MC-13-2270, e 1-5 -_-22,
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-185268 Permit Number: MC -2-13-227
Scheduled Inspection Date: November 10, 2014 Permit Type: Mechanical - Residential
Inspector: Perez, JanPierre
Inspection Type: Final
Owner: YZQUIERDO, JOSE Work Classification: A/C Replacement
Job Address: 1351 NE 101 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132050230080
Project: <NONE>
Contractor: A&P AIR CONDITIONING CORP Phone: 305-556-7849
tsuuamg uepartment comments
NEW AC DUCT WORK NEW AC UNITS Infractio Passed Comments
INSPECTOR COMMENTS False
V
November 07, 2014 For Inspections please call: (305)762-4949 Page 1 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 1 of 35
0812112013 15:55 (FAX) P.0011001
01E. !ur CERTIFICATE OF LIABILITY INSURANCEX20"
1" '
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.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDHR. 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(% AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate Wdsr Is an ADDITIONAL INSURED, the polloy(lee) 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 sndorsemGn s .
PRODUCERLavra
8usatt
Prank H. Furman, Inc.
P ON6 . (954)943-5050 (9sa)9"2-6310
1314 East Atlantic Blvd.
E -MAUL ADDRESa.isura®furneaaiasuraacs.eomo
P. 0. Sox 1927
Pompano Beach FL 33061
INVURCRM AFFORDINGCOVERME NAIc
INSURERA$irst SPOCiAltV Ins Corp 34916
visun"
-Travelers PrLpPertY Casualty c 25674
A a P Air Conditioning Corp
INSURER :American Guarantee a Llabtllty 26247
2322 Neat 76th Street
INSURER D:
1111RERP•
Hialeah 8'L 33016
COVERAGES CERTIFICATE NIIMBER- 0C%nnl1%wl u1 /aaaate.
.VIV I\ 1\VIRVYI\,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTA
TYPE OF INSURANCE
LIVI.
P LI H!
POLICY EFF
POLICY EXP
uMrrs
GENERAL LIABILRY
EACH OCCURRENCEti X '000,000
X COMMERCIAL ORNERA. LIABILITY—PREMISES
law ocum"981 .$ �50: 000
A
CLAIMS -MADE OCCUR
rRG0005935 03
/23/2013
/23/2014
MED EXP (Any anv mon) $ EXCLUDXD
x Per PL'01e0t AGA $5191
PERSONAL AADV INJURY S 1 000,000
K Prior Yrittwn aontreot
GENERAL AGGREGATE s 2,000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS C�YIP/OPAGG S 2,000,000
POLICYx P LOC
S
AUTOMOBILE UAa1LnY
X
1'000'-000
B
ANY AUTO
BODILY INJURY (Par peraw) 4
ALL OWNED SCHEDULED
AUTOS AUr'OS
953R45A/23/'2013
/23/2014
BODILY INJURY (Per soeldaM) s
NON
x HIRED AUTOS OgWNED
$
S
X UMaltlLLA LIAM
N OCCUR
EACH OCCURRENCE 3,000,000
C
ExcEss LIAR
CLAIMBMADE
AGGREGATE s 31000,000
DED I x I RETENTION a
s
oc 5472095-01
/23/2013
/23/2014
WORKERS COMPENSATION
AND EMPLOYERS' LWBILnY
WC STATU- OTH•
ER
ANY PROPRIETORIPARTNER/EXECUnVE YIN
E L EACH ACCIDENT "'-_—`I •yY-_
S
OFFICEIMEMBEREXCLUDED9 ❑
NIA
(Mandatory to NH)
DEet:RIP110'N OF OPERATIONS
E.L. DISEASE- FA EMPLOYE s
E.L. DISEASE -POLICY LIMIT
bakHv
DRECRIpTION OF OPHRATIONS I LOCATIONS /VEHICLES (Atleoh ACORD 101, Addh(onal Remerka Schedule, tl mon apses ti npuind)
CERTIFICATe unl nee _ ...
Miami Shores Village
10050 Northeast 2nd Avenue
Miami Shores, FL 33138
ACORD 25 (2010/05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE MTN THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD
- 1 — no -a Irra a name ann rnnn am rania4arrei a\aarlra eft Armon!
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
Permit Type: MECHANICAL
FEB 0.6 �Oi3
FBC 2010
Permit No. M&13 O�-4-
Master Permit No. 12 -C -A 3 `025
JOB ADDRESS: 1 1G l C) 5
City: Miami Shores County: Miami Dade Zip: l -3 t)
Folio/Parcel#: I k- �3-2 S^ 0 Z,-3 R U 0 b C
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): "3 cr2z t1
Address. 1X51 4 G v) 1 CT
City: Jy\ l O i A �
Tenant/Ussee Name:
Email:
L
atS,4-SZG-'4sS a
State: -Ti-- Zip: _7S__3> N 3
CONTRACTOR: Company Name: A,%
Address:(�
City: Q V2 c U St
C` L'(2.) v -
" A0 >—ISS Ce 31�4 I?
Qualifier Name: �CVVA_ t2- V1 l.c Phonei
State Certification or Registration #: (f 46- '525 qZjCertificate of Competency #:
Contact Phone#:
DESIGNER: Architect/Engineer:
mail Address:
Value of Work for this Permit: $ 6 3 0-0 ` Square/Linear Footage of Work:
Type of Work: OAddress ll OAlteration ONew
Description of Work:
Submittal Fee $ Q • U� Permit Fee $
Scanning Fee $ Radon Fee $
Zip: �3 3 0) !k
CCF $ CO/CC $
DBPR $ Bond $
ODemolition
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
s
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
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 approyedyM a reinspection fee will be charged.
Signature Signature
er Agent Contra o
The foregoing i strument was acknowledged before me this 9 The foregoing instrument was acknow ed before me s 4-7
day of , 20 13, by �C�-�... Zy. -ce ��, day of _, 20 13, by K u ULC i 2
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath.
NOTAR
tary Public St e f Florida
R o z
Sign: IsMon 043995
2086020 114
Print:
My Commission Expires:
as identification and who did take an oath.
NOT
ty P is state of ® a
db® Bench@
M Mal I 1
Sign:
Print:
My Commission Expires:
APPROVED BY / ' IYJ,J L Plans Examiner Zoning
Structural Review Clerk
Revised 3/12/2012XRevised 07/10/07xRevised 06/1012009)(Revised 3/15/09)