MC-14-479p r
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
� /�" 09 11
Inspection Number: INSP-208811 Permit Number: MC -3-14-479
Scheduled Inspection Date: February 18, 2015 Permit Type: Mechanical - Residential
Inspector: Perez, JanPierre
Owner: LEONE, DEBORAH
Job Address: 5 NW 105 Street
Miami Shores, FL
Project: <NONE>
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1121360050320
Contractor: X-TREME AIC SERVICE, INC Phone: (305)821-4320
sunaing uepartment comments
MECHANICAL WORK FOR NEW ADA BATHROOM Infractio Passed Comments
ADDITION INSPECTOR COMMENTS False
Q L 101,5
February 18, 2015 For Inspections please call: (305)762-4949 Page 2 of 52
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
February 18, 2015 For Inspections please call: (305)762-4949 Page 2 of 52
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
JOB ADDRESS: 5 NW 105 STREET
FBC 20
Permit No. ge /Z/' 7� .
Master Permit No. (' �Z— L13,5 --
City: Miami Shores County: Miami Dade Zip: 33150
Folio/Parcel#: 11-2136-005-0320
Is the Building Historically Designated: Yes
NO X Flood Zone: X
OWNER: Name (Fee Simple Titleholder): DEBORAH LEONE Phone#: 305-778-7774
AddrPcc• 5 NW 105 STREET
City: MIAMI SHORES
State: FL Zip: 33150
Tenant/Lessee Name: N/A Phone#:
Email: LEONENWSA@AOL.COM
CONTRACTOR: Company Name: X-TREME A/C SERVICES, INC Phone#: 305-821-4320
Address: PO BOX 557819
City. MIAMI
FL
33255
Qualifier Name: JOHN REMEDIOS Phone#: 305-412-5863
State Certification or Registration #: CAC039647
Certificate of Competency #:
Contact Phone#: 305-821-4320 Email Address: MAYI@X-TREMEAC.COM
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $- k A20 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace
Description of Work: MECHANICAL WORK FOR NEW ADA BATHROOM ADDITION
❑Demolition
Submittal Fee $ Permit Fee $ 1 ` CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $ 1&,
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
N/A
N/A
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 approved and a
reinspection fee will be charged.
Signature%Y' �I'� I Signatur
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this �— The foregoing instrument was acknowledged before me this 7
day of�ka {1j, 20 Lq, by -be J!g�N-h Lkday of MARCH 20 14, by JOHN REMEDIOS ,
who is personally known to me or who has produced IF,-- who is personally known to me or who has produced
As identification and who did take an oath. as i tification and who did take an oath.
I
NOTAR P B ,°°° r'P�B., Lory Mendez NOT PU C: °�p°u'�poe om Lory Mendez
co' %commissa#EE167083
A n1:-COMMrISSION#EE167083 ''"a' a ES: MP.t1,17,2016
�- ,y ea EY.PIR
eEMRES: MA -117 2016 c °
Sign:, I °oBoorsgFe°° www.AARONNoTARY.com Sig : �ie'ames°a dV1NW.AAROiVIVOTARY.COrt1
1 ,o
Print: PL Pri, t• VU
My Commission Expl es: l� l `�4, My om ission Expires: "? \1
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel. (305) 795.2204
Fax: (305) 756.8972
AIR CONDITIONING REPLACEMENT DATA
PERMIT NUMBER: MC
This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data
sheet. Multiple units on single sheets are not acceptable.
Job Address (where the work is being done): 5 NW 105 STREET
City: Miami Shores Village County: Miami Dade
Zip Code: 33150
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
ARI (AHRI) DATA SHEET REQUIRED
Change Disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
KW HEAT
NOM TONS
AHU CU
PKG
1 M.C.A
AHU CU
PKG
AHU CU
PKG
2 M.O.P
AHU CU
PKG
AHU CU
PKG
3 VOLTS
AHU CU
PKG
PKG UNIT
I I
PKG UNIT
EER/SEER
YES
NO
REPLACING DUCTS
YES
NO
YES
NO
REPLACING THERMOSTAT
YES
NO
YES
NO
NEW 4"CONCRETE SLAB
YES
NO
YES
NO
NEW ROOF STAND
YES
NO
YES
NO
NEW RETURN PLENUM BOX
YES
NO
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: X-TREME A/C SERVICES, INC
State Certificate or Registration N. CAC039647 Certificate of Competency
Phone: 305-821-4320
Signature Date: 3/7/14
(Qualifier's signature only)
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES D OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR IID INSURANCES EACH TIME A PERMIT I
SUBMITTED INFORMATION FOR A $30 00 FEE PER YEAR.
A. x COPY OF QUALIFI
B. x COPY OF LOCAL
C. x COPY OF LIABILII
D. x COPY OF WORKI
A. COPY OF CERTI
B. COPY OF MIAMI
C. COPY OF LIABIL
D. COPY OF WORN
STATE LIC CARD
)SINESS TAX RECEIPT
INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION)
kill
OF COMPETENCY OF QUALIFIER
COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
INSU RACE ,(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
■■■■■■■■■■■■■■■■u■■■en■o■�����COMPLETE CONTRACTOR'SINFORMMAT
ION■■�e■■■■sae■■■aro■■■■��■■■■■■
BUSINESS NAME: X-TREME A/C SERVICES, INC
BUSINESS ADDRESS: P•O• BOX 557819 CITY MIAMI
STATE FL ZIP. CODE 33255
FAX NUMBER3( 05 1412-1925
BUSINESS PHONE: 3�5 821-4320
CELL PHONE7( 86 14125863
QUALIFIER'S NAME: JOHN M REMEDIOS
QUALIFIER'S LIC NUMBER:. CAC039647
E-MAIL ADDRESS (IF APPLICABLE): mayi@x-tremeac.com
i
Created on 3119109 BY MLDV I WON MLDV
0o a o' e a 0•• ,
AC# 617 3 4 3 3 STATE OF FLORIDA
DEPARTMENT OF BUSINESS ND PROFESSIONAL REGULATION
CONSTRUCTION IND- TRY LICENSINN9 BOARD SEQ#L12062500514
n. LICENSE NBR
106/25/201211183.90932 ICAC039647 .
The CLASS A AIR CONDITIONING CONTRACTOR
Named below IS CERTIFIED
_ iTzdgr the provisions of Chapter :489 FS. '
Expiration date: AUG 31, 2014
REMEDIOS, JOHN MANUEL
X-TRENE A/C SERVICES INC
6031 SW 93RD COURT
MIAMI FL 33173
,i
! RICK SCOTT KEN LAWSON
GOVERNOR SECRETARY
DISPLAY AS REQUIRED BY LAW
eoze�a
Local Business Tax Receipt
Miami -Dade County, State of Florida
THIS IS NOTA BILL -00 NOT PAY LkJT
6275820
BUSINESS NAMMOCATION RECEIPT No. EXPIRES
X --TREE Ac SERVias INc RMEWAL SEPTEMBER 30, 2014
6031 SW 93 Cr 6541404 Must be displayed at place of business
MIAMI FL 33173 Pursuant to County Code
Chapter BA - Art. 9 & 10
OWNIER sr -C. TYPE OF BUSINESS PAYMENT RECEIVED
RVI
X-TREME AC SERVICES NC 198 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR
Worker(s) 4 CAC039847 $75.00 07/15/2013
ECHECK-13-004687
Ibis tical Business Tax Receipt only confirms payment althe Local Busim, Taa. Tha Racal -0 u am a ilcamo,
pamtil,oracaniRcmioo01dmholdenagaaliRcmlonstodobushm, Holder must comply with any 0ovammoutalor
nongavmmmmal regalmoty Imus and regnf is wbicbapply to the husbum.
Us RECEIPT N0. above must he displayed an an comomroial vehicles -Miami-Dade Cada Scolia -216.
For mare inimmmion, visit www giamidnde.gn dMoeilectar
ae b® CERTIFICATE OF LIABILITY INSURANCE
MY
D03/07712014
THIS 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 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 endomemen a►.
PRODUCER
A&A Underwriters, Inc.
8796 SW 8 St
Miami, FI 33174
NAME:CT Pablo M Conde
PHONE 305-220-7447 a No: 305-220-4821
ADDRESS: pmc@aaunderwriters.COm
INSURERS AFFORDING COVERAGE NAIL S
INSURER A: Scottsdale Insurance Co.
INSURED
X-Treme A/C Services Inc.
P.O BOX 557819
Miami FI 33255
INSURER B: Mount Vernon Fire Insurance Co.
INSURER C:
INSURER D:
INSURER E:
INSURER F:
e-MICO r•--ee r`CCTIcIPATC ILII IaAl2=0- 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.
LTRR
TYPE OF INSURANCE
ASL
R
POLICY NUMBER
MMMIDDD EFF POMJDD
EXP
LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
PREMISES R ce $ 50,000
A
CLAIMS -MADE � OCCUR
CPS1359192
06105/13
06/05/14
MED EXP(" one Person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GEHL AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS -COMP/OPAGG $ 1,000,000
X POLICY ❑ JJEECTT F-1 LOC
OTHER
AUTOMOBILE UAJ31UTY
MBI$
a acddent NED SINGLE LI $
BODILY INJURY (Per person) $
ANY AUTO
$
BODILY INJURY (Per accident)AUTOS
AAL OOWNED SCHEDULED
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE $
fPer accident
$
B
X
UMBRELLA LIARX
EXCESS LIAB
OCCUR
CLAIMS -MADE
XL2117334A
06/05/13
06/05/14
EACH OCCURRENCE $ 1,000,000
AGGREGATE $ 1,000,000
DED I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETORIPARTNER/EXECUTIVEE.L.
TATUTE I I OERTH
EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
OFFICERIMEMBER EXCLUDED? a
(Mandatory In NH)
NIA
i
E.L. DISEASE - POLICY LIMIT $
If yes dasaibe under
DES6RIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, AddlUonal Remarks Schedule, may be attached K more space Is required)
AIR CONDITIONING CONTRACTOR - CAC039647
r•wklr =! r ArIMM
v� MIAMI SHORES VILLAGE BLDG DEPT
SHOULD ABOVE ICANCELLED BEFORE
10050 NE 2ND AVE
RA71ON DATETHERE F, NOTICE WILL BE DELIVERED IN
THE EXPIRA71ON
MIAMI SHORES, FL 33138
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2013104) The ACORD name and logo are registered marks of ACORD
PDF created With pdfFactory Pro trial version www.pdffactory.com
XTREM-2 OP ID: SG
T
CERTIFICATE OF LIABILITY INSURANCE
DA03107/201TE Y)
03!07!2014
THIS 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 poll:y(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
W.F. Roemer Insurance Agency
4752 W. Commercial Blvd
Fort Lauderdale, FL 33319
Jonathan F. Remes
CONTACT
HONE
c No A/C do
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIL #
INSURER A; Association Insurance Co. 11240
INSURED X -Trema A/C Services, Inc.
P.O. Box 557819
Miami, FL 33255
INSURER 8:
INSURER:
PERSONAL & ADV INJURY $
D
INSURER D
INSURER E :
PRODUCTS - COMPIOP AGG $
INSURER F:
rnVGoer_cQ r1G0TIRIr1AT= M"1111911=12- 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.
IIN.TR
TYPE OF INSURANCE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Village of Miami Shores
POUCY NUMBER
M EFF
P
IMMIDWYYYYI
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F OCCUR
EACH OCCURRENCE $
PREMISES Ea occurrence)$
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEML AGGREGATE LIMIT APPLIES PER:
POLICY PROi L1
JEC LOC
PRODUCTS - COMPIOP AGG $
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOSNON-OWN
HIREDAUTO,S AUTOS ED
(Ea aBINdatSINGLE LIMIT $
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
ERACCIDENT $
UMBRELLA UAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE S
DEO I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNF_R/EXECUTIVE Y/�N
OFFICE EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS belay
N f A
WCV 0108333 02
07/13/2013
07/13/2014
X TRY LIAMrrjTU ER
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMP LOYEE S 1,000,00
E.L. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, I more space is required)
Air Conditioning Contractor - CAC039647
/�L-!^ATG Uhl r%cm rANC`E I ATICTN
MIAMIS2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Village of Miami Shores
ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2 Ave.
Miami Shores, FL 33138
AUTHORIZED REPRESENTATIVE
V Iwo"-N9u A6vKu %'Vr%rVMM 1 Ivry. Nu rganW evaae rvu.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD