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MC-14-1545Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 ENIM-01", Inspection Number: INSP-216118 Permit Number: MC -7-14-1545 Scheduled Inspection Date: November 10, 2014 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: ALEXANDER, DAVID Work Classification: Addition/Alteration Job Address: 1640 NE 104 Street Miami Shores, FL Phone Number (646)675-3489 Parcel Number 1122320320430 Project: <NONE> Contractor: MASTER MECHANICAL HVAC CORP Phone: (305)394-6218 Building Department Comments RELOCATE A/C DRIP AND INSTALL NEW 3 Exhaust FAN Infractio Passed comments INSPECTOR COMMENTS False November 07, 2014 For Inspections please call: (305)762-4949 Page 7 of 35 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 07, 2014 For Inspections please call: (305)762-4949 Page 7 of 35 ® _ R —9 \1P k7 v o Miami Shores Village BY. JUL 17 2014 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNE PHONE NUMBER: (30S) 762-4M9 FBC 20 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No.� d. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1640 NE 104 St City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2232-032-0430 Is the Building Historically Designated: Yes NO X F IIB AE 10.0 8.19 Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): D. ALEXANDERN. AGUIRREBEITIA phone#: 6-675-3489 Address: 1640 NE 104 ST City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: CONTRACTOR: Company Name: r At t -TC I•n4,n o 141 0 (�Dl s hone#:.3i9S — 3W Address City: 1j'f tel/ State:—I� Zip: Qualifier Name: /s 0 Ac, t197 Phone#: 77- F96q 'fes mi 31� State Certification or Registration #: C14C Certificate of Competency #: DESIGNER: Architect/Engineer: DEN ARCHITECTURE LLC Phone#: 305-335-6085 Address: 1477 SW 14 TERRACE p,, y City. MIAMI State: FL Zip: 33145 Value of Work for this Permit: $Square/Linear Footage of Work: Type of Work: ❑ Addition [ . Alteration 9 ❑ New ❑ Repair/Repla ❑ Demolition DesctptionofWork: �ilf'/evrzb�'�.� Specify color of color thru tile: Submittal Fee $ Permit Fee $ ® %, �2 CCF $ CO/CC $ Senning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Rev1sed02/24/2014) DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) CITIBANK NA 1000 TECHNOLOGY DR Mortgage Lender's Address city 07ALLON State MD 63368-2240 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 $2500, the plicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be deliv d to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencemen us a sted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the sent of ch posted notice, the inspection will not be a proved and a reinspection fee will be charged. S1gnat Signature OWNER or AGENT N The foregoing instrument was acknowledged before me this The foregoing inst a acknowledged before me this 2-7 day of �/ d �2 20 'I 7 by day of 20 �, by l7._ J �i ><��nd 2✓ . who is personally known to who is personally/known to me or who has produced L 101. as me or who has produced as identification and who did take an oath. identification and who id take an oath. NOTARY PUBLIC: NOTARY PUBLI 4 Sign:lift— Sign: Print: Print:Nib a Maxine Y Gomez amm or rlda •��.a �I'% MARIO CABRERA Seal: ' My _ N0tafy PubIHC - Stite OI Florida ��cdt'e EExphw 3 'DE8 9238 4 my Comm. Expifes Aug 11.2017 SI+� FF 1463 N�b�k R +RB*R �R �FB�Y Ne k+kNe�k tele �kiRsaminer �k�k BSM+k�k�R�R4�k&�&M�84�k�k+k+6+N•�k�k �Rffi�kW�k�k �h�R�k�k�b �N�N �F �P�P 9��PNPB�k �M+k�k•k�k�N �k84� '��iii.i•i�`• Bonded Through Wonal Notary As$n. APPROVED BY w PlaZoning Structural Review Clerk (Revised02/24/2014) Miami shores Village Budding Department © 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla_ Stat. § 440.03 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is Sled or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carver since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS to CONTENTS. Owner Contractor Print Name: n A IC—mht Print Name: Signature* Signature: State of Florida ) State of Florida County of Miami -Dade) Sworn to and subscribed before me this . Countyof Mi i- Sworn to de) before me this day of :7,j,,g , 20 14 day of 0/ ] By1Jc.v: �C �t .•.�@y By �}4 Notary 0011c stage or Florlda (S(SEAL) 'Q �a My Cmnmisaion EE 839239 Expires 09/30,2018 T e c T of Identification ra u'se'tirb"` • 112017MyC , ,._ CommisomfFF0N�3 .ecov® . CERTIFICATE OF LIABILITY INSURANCE L.THIS DATE(MM/DD/YYYYj 7/17/2014 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. if SUBROGATION IS WANED, subject to the terns and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ADVANTAGE INSURANCE OF AMERICA 4520 NW 7th St Miami., FL 33126 CONTACT NAME: PHONE No Ext: (305) 649-5566 A/C No:�305) 649-5559 AnMPJLDlESS:jackiebatista 749@hotmail.com CUSTOMERID* INSURERS) AFFORDING COVERAGE NMCS INSURED MASTER MECHANICAL H . V . A. C CORP 4521 NW 33 AVE MIAMI, FL 33142 INSURER A: AMERICAN VEHICLE INSURER B : CASTLE POINT FLORIDA INSURANCE INSURER C: INSURER D: INSURER E: INSURER F THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L7RR TYPE OF INSURANCE GENERAL LIABILITY x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR nusR X GU Y POLICY NUMBER GL -22545-00 MM/DD F 06/02/14 MM/DD 06/02/15 LIMITS EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 MED EXP (Arty one Person) $ 5,000 PERSONAL &ADV INJURY $ 11'0001000 GENERAL AGGREGATE $ 210001000 a -0 Ann wnllCn rN1DDr'im AN All rinhtc racerved_ PRODUCTS - COMP/OP AGG $ 2 , 000'000 GEN'L AGGREGATE LIMIT APPLIES PER R POLICY PELT LOC AUTOMOBILE LIABILITY A $ COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ ANYAUTO ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ (Per accident) NON -OWNED AUTOS UMBRELLA LIAR7F1 OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE $ DEDUCTIBLE WC STATrU OTH- TORY LIMITS ER RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNOUMCUTIVE YIN OFFICERIMEMBER EXCLUDED? 7 nyyeeenaad d°�ry In �� DES6descRIPTibe OF OPERATIONS below NIA 253351 02/06/14 02/06/15 E.L.EACH ACCIDENT $ 1 / 0- 0, OOO E.LDISEASE -EAEMPLOYEE $ 1,000,000 1, 000 000 E.L. DISEASE -POLICY LIMIT $ r DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) AC INSTALLATION,SERVICE AND REPAIR CERTIFICATE HOLDtl{ `�^'•"'-" ^ ""^ MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N. E 2ND Avenue MIAMI SHORES FL 33138 AUTHORIZED REPRESENTA a -0 Ann wnllCn rN1DDr'im AN All rinhtc racerved_ ACORD25(2009/09) The ACORD name and logo are registered marks of ACORD