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MC-14-2514Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-229416 Scheduled Inspection Date: April 06, 2015 Inspector: Perez, JanPierre Owner: LYTLE, JAMES & JOYCE Job Address: 429 NE 101 Street Miami Shores, FL 33138-3163 Project: <NONE> Contractor: FGK SERVICE INC Permit Number: MC -11-14-2514 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (305)546-2376 Parcel Number 1132060170640 Phone: (305)322-5673 Building Department Comments 2 A/C Infractio Passed Comments INSPECTOR COMMENTS False n V Passed 91 Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-223442. missing lock caps and pour concrete April 06, 2015 For Inspections please call: (305)762.4949 Page 14 of 40 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LIME PHONE NUMBER: (305) 762-4949 ❑BUILDING ❑ ELECTRIC M ROOFING FBC 201 'Z� Master Permit No. ��A 20 -1 Sub Permit No. r —3�sl ❑ REVISION ❑ EXTENSION RENEWAL []PLUMBING (MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF Q CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: '4-a� n (� 1 '�rC Folio/Parcel#: L _ ��®� �`��� is the Building Historically Designated: Yes Occupancy Type: Load: OWNER: Name (Fee SimplepTi Aelrlracc• A-a� cv ;My!f I e�� 10U (C's Construction Type: Flood Zone: BFE: rn6'�; . State: TL " 7in: Tenant/Lessee Name: Phone#: Email: NO FFE: CONTRACTOR: Company Name: T' C2 K• Seeyt CSL r C Phone#: 30 32 i S673 Address: 13a I ( Sw O/ Z A,, -Az. -iL- SZ City: t-� lM„yn'l State: pL Zip: 33 Qualifier Name" -Ka ��-� Phone#'3c-)s Y-71 8-713 State Certification or Registration #: CAC.. 1$ (S S 3 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: _ Address: ori City: State: Value offflork for this Permit: $ q C� �� — Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Description of Work: aer conte o► Specify color of color thru i Alteration ❑ New ❑ Repair/Replace Trp: ❑ Demolition Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Rev1sed02/24R014) CCF $ CO/CC $ DBPR $ Notary $. Double Fee $ Bond $ TOTAL FEE NOW DUE r - r Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Uri 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 TWCE 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 pro .e in good faith that a c py of the notice of commencement and construction lien law brochure will be delivered to the person whose operty is sub) ct t chmen�t Also, a certified copy of the recorded notice of commencement must be posted at the job site for the inspection hic rs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection of be app ve (a reinspection fee will be charged. OWNER CONTRACTOR v The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of f -)C " - . 20 �q , by day of 20 , by &4 ho is personally known to �4�ywho is personally known to meteor who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: STATE OF FLORIDA Comm# EE144213 Expires 11/13/2015 (Revised02/2412024) STATE OF FLORIDA Comm# EE144213 t ir" 1111312015 Structural Review Clerk Local Business Tax Receimpt M yam' -Dade .1 County, State of Florida .-TFVS, IS NO"' A Sit L - DO NO' PA a -5804,MO RU&NVISS OCATION FGK SEWCES INC I S8 16 SW 142 AVE STE 32 Rwcalprt 140 RENEWAL 6293625 EXPIRES SEPTEMBER 30, 2015 Mu st be disOayed *A Oace oi hus, rtv b, Pursuant to coulity Code. Chapter SA - Art 9 �& 10 OWNS^ 64C. TYPIR Of BUSIMIESS PAYMENT RIECIUVILD FG -K SERVIaS PYC 196 SPEC MECHAWAL CONTRACTOR CAC1815453 8V TAX COLLECTOR W04"(s) 7 $75-00 07/22/2014 GiECK21-14-030199 p"ww Local empom Tarr goce* o0y cowfim paymont of ft La"4 Smumm Tim Th* %*go* is rm & kom*L wfifts"* of 00 bob"t's ,10 " bawom Howet was cam* *16'sav or nompvenw 1 11'01 ftq918" hr*S 04 "I'"soft "#C -h NP* so the bokmm& Tie AECM W shm most be 604"4 40 IN C*m"ftq*4 V9b4CW - U*W 04 d* Z000 SOC 16-M Formwe A!'nQ ® spa r 9.%—■ ® — -- ` rnm (I 011`11+A It U1- LIASILITY INSURANCE DATE(MM/DD/YY) 11/14/14 PRODUCER Accurate THIS CERTIFICATE S ISSUED AS A MATTER OF INFORMATION 8300 West Hagler Suite 114 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Miami, FL 33144 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Phone (305)226-8727 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fax (305)226-8767 INSURERS AFFORDING COVERAGE NAIC # INSURED FGK SERVICE INC. INSURER A: Granada Insurance Company 13816 SW 142 Ave Suite 32 INSURER B: Miami, FL 33186 INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ANY REQUIREMABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ENT, TERM OR CONDITION QF ANY CONTRACT OR OTHER DOCUMENT MAY PERTAIN. WRH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT POLICIES. AGGRTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH EGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIPRS. tNSR TR A ADD'L IN D ❑ TYPE OF INSURANCE GENERAL LIABILITY ® COMMERCIAL GENERAL LIABILITY ❑❑ CLAIMS MADE ❑J OCCUR ❑ ❑ GENT AGGREGATE LIMIT APPLIES PER: ® POLICY ❑ PROJECT ❑ LOC POLICY NUMBER 018FL00050649-1 DATEYPdM DD TIVE 07/05/14 p ICY EXPIRATION LIMITS 07/05/15 EACH OCCURRENCE 1,000,000 PREMIGE TO SES EaRENTED nce 100,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS - COMPIOP AGG 2,000,000 I ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS COMBINED SINGLE LIMIT (Ea acedent) BODILY INJURY (Per peen) BODILY INJURY ❑ (Per accident) PROPERTY DAMAGE (Per accident) ❑ GARAGE LIABILITY ❑ ANY AUTO [] AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG ❑ XCESS/UMA LIABILITY EBRELL ❑ OCCUR ❑ CLAIMS MADE EACH OCCURRENCE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER/ EXECUTIVE OFFICER/ MEMBER EXCLUDED? ' ❑ WC STATU- ❑ OTH- ORY LIMITS _ E.L. EACH ACCIDENT If yes, describe under SPECIAL PROVISIONS below OTHER I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS E.L. DISEASE - EA EMPLOYEE E.L. DISEASE -POLICY LIMIT DESCRIPTION Lic# OF OPERATIONS / LOCATIONS I VEHICLES CAC1815453 Air conditioning and refrigeration CERTIFICATE HOLDER CANCELLATION City of Miami Shores 10050 NE 2 Avenue Miami Shores, FI 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICfORTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSUOR REPRESENTATIVES. AUTHORIZED REPRESENTA Lucia Estrella ACORD 25 (2001/06) '��Rj'® CERTIFICATE OF LIABILITY INSURANCE DA�;;;�094''/' 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 endorsement(s). PRODUCER Ariskco, Inc. 9016 Philips Hwy. Jacksonville, FL 32256 CONTACT NAME: PHONE FAX Ext Alc No E.siAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # LIMITS INSURER A :Normandy Harbor Insurance Company, Inc. 13012 GENERAL LIABILITY INSURED MatrlxOneSource INSURER B: INSURER C: Ally Hr, Inc & Ally Hr II, Inc 9016 Philips Hwy Jacksonville, FL 32256 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUM13ER!WNYUGY39 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MWDD POLICY EXP MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE O RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ CLAIMS -MADE F_] OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per acc dent HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIABOCCUR HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N OFFICER/MEMBER EXCLUDED? E (Mandatory In NH) N / A NHFL140285 01/01/2014 01/01/2015 X WCSTATU- OTH- TORY LIM TS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 Ifes, describe underCanki DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, U more space is required) Coverage is extended only to the insured's employees who are leased to the client company employer: FGK Service Inc 2202094 Effective 4-15-13 DISCLAIMER: Coverage is not extended to any employee of the client company employer who is not leased from the insured or to any leased employee for which the client company employer is not reporting payroll hours to the insured. This certificate remains in effect provided the client company employer's account is in good standing with the insured. Please contact the insured at 866-453-2722 for verification of employees leased to the client company employer by the insured.. Current number of leased employees: 5 This certificate only applies to Licence: CAC 1815453. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Miami Shores AUTHORIZED REPRESENTATIVE /n 2nd Ave Miami Miami Shores,, FL 33138 Page 1 of 1 © 1988-2010 ACORD CORPORATION. All rights reserves. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD