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MC-14-2240Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-233806 Scheduled Inspection Date: May 06, 2015 Inspector: Perez, JanPierre Owner: CEBALLOS, FABIO Job Address: 9510 NW 1 Avenue Miami Shores, FL 33138 - Project: <NONE> Contractor: ARCO TEMP AIR CORP Building Department Comments REPLACE EXISTING UNIT 4 TON Permit Number: MC -10-14-2240 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1131010240260 Phone: (786)470-7857 INSPECTOR COMMENTS False CREATED AS REINSPECTION FOR INSP-233479. CREATED AS REINSPECTION FOR INSP-221495. no access 11 am SAME AS ABOVE Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-233479. CREATED AS IE REINSPECTION FOR INSP-221495. no access 11 am SAME AS ABOVE Failed ❑ SABIO GIL 787-638-1353 MAYLINE 787-598-1851 Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid May 05, 2015 For Inspections please call: (305)762-4949 Page 29 of 50 10/01/2014 WED 14,23 FAX 3054606979 J1002/004 �� q I Miami Shores Village m ��rvED Building• Department QGQ 4 V14 IM N.E.2nd Avenue, Miami Shores, Florida 33138 Tel= (305) 795-2204 Fm (SOS) 756-8972-- iNSPECrIR'!N LINE PHONE NUM8611h (805) 762-4949 FBC 20 LO BUILDING twemr Permit No. M C-44— 22 `-!' D PERMIT APPLICATION sub Penult NO. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING )d MECHANICAL ❑PUSLIMORKS ❑ CHANGE OF ❑ CANCELLATION 'Q SHOP CONTRACTOR DRAWINGS JOB ADDRESS; q hru the BuR ding Mentally Peftnetpd: Yes NO Occupancy Type: Load; Construction Type: _______FIood Zone; BFE: FFE• OWNER: Name (Fee Simple cny: 1� VY Stati - IL �� ISO Tenant/Lessee Name: - _ _ _Phoria: Email: 'j k CONTRACTOR Company -Name: ruo 19m i- Phone#: G� Address: �-7 2- City: I State: ZIP" 1 3 Mallfler Name: & "I n) 4l'WA Phonet. State Certification or Registration #: L-A G _ 0(y _ VA CertifleM of Competency #: DESIGNER: Architect/Engineer: Phone#: State; Zlp: Value of Work for this PerndD $ 2— _ Square/Linear Footage of Work Type of Worle © Addition ❑ Alteration ❑ New Repair/Replace Demolition Liendption of Worlu A C t G Specify color of color thm tile: submittal Fee $ Permit Fee $ CCF $ CO/= $. �+ - Scenning Fee $ ��. Radon fee $ Q_ DSPR $ Notary $L - Technology Fee $ Training/Educatfon Fee $ 0 - ® DOYIde Fee $ Structural Reviews$ ® Band $ TOTAL Ki NOW DUE $ (Aavlsed�J24/eD141 . 10/01/2014 NED 14:25 FAX 9054656979 SmOng Company's Name (if applicable) Sonding Company's Address city - - State Dp Mortgage Lender's Name of applicable) Mortgage Lender's Address City State . 21 IM004/008 Application is hereby made to obtain a permit to do the work and Installations as indicated. i oertity that no work or installation has commented 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, TANM AIR CONDITIONERS, ETC.... OWNEWS 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 pennit with ari estimated value exceeding S2m, the applkont mast promise in good frith that a wpy of the notice of commencement and construction lkn law brochure will be de6ered to the peMn whose property is subject to dttachmenr. Also, a c efdjled cW of the recorded notice of commencement mast be pasted at the Jab sft for the first inspection which occurs seven (7) days after the building permit Is Laued. in the absence of Soch posted notice, the Inspection will not be approved and a relrupecdon fee will be charged. f Signature WNER or AGENT Ili The foregoing instrumant was acknowledged before me this day of Lloi 20 by who Is personally known to me or who has produced C%�i��c3 identification and who did take an oath. NOTARY PUBLICO ,ted Motel p_u�b�li_c�S�t 0 27* 27*41 Seal' a `' MY GO . Joanna 0n r 09 of $ 011121201$ ii4ii#ii#iiiaiiiir►#ii#iii#iii#irti#i#i*s' APPROVED BY I i�/ao�rl Signature _��j -1 -a CONTRACTOR The foregoing Instrument was acknowledged before me this --;' day of 064 6 -sr 20 --� by OL n,dd e g ho. personably knew o me or who has produced as Identification and who did take an oath, NOTARY PUBLIC: Print: J Seal: i*sssaiTff#!#si#i� LIPlans Examiner _ Structural Review R. 1111181.194 BMW 1Ntaidl Neral toning Clerk 10/01/2014 esD 14e25 FAS 3054606979 AIR CONDITIONING REPLACEMENT DATA (1005/008 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (WS) 795.2204 Fax:(305) 756.8972 PERMIT NUMBER: MC This form, must accompany ALL air conditioning replacement permit applications. Eachunit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the wank is being done): ()I J t 0 K) W i A t City: Miami !8m" vinage county: Miami Dade Zip Codec 3 "` 1 SC) ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.LM.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUSNUTALS AHRI DATA SHEET REQUIRED Change dk=nneWng means: YES ❑ NO ❑ ARNI Sheet AttaghW: YES NO ❑ Contract AtttrcW: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker size): 3. Voltage of Circuit (20$/240/480): 4. Size Disconnecting Means: Cont= is Company Nana: Phone: 3 01 State Certlficate or Re&riftn No. C Q e V� 1(p « Certificate of Competency No. Signature Date: /2 (tlw mws slgeewd UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # (- COND. UNIT MODEL # KW HEAT NOM TONS ZA AHU CU PKG 11 M.C.A AHU CU PKG AHU CU PKG . 2) M.O.P AHU CU PKG AHU CU PKG 31 VOLTS AHU CU PKG PKG UNIT % PKG UNIT EER/SEER k L40 YES NO REPLACING DUCTS N0 YES NO REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLAB YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOIL YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker size): 3. Voltage of Circuit (20$/240/480): 4. Size Disconnecting Means: Cont= is Company Nana: Phone: 3 01 State Certlficate or Re&riftn No. C Q e V� 1(p « Certificate of Competency No. Signature Date: /2 (tlw mws slgeewd STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC1816147 The CLASS 8 AIR CONDITIONING COI Named below IS CERTIFIED Under the provisions of Chapter 480 FS. Expiration date: AUG 31, 2016 CHONG, ARNOLD ARCO TEMP AIR CORD 7448 NW 8TH STREET MIAMI FL 33126 ISSUED: 07/17/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1407170WOMS T From: 7865395989 Mon Oct 13 15:51:21 2014 _ -•-fie 1 of -1 . _.... a46C)Rbf CERTIFICATE OF LIABILITY INSURANCE010/1$ �. 94 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'S 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 INSURERS), AUTHORIiED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE. HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL. INSURED, the pol"Iesj must be endorsed. If SU5ROG,ATION IS WAWED. sublect to - the temss 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 endorsene FRooucER Xarret BarrsraS Temax insurance Inc PDNE (7$6) 539 -5889 35t± -1235 ODICAODRWxam@tl@temaxintUrande.com 7990 SAI! 117 Ave INSURER(s) AFFORDING COVERAGE NAIL o Suite 113 M1011RI. FL 33183 TNsUriE: Capacity Insurance Company INOURED INSURER : PAUKR C Arco Temp Air Corp 6904. NW 46 St VAURER D: 'R E Miami FL •33166 'COVERAGES ERTIFICATE 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. NOTANTHSTANDING 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 PQLICIE& DESCRIBED HEREIN IS SUBJECT TO ALA- THE TERMS, EXCLUSIONS AND, CONDITIONS OF SUCHROLICIES. LIMITS SHOIflN. MAY HAVE BEEN REDUCED BY PAID (CLAIMS. INBRLT, TYPE OF INSURANCE AWL SUER N � POLICY EFF POLICY E7tP LIHflIS GENERAL LIABILITY EACH OCCURRENCE S 1.00010w X COMMERCIALGENERALUABILIY DAMAGE TO REI S 100;000 CWMJ-(WADE Fx] OCCUR MED EXP ww n S. SAM pERsoNALa.azvj aw & 1,000,000 A CLM01002352B 11/16/2013 11/16/2014 GENERAL AGGJFEGATI S 2,000,000• GEML AGOREGATE LIMIT APPLIES PER PRObUCTS - C bMPIOPAGG S 2,400 s X POLICY PRO- LOO AUTOMBILE VABILnY T11INEo SINGLE OMIT WOILY IKIUFIY iW P8004 S• ANY AUTO BODILY M"Y.(Per audde" S PROPERTY DAMAGE' S ED ULED AUTOS Ms NON -OWNED HIREUAUTQS AUTOS S UMBRELLAUAS OCCUR EACH.00CURRENCE S EXCESSLIAB CLAIM&MADE AGGREGATE S D S WORKERS COMPENSATION AND E APL'OYER3 LIABILITY ANY PROPRIETORIPA�E I N OFFICERMEMBEREXCLUDED1 NIA .WC STATU- PTH-. TORY LIMrrS ER EL EACH Acmotmr S (RDwwmry in NHI E:L DISEASE - EA EMPLOYtf 0yes, dewribe under DESCRIPTION OF OPERATioNs bebn E.L.DISSASE- POLICY LINT S DESCRB>noN OF OPERAnoNw LOCATIONS f VEHKX.ES (Anaah ACORD101,AddMlonal Remarks Sohedule,.M morewcels regUYSM Air Conditioning CERTIFICATE HOLDER CANCELLATION ®1988 2010 ACORD COP"RATTON, All rights rwerved.. ACORD 25 (2010105) The ACORD name and logo are reglstercd marks of ACORD SHOULD ANY OF TH9 ABOVE DESOMBED POLICIES SE. CANCELLED BEFORE City of Miami Shares THE EXPIRATION DATE THEREOF, NOTICE WILL SE' DELIVERED IN Miami Shores Village Building Departmen ACCORDANCE WM4 THE POLICY PRCMSIONS. 10050 NE 2nd Ave. AUTHDRRm RI3RE:EN1ATIVE r Miami FL 33138 ®1988 2010 ACORD COP"RATTON, All rights rwerved.. ACORD 25 (2010105) The ACORD name and logo are reglstercd marks of ACORD Q i IBM Lexi Business Hess Tai ReCeipt Miami -Dade County, Std of Flora a TM, I IS NOTA SU - 00 NOT PAY 8394621 LBT ovEaaa�Na TF4Nt . zit3�e►e•rNo. EXPIRES ARCO TEMP M Co R"AWAIL SEPTEMBER 30, 2015 6904 IWV 46 Si 88821337 Must be dlspl&M 8t 0gus of bustaa MIAMI Fl. 33166 ftnwont to County Code Chapter8A-Art. ®& t0 OWNER GM TYPE OR *UMNEGS PaYlIRGN7 1t�1Yti0 ARCO TIMP AIR CORP 198 SPDC MECHANICAL CONTR =111 Er rwx cat�.tsaroE wcr�er�s) 1 CACiti18147 $75.00 08/05/2014 ECHECK-14-140536 • ■ nd1Tfa mdimLwwt�r�TML tin baataiF ow n�qulr o d re e6.pNlyee & AUWge�i.,etusplF +al aw rMBE NO. don mmb Wrye MI®oo12MUetet-IldfAWWWaCall 3Mft K For mme tafam�etlos, Nab £/Z L5L£90ti80£ i!e dwa; 03Je Wd £8:£0 KOZ-430-£6 Miami shores Village 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-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 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 maybe personally liable for the worker compensation injuries of any_person allowed to work under this permit. 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 NOTICE AND UNDERSTAND ITS CONTENTS. Owner Print Name: /-&Gt£D Signature: � -*,%, . e (SEAL) Contractor ®� Print Name: Q (2 �' r Signature: MJ b s, State of Florida ) County of Miami - Sworn to and subs b e s f� .e of day of �C ' • �fp",.s Mari C0 $I` ` FF 07 $y a ,t vial Na of a O O 6 arc n = ` 3 State of Florida) County of Miami -Dade) o: , a Sworn to ansubscribed before m s o= rn C) day of - f 0� °'o; a ,20 C N T `4o By W a (SEAL) Contractor ®� Print Name: Q (2 �' r Signature: MJ b s, State of Florida ) County of Miami - Sworn to and subs b e s f� .e of day of �C ' • �fp",.s Mari C0 $I` ` FF 07 $y a ,t vial Na of 3r d i