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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