:
3052795506
To:3051568972
Paee:1/1
As.... CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YY)
03/20/14
PRODUCER MontOVi Insurance
9301 SW 56 Street, Suite E
Mlami, FL 33165
Phone (305) 279.5592 Fax (305) 279 -5506
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC it
INSURED CANE AIR CONDITIONING & INSTALLATION
9870 SW 45 Street
MIAMI, FL 33165
_- ....1305
INSURER A: GRANADA
A
INSURER B: AMTRUST NORTH AMERICA
GENERAL LABILITY
® COMMERCIAL GENERAL LABILITY
: CLAIMS MADE Q OCCUR
INSURER C;
12/23/2013
INSURER O:
EACH OCCURRENCE
INSURER E:
O
S T (Ea£occur ence)
COVERAGES
THE POUCIES OF INSURANCE USTED 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 AU_ THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
ADD'L
INSnD
TYPE OF INSURANCE
POLICY NUMBEfl
POL►CY EFFECTIVE
DATE (MM/DDMIYYi
POLICY EXPIRATION
DATE (MWDD/YYVV)
LIMITS
A
•
GENERAL LABILITY
® COMMERCIAL GENERAL LABILITY
: CLAIMS MADE Q OCCUR
01851100055391
12/23/2013
12/23/2014
EACH OCCURRENCE
1,000,000
O
S T (Ea£occur ence)
100,000
PERSONAL & ADV INJURY
1,000,000
❑
GENERAL AGGREGATE
2,000,000
GEM_ AGGREGATE UMIT APPUES PER:
❑ POLICY ❑ PROJECT • LOC
PRODUCTS •COMP /OP AGG
2,000,000
B
AUTOMOBILE LIABILITY
❑ ANY AUTO
• AU- OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
• IN
0 SCHEDULED AUTOS
• HIRED AUTOS
BODILY INJURY
(Per acddem)
[] NON OWNED AUTOS
0n
PROPERTY DAMAGE
(Per accident)
!. '
•
GARAGE LIABILITY
• ANY AUTO
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
•
AUTO ONLY: AGO
❑
EXCESS / UMBRELLA LIABILITY
• OCCUR • CLAIMS MADE
• DEDUCTIBLE
EACH OCCURRENCE
AGGREGATE
❑ RETENTION $
B
EMPLOYERS'
ANY PROPRIETOR
OFFICER
(Mandatory
If
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S u eN$A�oNAND
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/ PARTNER / EXECUTIVE
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In NH)
AL PRO Q
PROVISIONS below
AWC1026931
11/07/2013
11/07/2014
LITI� ER
E.L EACH ACCIDENT
100,000
E.L DISEASE • EA EMPLOYEE
100,000
E.L DISEASE - POLICY LIMIT
50,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
AIR CONDITIONING SERVICE, REPAIR AND INSTALLATION
CANCELLATION
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 NE 2 AVENUE
MIAMI SHORES, FLORIDA 33138
A"AffP! riv• b.ww..lw ..• w...
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS wRITTEN NOTICE TO THE CERT)RICATE HOLDER NAMED TO
THE LEFT, BUT FAILURE TO DO SO SHALL. IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON 1145 INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ,.�T,
air'
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