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MC-13-2791Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-204454 Permit Number: MC -12-13-2791 Scheduled Inspection Date: October 20, 2014 Permit Type: Mechanical - Commercial Inspector: Perez, JanPlerre Owner: , Job Address: 555 NE 87 Street Miami Shores, FL Project: <NONE> Inspection Type. Final Work Classification: Addition/Alteration Phone Number (305)326-9308 Parcel Number 1132060200970 Contractor: CITY CONNECTION A/C REFRIGERATION INC Phone: (305)380-7217 Building Department Comments INSTALL TWO NEW 5 TON SPLITS SYSTEMS AND ONE IPassed comments 3.5 SYSTEM WITH DUCT WORK INNSPECSPEC TOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 17, 2014 For Inspections please call: (305)762-4949 Page 2 of 38 Miami Shores Village ° Building D epartment IL 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 Permit Type: MECHANICAL FBC 20 Permit No. DEC 12 2013 Master Permit No./14/" k?—.,2-Z91- JOB ?, Z9/ - JOB ADDRESS: ��J`� �l�62 —*� City: Miami Shores County: Miami Dade Zip: ?3 1,3z Folio/Parcel#: /0-3,2 06 ®tea® — 0 9 70 Is the Building Historically Designated: Yes NO Flood zone; OWNER: Name (Fee Simple Titleholder): "JJP VI Z/,rkg � Phone#:_3Oa r e.Z �• �� _ a Address:1/15- �_� City: � s s,:+ � � state: zip: TenanvLessee Name: Phone#: Email: C 0 N T R A C T 0 R: Company Name: Address: City: Qualifier Name: zos3s o --t ?.,n State Certification or Registration #• C46 l ?)A b -S 5' 15 Certificate of Competencyk Contact Phone#19 (0' 4Q3 b Q (� Email Address: xw r,> 0-4—�,i/ 4 & �osr D ESI G N E R: Architect/Engineen Phone#. Value of Work for this Permit: 8 14,e Square/Linear Footage of Work: Toe of Work: DAddress OAlteration lew OReoair/Renlace ODemolition Submittal Fee 27n •4 ° Permit Fee a CCF S ILI - Z CO/CC 8 Scanning Fee S 12/)(1 Radon Fee S 910 DBPR S _Bond 8 Notary 8 Training/Education Fee 8 Technology Fee 8 1 H • Ll0 Double Fee S Structural Review 8 M -on 9R 0 0 `-i ce TOTAL FEE NOW DUE 8 (00 Name (if applicable) Address State Mortgage Lender's Name (if applicable) Mortgage Lender's Address 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 O F 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 82500, 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_08 job site for the first inspection which occurs seven (7) days after the building permit is issued, In the absence of suchposd not" a inspection will not be approved and a reinspection fee will be charged. I( Signature �z Owner or Agent 1? The foregoing instrument was acknowledged before me this 41 day of , 20 by Oly 4 64P who is personally known to me or who has produced As NOTARY PUBLIC: Sign: Print: /C IIr My Commission Expires: wwwwwwwwwwwwwwwwwtrwwwwwwww APPROVED BY and who did take an oath. Signature, Contractor The 4regoing ' ent was acknowledged before me this day of i%) er 20�A by ; X 6e who is personally otome or who has produces ac identi6catinn_and whn did take an oath. Sign: Print: My Commission Expires: Quo Z3 , ZD I LP ***w+►*w****w*wwwwwwwwwwwwwwwwwwwwwwwwww*wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww l/ ® 'P,;&amine. Zoning 14111 Structural Review Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Ravised 3/15/09) Clerk CITY CONNECTION AC Agreement/ 10932 Invoice No. Contractor# CITY CONNECTION AIRCONDITIONING Date Sales Rep. 12/02/13 Bill To: Pajovi Holdings CO Joao Ramon Perez 555 NE 87 St. Miami Shores FL 33138 CO Quality first homes Ship Via Terms service COD Agreement/ invoice Ship To: Same Tax ID na Quantity Item Description Amt Total 2 60/5116 5 Ton New Goodman R -410a16 seer split system & W 10 KW heat 3 Rpl Fiber glass R-6 direct plenum air supply 20'-30' 1 36/3t16 3 Ton New Goodman R4-l0a 16 seer split system & W 10 KW heat 3 Rfln Refrigerant lines 7/8,3/4,3/8 & w Armaflex 25' 3 Proline digital T -stats Full install to approved specs Heat load calcs, mechanical plans, electrical sheet, & permit run/processing Condenser stands & attachment (roofer required) Terms: 60% Down$1 1,500.00, 30%completion 10% on final ****5 year material warranty**** e Subtotal: 18000.00 Acepted by: Date Approved by: ,_.,bate The above specifications Shl�lnln Shipping: g prices, and commons are here by accepted You (the seller) We authorized to do the work as specified. Payments will be made as outlined herein. - --- - - Title to the above merchandise remains with CITY CONNECITON air conditioning )seller) until paid In full. N case of default In any terms of this contract, the Seger have right 10 and or Its agents, shag L, Miscellaneous: have the right to enter the premises and remove any equipment or Property on the premises belonging to Cm CONNECTION air conditioning and or its agents Chan and the lug amount of the purchase price then unpaid shall became Immediately due and payable at the Sagan option without g a order Balance Due: notR:e or demand. All moNes paid shag remain with the seller as liquidated damages. - - I n the event the services Of an attorney shag be required to enforce the Interest of the seller, the purahaser shag be required to pay all reasonable attorneys fees together with Interest and all cost there 10. In the event PWChM& MIUSes to allow seller 10 commence work after the contract has executed, purchaser shag be responsible to the seller for 154E of the total contract price as gquldated and agreed damages. Seger shag not be responsible for any existing bugding, mechandcon W electrical code violations. Petmils, impections and on other cltycode entorcerments are the homeowners responslbigly. (WHEN IN THE CASE OF WATER COOLED INSTALLATIONS FAILURE OF EQUIPMENT OR CLOGED TRAPS OR TO START OR STAY ON DUE TO BUILDING WATER PRESSURE. COOLING TOWER ANY PART FROM OR TO AIRCONDITIONWG EQUIPMENT SHALL BE THE SOLE RESPONSIBILITY OF THE HOMEOWNER OR BUILDING ASSOCIATION TO PROVIDE ADEQUATE FLOW Of WATER TO SAID EQUIPMENT) P.O. Box 693428 Miami Gardens, FL 33269-3428 Phone: 786-512-1929 E-Mail:info@centralairdepot.com 9/21/14 10:35AM EDT CITY CONNECTION AC REFRIGERATION INC —> Building Dept 3057568972 Pg 5/5 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 �* TALLAHHASSEMONROE STREET EFL 32399-0783 GUERRA, FLUX DFS J'ESVS CITY CONNECTION AIR CONDITIONING REFRIGERATION INC MIA304 MI SW 130TH COURT FL 33186 Congratulatlonsl With this license you become one of the nearly one million STATE OF FLORIDA y AC;� 6 28 3 i &S Floridians licensed by the Department of Business and Frefessionai Regulation. j DEPARTMENT OF BUSINESS AND I Our professionals and businesses range from architects to yacht brokers, from PROFESSIONAL -REGULATION { 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 ` CAC1916558• 08/20/12 120077582 For information about our services, please log onto www.myfloridalicense.corn. There you can find more information about our divisions and the regulations that CERTIFIED• AIR COMD' CONTR I impact you, subscribe to department newsletters and loam more about the Department's inlNatives. I t GUERRA, FELIX DE • JESUS CITY CONNECTION ASR , CONDITIoIQING ' Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. t Thank you for doing busing in Florida, and congratulations on your new licensel IS CIMTIFIED under the yrovseiaae of ®.489 as awirati= data, AUG 31, 2014 L12 0 82 0 416 6 3 DETACH HERE= AC # 6 2 8 3116 STATE OF FLORIDA DUFART20 CO SRrYCtIIFION YNDUSTR'pYRLICBNSINGLAOAGRDIILA'rION SEQ* LU 0 82 001663 The CLASS A AIR CONDITIONING CON%16 TOli Named belaw'IS CERTIFIED Under the provisions of Chapter' 489 FS, Expiration date: AUG 314, 2014• CITYYCCONNECTION$A RECONDITIONING REFRIGERATION INC* 1100,3030,44 SW 130TH COURT FL 33186 RICX SCOTT REN LAWSON GOVERNOR SECRETARY �_ AS.REQUIRED BY LAW B/21/14 10:35AM EDT CITY CONNECTION AC REFRIGERATION INC —> Building Dept 3057568972 Pg 4/5 ooteao Local Business Tax Receipt Miami—Dade County, State of Florida TFIIS IS NOT A BILL — DO NOT PAY %_LBT1 8445282 DUSNEGS NAMFJLOCATION RECEI F'Olm EXPIRES CONNECTION & AIR CONDITIONING RE1 kIGEf�L SEPTEMBER 30, 2014 10304 MIAMI FL 318 Cr 6713672 Must bo disoloyed at place of bualness MIAMI FL 33186 Pursuant to County Code Chapter 64 _ Art. 9 & 10 OWNER SEC. ':YPB OF DUSINBSS CITY CONNECTION & A/C REFRIG INC 196 SPECIALTY BUILDING CONTRACTOR PAYMENT nEf lVED Wofker(s) 3 CACIR16558 BY TAX COLLECTOR $75.00 08/28/2013 ECHECK-13-006243 lhia Loyal Bualnoi6 lar Receipt onlyrA oays payment of tiro Local s wmess Tsa. 7ba Noce le mot a limse. p�rmiL or a eanlfieatipu of tae ldei s Qnalifieadano 1p de business. floidar must comply with an govevammol or aavemwental repulata y laws And railoiremeate winch apply to the bagimesa The RECEIPT NO-abova moat he displayed an all aommefeW yegietes — Miom"ade Code Sec 9p-= For Moro hdomMtIM visit From:Jimenez Ins. 305 264 5382 08/21/2014 08:47 #015 P.001/001 CERTIFICATE OF LIABILITY INSURANCE DATE (MMMD/YYM 08/21/14 ..-r.� w 10oucu pas A MATi-ER 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 WAIVED, subject to the terms 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 I iC1AMBACT JULIO JIMENEZ Jimenez & CO., Inc. PHONE 8000 Cora( Way oaa) (305) 264-9900 I CNo): (305) 264-5382 Miami, FL 33155 i_AWRMW Julio ftimenemndcompany.com -INSURER(S) AFFORDING COVERAGE NAIC Phone (305).264-9900 Fax 305 264-5382 INgURER A : COVINGTON SPECIALTY INSURANCE CO INSURED INSURER S: CITY CONNECTION AIR CONDITIONING REFRIGERATION INC ! INSURER : 10304 SW 130 CT FRANCISCO PING I INSURER D: Miami, FL 33186 (306)380-7217 UVCRAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS 1S 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. LTR i TYPE OF INSURANCE f POl i GENERAL LIABILITY © COMMERCIAL GENERAL LIABILITY A ❑ ❑ CLAM -MADE ® OCCUR � VBA313822 I EJ❑ GEN'L AGGREGATE LIMIT APPLIES PER: E ❑ POLICY l PRO .T ❑ LOC AUTOMOBILE LIABILrrY ❑ ANYAUTO ❑ ALL WNED AUTOS ❑ AUTOS$ LED ❑ HIRED AUTOS F-1AUT SWN� ❑ ❑ ❑ UMBRELLA LIAR ❑ OCCUR EXCESS LIAR ❑ CLAIMS -MADE ❑ DED ❑ RETENTION $ WORKERS COMPENSATION ANO EMPLOYERS LIABILITY Y / N /A 100,000.00 07'/03)2014107'/03/20151 . MED EXP I PERSONAL & ADV INJURY I S 2,000.000.00 , ICCpp �$ L(Ee �dentIB SINGLE LIMI $ 130DILY INJURY (Per person) j $ BODILY INJURY (Per accident! $ FR�OPER DAMAGE I $ i P�P r f ent _ I $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedute, H more Space is required) AIR CONDITIONING CERTIFICATE HOLDER VILLAGE OF MIAMI SHORES 10050 NE 2 AVENUE MIAMI. FLORIDA 33138 FAX: 305.756.8972 ACORD 25 (2010105) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDWITH THE POLICY PROVISIONS. 1988-2010-ACORD CORPOr* ION. All rights reserved. The ACORD nam® and logo ar Istored marks of ACORD B/21/14 10:35AM EDT CITY CONNECTION AC REFRIGERATION INC -> Building Dept 3057568972 Pg IN 2/5 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * " 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 low. EFFECTIVE DATE: 7/12/2013 EXPIRATION DATE: 7/12/2015 PERSON: GUERRA FELIX DE JESUS FEIN: 262719168 BUSINESS NAME AND ADDRESS: CITY CONNECTION AIR CONO 10304 SW 130TH CT MIAMI FL 33186 SCOPES OF BUSINESS OR TRADE: WELDING OR CUTTING HEATING, VENTILATION NOC AND DRI AIR-COND Purausnt to Chapter 440.05(14), F.3., en o flcer of e Calppretion Wtro dsCb slotlMpOon cram this 011813Wby fling a cxrgAnta of election unQer this yeef>an may not recover benefits or oompeereatlon under ft Wtapter. Pursuant to Chapter 440.05(12), F.S.. Cert kmn of election to be exempt., apply only wiMin the swpe of the business or trade Now on the notice of eleogen to be exempt PUMOnt to Chapter 440.05(13), F. S.. Notices of election to be exempt and CWtff at" of election to be exempt shall be aubject to revocation U, at any Uma ager the t81np of the n00oe or the Issuance of the certificate. the parson naynad on Me notice or Certirrcate no lafr(jet meets the requirements of this section for lawprm of a oertincats. The department shall revoke a carti0oata at any time for failure of me pemn named an Mt cWtIll ate to meat the requirements of this section. OFS-F2-0vve-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (85M4M1609 MiamiS'rhones illa ge Building 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. § 440.05 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 -fie 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 filed 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 maw personallyliable for the worker cam enation in'uries of an erson allowed to work under this ermit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS CONTENTS. Owner Print Name: ✓"'��� �� Signature: State of Florida ) County of Miami -Dade ) Sworn to subscribed day of _ _ _ U TJ Rmmm (SEAL) Type of Identification C, ..-"- !�!!lJ/,pi11111 Print Name: Signature: UNDERSTAND ITS State of Florida ) County of Miami -Dade) Sworn to and subscribed before methis / V' - day of f+v °UMANS B °o�'y'rPua�:�, GEALONDSO #FF129050 €. o°' EXPIRES June 3, Z (SEAL) !e �aati��nService.com Type ofd ,.e