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MC-13-2242Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-200431 Permit Number: MC -10-13-2242 Scheduled Inspection Date: February 12, 2014 Inspector: Perez, JanPierre Owner: LLERENA, MARK Job Address: 1550 NE 103 Street Miami Shores, FL 33138 - Project: <NONE> Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (786)981-1301 Parcel Number 1132050310110 Contractor: AIR ZONE MECHANICAL INC Phone: (305)556-7667 Ismiaing uepartment comments INTERIOR REMODEL FOR 4 BEDROOMS AND 4 Infractio Passed Comments BATHROOMS INSPECTOR COMMENTS False REPLACE 4 TON UNIT AND DUCT WORK K�A) q Passed Inspector Comments Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. February 11, 2014 For Inspections please call: (305)762-4949 Page 5 of 39 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (30S) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Tyne: MECHANICAL OWNER: Name (Fee Simple Nov 1 2013 P`"a... .- _ amm, .,tee-�+�•._ Permit No. ?Zq Master Permit No. TenantIt9see Name.• Phoned: ' E1nai1: e JOB ADDRESS: City: Miami Shores County: Miami Dade 73p: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Address: U n 0 CD (� City: Qualifier Name: WS-vsCO4. St ite'C' rdh6tion or Registration #: 0 Vl A29c Certificate of`Gbmpetency #: Contact Phone#: �'`D�D-- �� Email Address•!~•l,� +rQ. 611 DESIGNER: Architect Engineer• Phone#• �(o &0. Oct Value of Work for this Permit: Square/Linear Footage of Work:— Description -of Work: Submittal Fee $ Permit Fa $— I 1, `U 6 I)(✓ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Stradural Review $ TOTAL FEE NOW DUE $, Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 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 COMN ENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR BIPROVEMENTS 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be. delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the jolt site for the first inf.-- Owner h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will ed and a reinspection fee will be charged Signature Signature or Agent Contractor The foreFong instrument was ac ledged b or me this —ij The foregoing instrument was acknowledged 4fore, me this day of 24:??—, by �� day ofb 20 JA by w personally known me or who has produced who is personally known me or who bas produced., ti As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY Sign: Sign: Print: Print: My Commission Expires I�'!' D�'� �� MY COMMI6SION # EE 666066 My C EXPIRES: 611,2015 Bonded ThruNotary Publ Underwriters da,kkN,k4s,kRrk�hhrkktk�k+kBM�lakk�kkrk,k�rk4`+krk$#+k$eN+bdj�h,Rkk+krk kk+k�kk#9ukAk�k�hrkrkR#i�k#tRk+ki APPROVED BY13S xaminer 1 Structural Review (Revised (Y7/10/07)(Revised 06/I012009)(Revised 3/15/09) IMM 1� O ibll EVIRES AuOust 04, 010 dfb Zoning Clerk PLASENCIA, BELGRABE AIR ZONE MECHANICAL INC 1166600 NW 54 AVENUE #3 MIAMI FL 33014 Congratulations! With this license you become one of the nearly one million I >srATIE 0F.r�ottroA Floridians licensed by the Department of Business and Professional Regulation. y D$PitTl<iENT "� Our professionals and businesses range from architects to yacht brokers, from PROFESSION boxers to barbeque restaurants, and they keep Florida's economy strong. a -< CAC18I4226s OS 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.myfloddalicanse.com. CERTIFIEiI,jbe CC There you can find more information about our divisions and the regulations that PLASENCIk � .BELGF impact you, subscribe to department newsletters and learn more about the ATR ZONE %1ECHAN3 Department's initiativ AC#:6 10 5 3.2. 7 F BUSINESS AND � R1?GIILATION :CI%Z2 120030216 M,CONTR es. !AL INC 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! 1S :CERTIFIED under the provisions of cn.489 Ps xgirarton data:; �4iIIG 31,2014 L12071700838 THIS :D000MENT HAS',A COLORED BACKGROUND _ MICROPRINTING • LINEMARK'° PATENTED PAPER 6.205327 STATE OF • Y 19W, 413 F? .. E:Vtv�lxu�alVN INDUSTRY :LICENSING. BOARD SEW L12 07 170 0 83 8 KEN LAWSON SECRETARY _,• q! R"FICAT L�ABI .1T f 1#i C DATE(MM/pDIYYYI� IS CERTIFICATE IS ISSUED AS'A MATTER OF INFOFMATION ONLYAND CONFERS NO RIGHTS UPON THE CER?1FICATE 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(SL AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURE 'the policypes) must be endorsed. -If SUBROGATIQN IS,WAIVEO; subject to the'terms and conditions of the policy, certain policies may require ah endorsement A statement on this eertlficc lite does not confer rights to the certificate holder in lieu of such endorsement(s). } ACQ p' PHONE (W5) 266-1700 FAX NO). (305) 267-1197 DDRE Mindan@eguino.com Miami, FL 33155 Phone (305) 266-1700 Fax (305) 267-1197 INSURERS) AFFORDING COVERAGE NAIC iii _,• q! R"FICAT L�ABI .1T f 1#i C DATE(MM/pDIYYYI� IS CERTIFICATE IS ISSUED AS'A MATTER OF INFOFMATION ONLYAND CONFERS NO RIGHTS UPON THE CER?1FICATE 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(SL AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURE 'the policypes) must be endorsed. -If SUBROGATIQN IS,WAIVEO; subject to the'terms and conditions of the policy, certain policies may require ah endorsement A statement on this eertlficc lite does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Eguin0 & Associates 7229 Coral Way CONTACT MARITZA INCLAN PHONE (W5) 266-1700 FAX NO). (305) 267-1197 DDRE Mindan@eguino.com Miami, FL 33155 Phone (305) 266-1700 Fax (305) 267-1197 INSURERS) AFFORDING COVERAGE NAIC iii INSURERA: SCOTTSDALE INSURANCE COMPANY INSURED Air Zone Mechanical, Inc. INSURER 8: INSURER C - 16600 NW 54th Ave, Unit #t3 INSURER D : INSURER E: Hialeah, FL 33014 (305) 556-7667 INSURER F: rnvr:oer-oe 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILLTRR TYPE OF INSURANCE ADD N RWVD. B POLICY NUMBER POLICY EFF MID POLICY EXP MMID LIMITS A GENERAL LIABILITY 0 COMMERCIAL GENERAL LIABILITY F-1❑CLAIMS-MADE C OCCUR ❑ Y CPS1630544 08!15!2013 08!15!2014 EACH OCCURRENCE $ 1,000,000.00 -TO RENTED PREM SES Ea AMAGE occurlnce $ 100.000.00 MED EXP (Any one person $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: I POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL AUTOS OWNED ❑ SUTOESULED ❑ HIRED AUTOS ❑ NON -OWNED COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident ❑ UMBRELLA LIAR � OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATIONY / N AND EMPLOYERS, LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICEWMEMBER EXCLUDED? ElN (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below / A ❑ WC STAND- ❑ OR O - RY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 111, Additional Remarks Schedule, I more space Is required) AIR CONDITIONING INSTALLATTION, REPAIRS AND SERVICES. CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE HALL 10060 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I I I MARITZA INCLAN ACORD 25 (2010(05) OF ©1888-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORO : CERTIFICATE OF LIABILITI/ INSUR ANC REPRESENTATIVE OR PRODUCER, AND THE CERT IMPORTANT: If the certificate holder Is an ADDITIOP the terns and conditions of the policy, certain pollci certificate holder In lieu of such endorsement(s) PRODUCER PAYCHEX INSURANCE AGENCY, INC. ROCHESTER NY 4620 INSURED Paychex Business Solutions, Inc. Air Zone Mechanical Inc 911 PANORAMA TRAIL SOUTH ROCHESTER, NY 14625-0397 + , :OEi/13/2013 RMA ON ONLY AND CIONFE[$S IYO GttTS WpON THE ERTIF)CA E HOLDER. THIS 11lELY•AMEND, EXTEI� OR.ALT R E;COYERAGE ApFOkbED BY"THE POLICIES IT COliff UTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED CATE HOLDER. . INSURED, thepoliry(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to may require an endorsement. A statement on this certificate does not confer rights to the CONTACT.`` "" Paychex Insurance Agency Inc JA�M NO. EXT): 877-266-6850 (A/C,No): 585-38&7426 r --MAIL Certs@paychex.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ILLINOIS NATIONAL INSURANCE COMPANY 23817 INSURER B: INSURER C: INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. T TYPE OF INSURANCE OL UBR POLICY NUMBER POLICY EFF POLICY DIP INSR LIMITS (MMroo/YYYY) (MMroomY� GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ CLAIMS-MAD�DCCUR MED EXP (Any one person) $ I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) Workers Compensation coverage is provided to only those employees leased to, but not subcontractors of the named insured. CERTIFICATE HOLDER MIAMI SHORES VILLAGE HALL 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE n., wn01888-2010 ACORD CORPORATION. 11)� Ahts reserved, nnn _�_ _ .__._ .........»......y.. a.v .ww.a .wa ILIAD vn ha.vw � i I PERSONAL 8 ADV INJURY $ ;ENL AGGREGATE LIMIT APPLIES PER POLICY = PROJECTF7 LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $COMBINED AUTOMOBILE LIABILITY ANY AUTO �� AUTOS HIREDAUTO$ '_.J AUT0.5ED SINGLE LIMIT (Ea accident) $ BODILY INJURY $ (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per acddent) $ EACH OCCURRENCE $ UMBRELLA Lytg OUR EXCESS LIAS CLAIMS -MADE I AGGREGATE $ DED RETENTION S I $ WORKERS COMPENSATION AND EMPLOYERa'UASM Y 013255888 06/01/2013 06/01/2014 X UIC STATLL OTH- OETRH E.L. EACH ACCIDENT $ 1,000,000.00 PROPR1ETORIPARTNERlEXECUTNE OFFiCERMEMSER EXCLUDED? Nandw l-1 N/A I I E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 N yea. desmbe� I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) Workers Compensation coverage is provided to only those employees leased to, but not subcontractors of the named insured. CERTIFICATE HOLDER MIAMI SHORES VILLAGE HALL 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE n., wn01888-2010 ACORD CORPORATION. 11)� Ahts reserved, nnn _�_ _ .__._ .........»......y.. a.v .ww.a .wa ILIAD vn ha.vw