MC-13-1064BUILDING
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) 762A949
FBC 2010
Permit No. 111 G I 3 --JO (D LI
PERMIT APPLICATION Master Permit No.'? 3
Permit Type: MECHANICAL
JOB ADDRESS: I�Z( Me /(6 r
City: Miami Shores County: Miami Dade
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 14.6"4 Phone#:
Address: /2 /Vt 006 5r
city: M M/ 54 ,IQS
Email: Tenant/Lessee Name: //A
Email:
CONTRACTOR: Company Name:
Address: If', a)/e4r 3
City: ii/Alifia
Qualifier Name:
State Certification or Registration #:
State:
Zip: 3,M l
Phone#:
4
b, a o` Ag d4a,—; i /j I`- 6Phone#: 4 31',/ 34'
State: oP
ddiZeil
Zip: 3 d °�
Phone#: (& 30--‘.3,9-9,V--
Certificate of Competency #:
Emu' /40-71 0- A /�
Contact Phone# tl Address
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permits $�4 50® Square/Linear Footage of Work:
Type of Work: °Address hdAlteration ONew ❑Repair/Replace °Demolition
D e s c r i p t i o n o f W o r k : Lf S 1 2 / / / l / e4 #iJ and /016, dpell )erk
eeees**** * ******aa * *e******s ****** * *** aF e ****** ***** * ****** ** ** ** e** ****** * ***
Submittal Fee $
eN
- Permit Fee $
Scanning Fee $ Radon Fee $
CCF $ CO/CC $
DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ `�
5\i6 Qe)
+finding Company's Name (if applicable)
Bonding Company's Address
City State flP
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Qty
01-
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
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 t absence of such posted notice, the
inspection will not be ed and a reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this
day of �GZ, , 2013 , by Um ,40,40 �) a
Contractor
foregoing ' : is nt was acknowledged before me this ilcd
, day of , 20 /a, by (9S 1)et 1h )gQr l,/
ns personallywn m who has produced
Who �or
as identification and who did take an oath
NOT
ho is persona�y known to or who has produced
N
As identification and who did take an oath.
LIC:
My Commission Expires:
o s::,, Zarl., JULIA A.T .
* `c * MY COMMON #DDE7862
********5'*e****e*5' **i'*a
APPROVED BY
My Commission Expires:
4.0 ,e.e. JUUA A TAQUECHEL
• • * MOOS= # DD 897882
E IRES: Au ust 8, 2013
* ***** *****************
Structural Review
Revised 3/ 12/2012)(Revise107 /10W07XRevised 06/10/2009)Revised 3/15/09)
Zoning
Clerk
FROM : SPP INSURANCE
r
IN
L
A
FAX NO. : 3058255694
Jun. 06 2013 11:59AM P1
CERTIFICATE OF LIABILITY I■53URANCE DATE NM/DDIVY)
tODUCER South Pacific Professional Ins.
500 K W. 49th Street
Hialeah, FL 33012
Phone (305)826-3636
Fax (305)8255 -5894
I ISURED HAVANA AIR CONDITIONING, INC.
887 West 34 Street
Hialeah, FL 33012
Iph:(305)389 -3272
:OVERAGES
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND '• :ONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.11'IlS CERTIFICATE DOES NOT AMEND, EXTEND OR
TERJE COVERAGE AFFORDED 6Y T
INSURERS AFFORDING COVERAGE I NAIL S
,)NSURERA: AS:,ENDANT UNDERWRITERS,LLC.
INSURER B: GR ANADA INSURANCE COMPANY
INSURER C: AS PENDANT UNDERWRITERS, LLC.
INSURER D:
INSURER E:
INSURER F:
'FIE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR' 'HE POLICY PERIOD INDICATED. NOTWITHSTANDING
.NY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
AAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TC ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
'OLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I Q ADIYL POLICY EFFECTIVE
. I IM9RD TYPE OF INSURANCE POLICY NUMBER DATE DERIDOIri)
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
❑[ 1 CLAIMS MADE n OCCUR
1"..I
II
GENT_ AGGREGATE LIMIT APPLIES PER:
I. I POLICY I I PROJECT I I LOC
AUTOMOBILE LIABILITY
LI ANY AUTO
El ALL OWNED AUTOS
WI
❑
U
I..J
SCHEDULED AUTOS
HIRED AUTOS
NON OWNED AUTOS
GARAGE LIABILITY
!
ANY AUTO
EXCESS/UMBRELLA LIABILITY
0 OCCUR ❑ CLAIMS MADE
1 I DEDUCTIBLE
L I RETENTION E
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR 1 PARTNER / EXECUTIVE
OFFICER / MEMBER EXCLUDED?
If yes, describe under
SI?ECIAL PROVISIONS below
OTHER
GI,- 39861 -3
1011F1_00003782 -2
WC- 327837
09/23/12
IIJCY EXPIRATION
ATE (MMIDOIYY) LIMITS
EACH OCCURRENCE.
00/23/13 PREMISES RENTED
(,�a accuroncc
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGO 1000,000
1000,000
100,000
5,000
1000,000
2000,000
COMBINED SINGLE LIMIT
12/31/12 12/31/13 (Ea accident)
BODILY INJURY
Per person)
BODILY INJURY
(Per aaaident)
PROPERTY DAMAGE
(Per accident)
A11TO ONLY - EA ACCIDENT
OTHER THAN EA ACC
AUTO ONLY: AGO
EACH OCCURRENCE
AGGREGATE
05/04/13 05/04/14
�TT- I
10,000
20,000
10,000
0 H-
EL. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
Ell SCRIPTION OF OPERATIONS/ LOCATIONS (VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS
.ERTIFICATE HOLDER
CANCELLATIO V
MIAMI SHORES VILLAGE
10050 NE 2 AVE
MIAMI SHORES, FL 33138
I FAX 4 305466 -8972
PCORu 23 (2001/08) (IF
SHOULD ANY OF 1HE AB
EXPIRATION DATE THER
30 DAYS VI RITTE
THE LEFT, BUT RA LURE
OP ANY KIND UPC tI THE
AUTHORIZED REll RESEN
DES' RI ED P • LICE
OF, THE : s • NG NSU
NOTICE • E TI
ODOSO
NSURER, I
100000
100000
500000
CIELLED BEFORE THE
DEAVOR TO MAIL
ATE H • LDER NAMED TO
O OBLIGATION OR LIABILITY
EPRESENTATIVES.
0 ACORD CORPORATION 19as
May 13 13 12:59p Havana Air Conditioning
11940 NORTH MONROE STR EET3 2 3 99 - 07 8 3
TALLAHASSEE
BORRELL, OSVALDO
HAVANA AIR CONDITIONING INC
887 W 34TH STREET FL 33012
HIALEAH
Congratulations! With this license you become one of the nearly one million
Floridians licensed by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to serve you better..
For information about our services, please log onto www.myfloridalicense.com.
There you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and learn more about the
Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for doing business in Florida, and congratulations on your new license!
DETACH HERE
7865588156 p.1
TH[S DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK' °:PATENTED PAPER ?e,N•w�
kc #.63206.35
STATE.OF FLORIDA' •
DEPARTMENT'. 'Og :BMSINESS PROFESSIONAL'' REGU'LA.TION
:CONS:TRUCTION INDUSTRY'• .LICENSI•NG BOARD eEr,# .
•
DATE BATCN NUMBER
08/30/2012. 128062236.:: CACOS6638
The CLASS B`AIR CONDITIONING ;CONTRACTOR
:.Named below. :IS CERTIFIED,
'Under the-.provisions vf'`Chapt :er 489 FS.
Expiration date: AUG .31, 20141
LICENSE NBR
BORRELL F ';OSVA ►DO ;: ;" •
• HAVANA. AIIR .CONDI.TIONING INC:..
887 W•34TH STREET
HIALEAH FL...33012
DISPLAY AS REGUIREDBY LAW
FEN LAWSON
SECRETARY.
7865588156
Havana Air Conditioning
May 131312:59p
* • • • : A
• • t. • ..
.MIAMI-DADEO.COW:!..;
•TAX COLLECTOIV-
iitsmovit: • • -.•
• .-Nualt0"30130-!:.s.;:.:
THIS IE NOT A BILL — DO NOT PAY
ERA RIM / LOCATION
HAVANA AIR CONDITIONING INC
887 W 34 ST
33012 HIALEAH
OWNER
set! iitipithutiLCONDITIONIN8 INC
nu is La6 ABM MECHANICAL CONTRACTOR
BUSINESS TAX RECEIPT. rt
DOES SOT PERMIT THE
HOLDEN TO VIOLATE ANY
mason REGULATORY on
ZONING LAWS OF THE
COUNTY OR CRIES. NOB
DOES IT lumpy THE
HOLDER MORI ANY OTH58
PEWIT OR LIMO
REQUIRED BY LAW. THIS 16
NOT A CERTIFICATION CIF
THE HOLDER'S OWILIRCA•
MON&
PAYMENT RECEIVED
WAMI-DADE COUNTY TAX
COLLECTORt
$
09/26/2012
02250028001
000045.00
SEE OTHER SIDE
FIRST-CLASS
U.S. POSTAGE
PAID
47; MIAMI, FL
PERMIT NO. 231
RECEIPT
•STATE* CAC056638
WORKER'S
• 1
DO NOT FORWARD
HAVANA AIR COND/TIONINO INC
887 W 34 ST
HIALEAH FL 33012
11.1.1.1d..11,1,14MAIHAdhd
128
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 191511
Permit Number: MC -5 -13 -1064
Scheduled Inspection Date: March 05, 2014
Inspector: Perez, JanPierre
Owner: QUESADA, HUMBERTO
Job Address: 125 NE 106 Street
Miami Shores, FL 33138 -2036
Project <NONE>
Contractor: HAVANA AIR CONDITIONING, INC
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number 1121360060350
Phone: (305)558 -9136
Building Department Comments
INSTALL NEW EQUIPMENT
Infractio Passed Comments
INSPECTOR COMMENTS
RH 5
False
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 04, 2014
For Inspections please call: (305)762 -4949
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