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MC-13-370Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-186344 Permit Number: MC -2-13-370 Scheduled Inspection Date: June 24, 2013 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: BURKHALTER, LAWRENCE Work Classification: Kitchen Hood Job Address: 185 NE 105 Street Miami Shores, FL 33138-2032 Phone Number 305-494-8858 Parcel Number 1121360050160 Project: <NONE> Contractor: TSE AIR CONDITIONER CORP Phone: (786)536-8517 Building Department Comments INSTALLATION OF HOOD AT KITCHEN Infractlo Passed Comments INSPECTOR COMMENTS False Q4 t:, 1 -2- q [3 June 21, 2013 For Inspections please call: (305)762-4949 Page 9 of 37 Inspector Comments Passed Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 21, 2013 For Inspections please call: (305)762-4949 Page 9 of 37 �t �G F_� ``. Miami Shores Village HE_11 r'�' z v LlAe) Building Department B Y� ------ 1 0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: MECHANICAL FBC 20 h _ Permit No. Master Permit No. " JOB ADDRESS: ^% / D S ,� `}rt,_t City: Miami Shores County: Miami Dade Zip: 3z /z Folio/Parcel#: Is the Building Historically Designated: Yes NO �'� Flood Zone: Aj U OWNER: Name (Fee Simple Titleholde r): � d�-ecus , �y rZjI _ `1 A-9 •L-�-2 Phone#: .�' 77 L/ Address: / 0 S- n. , ! D a , • City: 0 r` (QAAA� '-sh 0 yK.'a► State: ( — Zip: 5,313,P Tenant/Lessee Name: Email: l Q O 1/6`, CONTRACTOR: Company Name: . �- • J { �`0 i�d ty Phone#: '7 �� v Address: 3 3 {N 0 C City: Mom State: Qualifier Name: pp // / Phone#: State Certification or Registration #: l.A (0 (0 (0 Certifi to of Compete #: Contact Phone#: Email Address: ►1 . DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ v . y SquarelLinear Footage of Work: 0 01 Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Notary $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ zaJ4 W, 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 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 Inaksence of such posted notice, the inspection will not be approved and a reinspection fee will be charged 00 i Signa a Signature l 111 V Owner or Agent 7/ Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this V day of 0 �, by11__U3t91'dz..x. up214;0ay of �, by l�. 1 irk `fre who is 4erOff affy—k-n—own'tqme or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: - f f 1,eW' "u' Print: My Commission Expires: APPROVED BY MATTHEW F. YON * MY COMMISSION # EE 202596 EXPIRES: July 20, 2016 Board Thm Ikdo Notmy smokes Plans Examiner Structural Review Revised 3/12/2012)(Revised 07/10/o7)(Revised 000/2009)(Revised 3/15/09) Sign: Aav,&aer Print: t °,•••, n MATTHEW F. YON My Commission Expires: MY COMMISSION # EE 2025H EXPIRES: July20,2016 Od-�r* BodedTku 09* Nfty Sw&n Zoning Clerk THIS IS NOT A RILL - DO NOT PAY BUST 4WL1ILOCATION RWOFMEVAL 700994-7 TSE AIR CONDITIONER CORP STATE# CACIS26686 33 NW 108 CT 33172 UNIN DADE COUNTY OWNER sj�&§RMDITIONER CORP WORKER/S MECHANICAL CONTRACTOR 1 DO NOT FORWARD C.OUNTL' TAX m,A: 08/01/2012 0901f0074001 000075.00 SEE OTHER SIDE TSE AIR CONDITIONER CORP PEDRO MILIAN 33 NW 108 CT MIAMI PL 33172 j} 1 tilt 111 11 1111 111111 1 111 A 1111 It 11116111 A fill till 111 11411 STATE OF FLORIDA DEPARTMENT OP alisnass An PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MILIAN-PRIETO, PEDRO -TSE AIR CONDITIONER CORP 33 NORTHWEST 108 COURT MIAMI FL 33172 Conpratuiationst Wiih this iksnse you become one of the nearly one miiiion Floridians licensed by the Department Business Prof mwAonal Regulation. l T of and , 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 For infonnatison about our services, please log onto .myfioridalloonse.corn There can 11nd more kdormatlon about our divisions and the regulations that CffiRTI�'I IA you imPad You, subscribe to department newsletters and seam more about the Department's inhia Our ndsson at the Departrnent Is. license Ef lently, Regulate Fairly- We I constantly strive to serve you better so that you can serve your customers, sTx> x Thank you for doing business in Florida, and congratulations on your new licensel DETACH HERE r Gs T ON ',f 12.7006.25 1221-2012 * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has- elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 12/21/2012 EXPIRATION DATE: 12/21/2014 PERSON: MILIAN PRIETO PEDRO SR FEIN: 273630682 BUSINESS NAME AND ADDRESS: TSE AIR CONDITIONER CARP 1183 NW 125 CT Mimi FL - 33182 SCOPES OF BUSINESS OR TRADE: 1- HEATING, VENTILATION, AIR -GOND tMPORTANT: PM=t to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ander Ibis section may not recover benefits or compensation ander this chapter. Personal to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the basioess or trade limed on the notice of election to be exempt. Puramat to Chapter 440.05(13► F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation It. a any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section ler Issuance of a certificate. The department shall revoke a certificate at nay time for lettere a the person named on Me certificate to meet the requirements of this section. QUESTIONS? (8501 413-1608 OWC-252 CERTIFICATE 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 SLRVOW OMSION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERThF(CATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' NIDI LAW 0 EFFECTIVE 12/21/2012 EXPIRATION DATE: 12/21/2014 PERSON PEDRO MILIAN PRIETO SR FEIN 273831682 BUSINESS NAME AND ADDRESS: TSE AIR 001011 R CORP 1183 NW 125 CT MIAML FL 33182 SCORE OF BUSINESS OR TRAM 1- HEATUM VWHAT10% AIR-COND - - - IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.0502), F.S., Certificates of election to be• H exempt- apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05031. F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person nailed at Use certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 CUT HERE $ Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXERT REVISE 01-11 2013-03-01 08:47 TSE Air Conditioner 3055595364 >> 1 800 685 753001 1 _ p +1 .• CERTIFICATE OF LIABILITY INSURANCE"""' - 02125!13 C _ MS 1PIC TIA 0138IiA AS A 4MIYTLA t>1r iNFORINATION ONLY AND CONfERB NO RIGHTS UPO TN M +�ilmm-ATE HOLDER. CSkTfFICAFE DOES NOT AFFIRMATIVELY OR 1411103ATi M AMSND, MEW OR ALTER THE COVERAW AFFORDED 13Y TH@ POLIMS SSLOW. THIS CERTIFICATE; OF INSURANCE WRS LieO'r CONa111111TE A CONTRACT DETY11EEN THE issu 10 MURER(SI, AUTHORIZED REPR"- W ATIVE OR PRODUCER, AND THE CER' PKAT! HOLDER. �ORTAt4i: I tlsa cortMfcAb Aold� -s sn 4DID1'ftpNAL - • � t!M poYcy(Nt) et�t ei i.+do'raae. Y T�+f 18 wANeO, svbJect to '-- - , ... _ ..... -i Ute tUM and earl boas of IM Pte. —UM pokles may ragQ" all 0WOrsamsrM, A sdtemK4 on Lith! arNaala does red egaW rWft t0 nm NrtVIGita holder In lieu e1 suoh mdo►sematRis)- FRWUCRR First Insurance Group 10387 SW 40 St Miami, FL 33188 phGne X21-787_8_ Fox (30655x7090 TSE AIR CONQMONER CORP 33 NW 108 Ct MIAi►6!. Ft, 33172 - Be "OP atSURMiCE ORlIa11At. ttT AexliY ® GQItl�RCtAt GENERAL llltalLlrY Q CLA1N8-t w Q traaua rl Cl 0M AGON"Ta UW APPLIES PER. 0 LOO UMMOWZUAmry ❑ ANY AUTO Cl W ° p P O MVftAVTOS pUT WORM" LIOU ©OQCUR ❑ EtcEn UAa 171.. -- LWAY*" / VoaG19a MIAMI SHORES VILLAGS 10080 NE SECOND AVE MIAMI SH(RES, FLORIDA 3$135 ACOTw 2i 1110" QF IA - i1tt1'iese®a0l,cnrti .....-...__..,.e...,..................li 17878 ►erns (30d�3i54-70W _ m* cum .. -- AIaUNINA s �Flilm W►TED WITIONL INAURANCE �+.. _... . r�UgsRa;.. f . f.L-- .. tN1It1R@Pt E NIIM13Qi; — - • --�� JCis ailD BEI, qy� j TERM OR CONMM0I# OP ANY C INSWW4E AFFORDED eY THE ONTS SHOWN At y HAVE BEEN 1 PW N"M@L— 900$8582-01 AOOMD mt, Atle. W Ibewlu CHIN � THE NMStI WYNED ASO FOR TILE 9�CY PEii100_... . _.. OR OTHER DOCL*Mff VWTH RESPECT TO VWH" TMIB o1:scRMW HEREIN O SUBJECT TO ALL YHE PERMS, 9Y PAID CLAWS 0111112013101H1r14 `= tt mow t+oaau awl El -t 1,000,W0.00 �a t!Fclw�ll. _-- 31 !, ADV MMY s 1,00Q0W.00 - -mewt 2'pp.000.00� RytP•*asRon) s kama _ ova _4 -EARMVL i •notw�r��r�.s �a�py�v WOULD ANY OF TW ABOVE MCRIMLID POUCWS M4 CANCIELL D 10001K THE R)"A110N DAYS ' t+IOTICt{ YY1LL BE rfe1N[R!D RV AccORDANCB "M TIS rout2Y P)tDVISIONL a l AtRIrOM2js*REDr4MTA W 01 mg icier— ThO AMRO toff and Ap rigms rosmsd, A marks of ACORD 200-02-26 1066 THE FIRST INSUR 3M 554 7090 Pbgina 1