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MC-14-1018Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-233635 Permit Number: MC -4-15-1018 Scheduled Inspection Date: May 06, 2015 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: HANSEN, DENNIS Work Classification: A/C Replacement Job Address: 10642 NE 10 Place Miami Shores, FL 33138 - Project: <NONE> Contractor: RUIZ CONSTRUCTION INCORPORATION Building Department Comments I,�T•Tir= ZMIi1M Parcel Number 1122320280860 Phone: (305)688-9770 EXACT REPLACEMENT OF 5 TON UNIT Infractlo Passes comments INSPECTOR COMMENTS False 4 '- [�'(5 May 05, 2015 For Inspections please call: (305)762-4949 Page 28 of 50 Inspector Comments Passed ga Failed 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 28 of 50 Miami Shores Village 10050 N.E. 2nd Avenue NE " Miami Shores, FL 33138-0000 Phone: (305)795-2204 ProJectMorass Parcel Number Applicant 10642 NE 10 Place 1122320280860 DENNIS HANSEN Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell DENNIS HANSEN 7430 BEACHVIEW Drive NORTH BAY VILLAGE FL 33141- 7430 BEACHVIEW Drive NORTH BAY VILLAGE FL 33141- Contractor(s) Phone Cell Phone RUIZ CONSTRUCTION INCORPORATI (305)688-9770 5 Info: EXACT REPLACEMENT OF 5 TON UNIT ion: Residential In Review nents: Date Approved:: In Review Denied: Type of Work: Fees Due Amount CCF $2.40 DBPR Fee $2.10 DCA Fee $2.10 Education Surcharge $0.80 Permit Fee $140.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $153.60 Valuation: $ 4,000.00 Total Sq Feet: 0 Pav Date Pav Tvoe Amt Paid Amt Due I Invoice # MC -4-15-55371 05/05/2015 Credit Card $ 153.60 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above-named contractor to do the work stated. May 05, 2015 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy May 05, 2015 1 BUILDING PERMIT APPLICATION Miami Shores Village Building DepartmentYI APR29 i�3: 10050 N.E.2nd Avenue, Miami Shores, Florida 33138–=� Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑BUILDING ❑ ELECTRIC ❑ ROOFING FBC 20 tO Master Permit Nogr, 0 -V " 0 3 63 Sub Permit No. hcc S ® � U B ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING © MECHANICAL [PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ) 6 (47L, , r t6 � � •L� (•L� �. Folio/Parcel#: Is the Building Historically Designated: Yes NO -.— Occupancy Type: Load: Construction Type: l Flood Zone: BFE�:a FFE: c� OWNER: Name (Fee Simple Titleholder)-. b►=� 5 k �s t- 13 Phone#: 0 J Q U 7 La_ A1/ Address �f A_C� h �^ City:y ��T� State: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Ruiz Construction Incorporated Phone#: 305-688-9770 Address: 3827 NW 125 Street City; Opa LOcka state: FL zip: 33054 Qualifier Name: Jorge Ruiz Phone#: 786-488-8257 State Certification or Registration #: CAC1817314 Certificate of Competency #: DESIGNER: Architect/Engineer: Value of Work for this Permit: Type of Work: ❑ Addition ❑ Alteration Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ State Zip: Square/Linear Footage of Work: ❑ New Repair/Replace ❑ Demolition , CCF $ CO/CC $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $. (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 Signature 4-� 0 N R or AGENT C NTRACTO The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Oq day of L -,,� , 20 S , by 28 day of April . Z0 5 , by S J SaN1 ►% MG(Ll�w�i�1 personally known to Jorge Ruiz ,who isip rsona yTcnown to me or who has produced identification and who did take an oath. as me or who has produced NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY (Revised02/24/2014) Notary Public State of Florida �d Sindia Alvarez < iyiy Commission FF 158750 A Expires 08/0312011 �BA� j identification and who did take an oath. as Print: Janet IU rejon V °°'�pRv PPB � Janet Morejon Seal: cOMMiSSION#FF000743 EXPIRES. MAR. 25, 2017 '•,;fit. i�,aO WWw,AARONNOTARYwm e*a�x�se•waeasa��ase�e�a�s�xa�we+x�see8*�+pe�x�st�eee�xsee*+yew*�xewx� Examiner Structural Review Zoning Clerk 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): City- Miami Shores Village County: Miami Dade Zip Code: 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 AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ 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: Ruiz Construction Incorporated State Certificate or Signature (Revised02/24/2014) Phone: 305-688-9770 181714 Certificate of Competency No. .04/28/15 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 / / 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: Ruiz Construction Incorporated State Certificate or Signature (Revised02/24/2014) Phone: 305-688-9770 181714 Certificate of Competency No. .04/28/15 OWNER SEC. TV" OF BUSINESS PAYMENT RECEIVER RUIZCON5iRucnoNINCORPORATED 196 SPEC MECHANICAL CONTRACTOR aYTAX COLLECTOR warker(s) 1 CAC18173% $45.00 08/0612014 FPPU05-14-014755 TWsU*dBmdv TaxR� tt jcmffl=paymsotcltheLoadBnh%=TmLThellowiptsnotallson; p oo eracertl5catleadtheLsldu todehos. How"motaampiyW01my9ave+nmer1 ornongtlyammeomlrepnfelsrylews n ichR*tothe bmdmso. 'hisRECEBRN4 ebave m�he d�played ooaRcmamercial eshlcies-tld�mi-RNdafa>� Recce -278. iaraWeGdanNaisa, " .OWNER SEC. TYPEOP Business 196 GENERAL BUILDING CONTRACTOR PAYMENTRECCTOR RUIZ CONSTRUCTION INCORPORATED 196 TAX cp>ascroR worker(s) 1 CBCG&qm $45.00 08/06/2014 1PPU05 ,14-014755 rnisLtroa►sasiaesarexRWeipramyamdira>s aFBretacel8arax.rtra6e�riamtaR+ean�, permif,tlraaertiH aoitlre ldar' - mdoh�mfoeae. HeldermMicrosplyt�eayB�et1 er A�olaroryhaea regair�s�tr�ichepplylathehtBivasg. TGe1�E1:EIPr ren elrore aoMhau�playad oirsN gosmtaraiel rehk►os-Miemi-ReaejEis�s �a�-tis. Forowre 4dmmeaoe, vN3twttlnemiamidaaacavxaxael�emr STATE FLORIDA ISSUED: 06M412014 DISPLAY AS REQUIRED BY LAW SEQ# L140604=1481 RICK SCM GOVERNOR KEN LAMON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD of Chapter 489 FS. i 39, 2018 ISSUED: 06M4/2014 RICK SCOTT, GOVERNOR DISPLAY AS REQUIRED BY LAW STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROM KEN LAWSON, SECRETARY NAL REGULATION G BOARD CCC1330316 The ROOFING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 J3 ANC E® [_FRT(Fir-A'T'P OF I IARILITY INSURANCE 14rt4>2 1 THIB. CERTIFICATE A ISSUEDAS A MATTER .OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 490TIFI `ATB HOLDOL THIS CERTIFICATE DOES NOT AFFMKATWELY OR NEOATRMY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES B®.CARL THIS CERRTWICATE OF IRSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSU NG St AUTHORM!D REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. mtTRTANT. R the ceralicate hokia is an ADDITIONAL INSURED, tm poHoy(lea) must M endww& V SII AIM IS WAIVED. SubJeet to the trims and comtitors of the pocky, oilrI I poudes may mquim an enimsemeft A statement an tris mrmicu A don not eaufer rIgft to the cerfiffeds holler In Hou of such 9ndemement{s). PRODUCER WORLDWIDE n4sDRANCE GROUP 717 Ponce de Leon Blvd Ste 211 Coral Gables, FL 33134 yam. LIASL / (305)415-8767 jaw�(305)T§7-2637 /,Cw:aruidiaz ong.com MWtMM A 1NSURER A: FWCJA INSURED RAIZ CONSTRUCTION INCORPORATED DBA RCI ROUP INC 3827 NW 125TH STREET oEA LOCRA, SL 33054 FEW 264036190 04SUFMR B: mtsummC: INSURER o: mTSDRER E INSURER F: n nm¢e. (�JYt_tWl�t.�" l�GR11CINf11E ,wnocla.. ^— THIS IS TO CERTIFY THAT THE POLL ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE I iS-- 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 TEIM EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. UMTT3 SHOWN NAY HAVE BEEN RMUC®RYPAdD CLAS: tm TYPE OF INSURANCE POLICY NUMBER L0fBIB LTR yam. LIASL / EACH OCCURRENL'E S PR[ 8 CWIA SAAADE El OCCUR N®F]W(NWy per=) $ PERSONAt.8AMMAIRY $ GENERAL AG GATE e GWL AGGREGATE LMW APPUES PER: POLICY ❑ ,I� LOC PRODUCTS-COmpw ltfa`C, S S OTHER: alrroaRGeuLE LIAB0.ITY arslaelut S - SLY IV.IIRY (P>$pmw ✓8 ANYAUTO OWNED SO EDAMOSUUM ALL AUTOS NON -OWNED. HIRED AUTOS AUTOS BODILY 6NJt1RY (PeraWd®It) $ g '. S S. UMBRELLA LIAROCCUR EXCESS LIAR HCLAINIS4NADE EACH OCCIE AGGREGATE S f - - DID RETENTION la A WORKERS COMPENSATION AND EWLOYEW LY18LLttY Y/n OFFMOWNOMIER ,ANY ®NrA qacqaq�amt �Nin 66CR�+FVONOPERATTONS below 7D765073 /08/'2DIg /08/2818 g. ITE 9t GLI71Ix1ACCm8Nr s 1,000 000 E.L. D1SEA - EA s 1, 000 000 E1.06ERSE-FCN.ILY LmdIT a .,dao-- oa- DEBeftVr ON OF OPERAnO NS I LOCAVOW I VEMCLES (ACORD tDt; lYtNBksml Re,l srlrenae, mey ba ea a Bllras spew is hefrpa�iml) Goa®ral Constr¢otion, Roofing and Vjbth n ml NIMU SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CA THE EWMATION DATE THEREOF, NOTICE HE 10050 NE 2 AVEMM WILL MIAMI SHORES, FL 33138 . AUIHORQB> ATtYE � �' AGUtWZ*tLUT4/UT J IN e ACQRO® CERTIFICATE OF LIABILITY INSURANCE DATE w"My" 10/28/2014 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 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 s . PRODUCER Sihle Insurance Group/VERO 65 Royal Palm Pointe, Suite B Vero Beach FL 32960 =ACT Certificate Department PHONE 40748W5480 FAX 407_389-3580 DDR Certificates@sihle.com INSU S AFFORDING COVERAGE "Co 10/28/2014 INSURERA:Brid efield Employers Ins Co. 10701 EACH OCCURRENCE $1,000,000 INSURED INSURER B :Sentinel Insurance Company 11000 Ruiz Construction Incorporated RCI Group Incorporated 3827 NW 125th Street INSURER C: Berkley Assurance Company INSURER ° GENERAL AGGREGATE $2,000,000 Opa Locka FL 33054 INSURER E : IN RER F : AUTOMOBILE LIABRJTII-caunqMINGLE ANY AUTO AAUT8 NED X ACHESULEO NON -OWNED X HIREuODSAUTOS X r_nV1:0Af'=c f'=0T1CIreTF MI 11111=12- 1A.ri7-RR.'AQAA RFVflSInN NtIMF1FR- 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. ILSR TR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department POLICY NUMBER POLICY EFF LICY EXP LIMnS C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-1 OCCUR VUMC0072670 10/28/2014 10118/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES $100,000 MED EXP (Arty oneperson) $Excluded PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ jEpT F-1 LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOP AGG $2,000,000 $ B AUTOMOBILE LIABRJTII-caunqMINGLE ANY AUTO AAUT8 NED X ACHESULEO NON -OWNED X HIREuODSAUTOS X 21UECPPOM Oi21=14 10128!2015 LIMIT (EaaaJderrt $1,0now BODILY INJURY (Per person) $ BODILY INJURY (Peraccidenl) $ PROPERTY $ FL Basic PIP $10,000 UMBRELLA LIAR EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC) RETENTION $ $ A WOWLERSCOMPENSATION830-53414 AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yea, describe under DESCRIPTION OF OPERATIONS below NIA 1=14 15=15 X STA UTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Rernaft Schedule, mey be atmched If more space is required) General Construction, Roofing and Mechanical CFRTIFICATF HAI nFR CANCELLATION ©198&2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE ©198&2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD