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MC-12-1305Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 �V Inspection Number: INSP-175867 Permit Number: MC -7-12-1305 Scheduled Inspection Date: May 05, 2014 Inspector: Perez, JanPierre Owner: , Job Address: 9767 NE 13 Avenue Miami Shores, FL Project: <NONE> Contractor: BEL AIR SERVICES & AIR CONDITIONING INC suuaing uepartment comments MECHANICAL WORK FOR ADDITION 05/29/2013 - EXPIRATION EXTENDED AS PER LAST APPROVED INSP. a Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132050090520 Phone: (954)895-1534 May 02, 2014 For Inspections please call: (305)762-4949 Page 2 of 26 Inspector Comments Passed —Ob Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 02, 2014 For Inspections please call: (305)762-4949 Page 2 of 26 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 2001 Permit Type. MEC�L4N CAL --<-" _ -- — 2� S 5- F- � h ,V L JUL 12 -1012 BY:-s---------°000----- Permit No. k 0 J '— Master Permit No. T `" OWNER: Name (Fee Simple Titleholder): &Z -op W (H'MknPnW XT -V_ Phone#:�� Address: I �1 � N W V, 5� Sl City: JM k*m(- (roiP,n State: Zip: 900 Tenant/Lessee Name: _ %J /p} Phone#: ' Email: _ A_t,,j(r0,Q % � 1.3d�P131.1 rI)� Q C I-, JOB ADDRESS: '3-7 b-1 &M 13 It City: Miami Shores County: Miami Dade Zip: -3bl Folio/Parcel#: 2. 0 Oq 6 !� 7,0 Is the Building Historically Designated: Yes NO Flood Zone: -CONTRACTOR: Company Address: City: Quali State Certification or Registration #: CQ G fffA= /Sib 2&Certificate of Competency #: _ Contact Phone#: ClslyAfq!� I"'�L/ —Email Address: CAioI) _e(2 jQ 44T DESIGNER: Architect/Engineer: Value of Work for this Permit: $ ; SSL I r o. C v Square/Linear-Footage of Work: Type of Work: Wtuw DAlteration ONew ORepair/Replace ODemolition Description of Work: M l AVL ut.-te t z -i0 49Lt Ll (- A-1)10 1 t3t*,*0 944 vs / CuMc't... Submittal Fee $ v $ CCF $. Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ ®� Bonding Company's Name (if applicable) 11 Bonding Company's Address -e�— City State Mortgage Lender's Name (if applicable) %i [Aa Mortgage Lender's Address 24�1— City State Zip 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 the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Owner o Agt n*p1a t �z�� The foregoing instrument was acknowledged before me this o1 day, -g0, l by whp is personally kno fo me or who has produced As identification and who did take an oath. Signa Contractor The foregoing instrument was acknowledged before me this day of 20 jam,, by T, _AQ Qom,- , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: --� un 1T44 My Commission Exp' es:�a" o,,� JUDITH DEMILIO My C kx pires: RBM � �.t� fol Pdit - f� of f a° �a Notary Public - State of Florida My C=m. SIP 28, IM4 • My Comm. Expires Jun 13, 2013 DD 99777t! s«°`�` oioiaona1NOiary�sn ��xas«a��x Asa ons APPROVED BY 1 sExaminer Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) DBPR - ROJO, IAN I; Doing Business As: BEL AIR SERVICES & AIR CONDITIONI... Page 1 of 1 4:09:13 PM 7/12/2012 Licensee Details Licensee Information Name: RO3O, IAN I (Primary Name) BEL AIR SERVICES & AIR CONDITIONING INC (DBA Name) Main Address: 3300 ATLANTA STREET APT 15C HOLLYWOOD Florida 33021 County: BROWARD License Mailing: LicenseLocation: 2700 NORTH 72ND AVENUE HOLLYWOOD FL 33024 County: BROWARD License Information License Type: Certified Air Conditioning Contractor Rank: Cert Air License Number: CAC1816213 Status: Current,Active Licensure Date: 04/15/2009 Expires: 08/31/2014 Special Qualifications Qualification Effective Class B 04/15/2009 Construction Business 04/15/2009 View Related License Information View License Complaint 1940 North Monroe Street Tallahassee FL 32399 :: Email: Customer Contact Center :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Copyright 2007-2010 State of Florida. Priyagy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public -records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. https://www.myfloridalicense.com/LicenseDetail.asp?SID=&id=A627ED48B5BD8FC111... 7/12/2012 7- Paga 2 -1 4 2012-07-30 12:S(31.10 (43MT) 19647607S77 From: n-1- RoJo CERTIFICATE OF LIABILITY INSURANCE CA -M """ 07/16M2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGH'T'S UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIR1111ATIVELY 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: Ethee certificate holder ban ADDITIONAL. D. the pofy(les) must he endorsed. N SUBROGATION IS WAIVED. subs to the terms and conditions of the policy, certain pommies may require an endorsement. A statement on this certificate does not canter tights to the cen~iticate holder in Neu of such endorsentengs� MOIN)CER 4ccredited Insurance 3099 Hollywood Bhfd Hollywood, FL 33024 Phone (954)984-5444 Fax (954)964-0772 391 Air Sentic es; & Air Ccr ditionlM, Inc 2700 N 72nd Avenue Hollywood, FL 33024 (954) 695-1534 CGMTACT Pte. E-* ADDRES,4: INSURER A : INSURE( 8 : I C: INSURER 0: INS E: (954)964-5944 ASCENDANT COMMERCIAL INSURANCE COVERAGES CERTIFICATE NU_BiBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIR 3MIT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WhTH RESPECTTD WWCH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. L&M SHOWN MAY HAVE BEEN REDUCED BY PARD CLAM 1A­DMAAiA "E: SR TYPE OF INSURANCE p�I ICY NUOR I iIAM�+ MQTS GENEflItL hJ1URLiTY ® a i ommmo12105 013 s ' BODILY I NJURY (Perpeum) S E]�.Y lNJI1RY(Perscdde II PRO E AsOAtiE � 8 -- EACH OCCURRENCE 6 EL D YM OF OPERATIONS I LOI;ATF;;t9I U@ILIM (Admh1 ACS 101, AddUlana1 RmmffM Sd e, If (am spme is rel AIR CONDITIONING SERVICE. REPAIR, INSTALLATION. ETC. CERTIFICATE HOLDER THE VILLAGE OF MIAMI SHORES 10050 NE 2ND AVENUE MIAMI SHORES. FL 33138 ACORD 25 (20101" QF CANCELLATION 100,000.00 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WIN THE POLICY PROVISIONS. AUTNORIM REPREIENTAWE ®1918-2016 ACORD CORPORATION, AN rights raserwed. The ACORD nam and Ifs are regilslind mawks of ACORD COMMERCIAL GENERAL LIA90.RY ❑ CLAems-[ ® OCCUR GL3998 A ❑ N El GEWLAGGREMTE LWT APPLIES PER ® POLICY ❑ Noi ❑ Loc AUTON E LIAINLM ._.._. ❑ ANY AUTO ALL ❑ AUrSCHEDULED OS ❑ AUTOS ❑ HMW AUTOS ❑AUrOS El 0- ❑ UMMO UA LhAB ❑ OCCUR ❑ em" LIAR ❑ CMMS-MADE DEO ONS 1NORWRS COMPENSATION _ AND E10PLOYERS LIABNM Y I N O�FFICER1MEMBE EXC�WD� NIA mya8.in de f Dfl PTION OF OPERATION bftw a i ommmo12105 013 s ' BODILY I NJURY (Perpeum) S E]�.Y lNJI1RY(Perscdde II PRO E AsOAtiE � 8 -- EACH OCCURRENCE 6 EL D YM OF OPERATIONS I LOI;ATF;;t9I U@ILIM (Admh1 ACS 101, AddUlana1 RmmffM Sd e, If (am spme is rel AIR CONDITIONING SERVICE. REPAIR, INSTALLATION. ETC. CERTIFICATE HOLDER THE VILLAGE OF MIAMI SHORES 10050 NE 2ND AVENUE MIAMI SHORES. FL 33138 ACORD 25 (20101" QF CANCELLATION 100,000.00 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WIN THE POLICY PROVISIONS. AUTNORIM REPREIENTAWE ®1918-2016 ACORD CORPORATION, AN rights raserwed. The ACORD nam and Ifs are regilslind mawks of ACORD Io: ►'6�0 7 oto Ea7 L -UI -:3V •1 •L: b(.1:'IU (CiM12 1HSA /4ai3 �:f�� rrorrc 1•teDoca FeoJo 03-21-2M ,EFF ATWATM STATE OF FLORIDA CHIEF FOAL OFFKXR DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION ie 4f COITIRCATE Of EL MW M BE MLIPT FIM FLORIDA WiRIKEW CWMg ATIDN LAW * - CONSTRUCTION INDUSTRY EXEMPTION This catifies W the individual listed below has elected to he exempt from Florida WorkeW Compensation taw. EFFECTIVE DATA 0312112M EXPIRATION DATE: 0312012("3. PERSON: ROJO ION ' FEIN: 202898788 BUSINESS NAME AND ADDRESS BEL AIR SERVICES 8 AIR CONDITIONING Its 3300 ATLANTA ST UNIT C 1401.1-YNOM FL 33021 SCOPES OF BUSINESS OR TRADE: I- HVAC CONTRACTOR •falPMM. Pa"ad to Ceipter 410 . 0$14). r. s.. m oftm d a mtxmafeu WW atectn etm10tim from ads Is,"$ by IM" t c"Micaw a eIota" 0adtr this .3eetihe may 001 reurot baedM " campempion War this tin no. Pms-m to tbaptat 4s0.05O2L F.S„ Cennicet- of election to be extent-- Q"fv dr wMi. am [saps of am balance es 0844 Tates - as sake or detl4le to M me fa. Porn" M 0mister 440.0511111, F.O., entices of etow" to In, eiampl ani certified" of olocWe to he etempt *0 he abject b terawiat it, at ay Ree nine We filing of be satke or can, istsstce of OR cwwkaa, the set elan 00 rbc mike Of C011111Ite m taegm mems Ne towitmem d Nit section Ice instance of a Cowman. 744 aepmteett swi tafete a caeficw ai say Oma 10 leifare at tie .pram attend - the eerliname to team the aepait" ant of tea actiaL IIllFSTtIIP157 D50 413 -ISM WX-252 CIRTIFtCATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVAM UMSION OF WORKEW CON ftTMN CONSTRUCTION INDUSTRY CFJtTU9CATE OF ELOOTION TO BE EXEMPTFtOSN FLORIDA WORttER8• CXRM4BrJATiON LAW 9 EF=FECTIVE 03/21/2011 EXPIRATION DATE: 03120/?OIS PERSON: IAN MM FEIR 20280$718 BUSIPESS NAME AND ADOREn- e>a Ant eERVAU 0 AIR COMTW;MW M 3909 ATt"TA ST um C dnitywoCD F( 3302/ SCOPE OF BUSiAESS OR TRADE I- WAC COM AC70R I'MIXORTA IT F Ptammd to Chapter 440.05114 F•S, an officer of a corparatioll afro D elects exemption from this chapter by fi tg a eor8fieate of etecffce 1- waist, tdis swoon may Trot "leaver bmtefits or Compensation eltder gds D dnpter. Pwstwit to Chapter 440.05(12L F.S. Ceretkides of election to be H exempt- apply rely while the scope of Ste bas�ss or Imb listed an R a*e wits of election to be exempt E Pursuant to cum 440.05f13b FS., Nodeas of election, to be exempt and certificates of election to be exempt staff be *subject to revocation if, at any fte after the fi'Ibtg of the notlee or dm issuefxe N ttte caulicate, fie "meed an Ora Imtiee or certificate 00 Imw eters tie regoiremems of this section for issuance of a certificate. Tfro deparmmnt shun revoke a cmtifmats at my time for failure of the parsec ttmned an Om certificate m new 910 nt"rements of t111s UMSTIGIM 450) 413-1603 CUT HERE • Carry bonom pordon on the Kik, keep LWW portion for yaw recOidis. OW -252 CERTIFICATE OF ELECT= TO BE Exam REvmEB eini1 -- - Io: "ga ZS of 14 an" w-u,r-:su 1;.-t.�. I U ('Cim I) lwb'4'lt.w'-2ser I-M� I-Cot� kt�jo -- * ..-..... 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