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MC-14-2649�- �(4 - � �3 1�3 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-224544 Permit Number: MC -12-14-2649 Scheduled Inspection Date: March 30, 2015 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: MARVIN R LIST & MARIA T MANERBA, Work Classification: Addition/Alteration eAA0111M C 1 ICY 4_ SAADIA T RHAAICCQA Job Address: 9929 NE 4 Avenue Road Miami Shores, FL 33138 - Phone Number (305)858-0204 Parcel Number 1132060171280 Project: <NONE> Contractor: AIR SYSTEMS A/C LLC Phone: (786)208-3484 comments REPAIR INSTALL EXHAUST FANS AND REPLACE 4 ------ EXHAUST -----EXHAUST MOTORS HOUSING INSPECTOR COMMENTS False March 27, 2015 For Inspections please call: (305)762-4949 Page 2 of 17 Inspector Comments Passed IN Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 27, 2015 For Inspections please call: (305)762-4949 Page 2 of 17 r BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 ❑BUILDING ❑ ELECTRIC ❑ ROOFING DEC 0 5 2014 BY - DEC Y FB��C 20 Master Permit No. R��b-1 H ' I gLB Sub Permit No. HC 19 — 2697 ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING 114ECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: `i City: (fMiami Shores County: Miami Dade Zip: t;:58 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Par) 4\ P' • Qe + � rel'4� 11tT - N ( ene# 3 � I 7 30 Address: a 1 N (-, N Poe City M r A TM+ t SLjo r c `g State: P1 Zip: 3 I TY Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Ac �N"7�rn� At) ) Phone#: L�� w( Address: y co A Q IJl) 133 � �--/ City: Ona I CfIQ State: i2 Zip: �y Qualifier Name: _Rn I Phone#: ifrcation or Registration #: 5 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit: $ 1000,00 Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition ,�1 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: i�Q G. (moi' P r� / �a �a �' 4 d Specify color of color thru tile: Submittal Fee $ Permit Fee $ c CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Educadon Fee $ Structural Reviews $ (Revised02/24/2014) DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ C) :K\q Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. e< , `Si` gna OWNER or AGENT The foregoing instrument was acknowledged before me this ® Cl`l day oft ,� +% :;L—, 20 �by LW, To t4n)ip b� I.4 , who is personally known to me or who has produced S61 5,5 9 7 S 76� ® r°/ as Signature eby � , CONTRACTOR The foregoing instrument was acknowledged before me this day of /& . 20 , P . by ®�a �&Z& ce g, , who is personally known to me or who has produced rO, 1)a1J-% b"Cc , as identification and who did take an oath. identification and who did take an oath. ARU)�L�C: NOTARY PUBLIC: Sign: �.� Sign: Print: Print: O l7 C r Seal �P` �6, ERNESTO RODRIGUEZ "" Seal: �a�PLe-,, ERNESTO RODRIGUEZ * Notary Public - State of Florida '�,* Notary Public • State of Florida -N * M Y Comm. Expires Sep 16, 2015 ; MY Comm. Expires Sep 16, 2015 Commission # EE 96605 �'l °e° w�Ij Commission # EE 96605 OF O �, �x+a*w**a� s*�#66faaFbe�aavel'NttFCttS`s''� **as�as+�+rs•**e+ss�wx ffia+e'��ee►e+asap+i#fRf�if'lstl6Tf�f�`r'�nssn. +sse*aa�x* APPROVED BY _ � x Plans Examiner Zoning Structural Review Clerk (RerisedO2/24/2014) STATE OF FLORIDA # DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SICENSE'NUMBER- 1 The CLASS AAIR CONDITIONING CONTRACTOR ' Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 VAZQUEZ, ROY AIR SYSTEMS AC LLC 4698 NW 133 STREET OPA-LOCKA FL 33054 ISSUED: 08/24/2014 003764 Local Business Tax Receipt Miami -Dade County, State of Florida THIS IS NOTA BILL - DO NOT PAY 6834460 13USINESS NAMEILOCATION RECEIPT NO. AIR SYSTEMS A/C LLC RENEWAL 4698 NW 133 ST 7108210 OPA LOCKA RL 33054 SEQ # L1408240002653 EXPIRES SEPTEMBER 30, 2015 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art 9 & 10 OWNER SEC. TYPE OF BUSINESS AYMENT AIR SYSTEMS A/C LLC 196 GENERAL MECHANICAL`CONTRACTOCY TAX COLLECTOR RECEIVED CAC033544 Y TAOLLECTOR.. Worker(s) 5 $45.00 07/14/2014 CREDITCARD-14-026620 This Local Business Tax Receipt only confirms payment of the Local Business Tan. The Receipt is not a license, permit are certification of the holdersqoalifications, to do business. Holder must comply with any govemmontel or nongovernmental regulatory lays and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicle-lNiemi-Rade Code Sac 1a-276. For more information, visit www.miamidade gllenter A� CERTIFICATE OF LIABILITY INSURANCE R00W 12/4/20114 THIS CERTIFICATEIS 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 pollcy(les) must be endorsed If SUBROGATIONIS 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 endomement(s). PRODUCER CONTACT NAME: PAYCHEX INSURANCE AGENCY INC INC, W,Fidr iaC,Nor (888) 443-6112 210705 P: F: (888) 443-6112 E-MAIL ADDRESS: PO BOX 33015 INSURER(S) AFFORDING COVERAGE NAICB SAN ANTONIO TX 78265 wsuRERA: Twin City Fire Ins Co 29459 HISURm wsuRER s: INSURER C: AIR SYSTEMS AC LLC INSURER D: 4698 NW 133RD ST INSURER E: OPA LOCKA FL 330541---ERF: COVERAGES CERTIFICATE 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. 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 1YPEOPP&LIRANCE ADDL SUBR POLICYAWMEER POLIEFF POLICYMKP Lim= COMMERCIAL GENERAL LU16LLI Y EACH OCCURRENCE g CLAIMS MADE OCCUR DAMAGE TO RENTED g PREMISES (Ea ocdarence) MED EXP (Fury me person) g PERSONAL & ADV INJURY g GENERAL AGGREGATE g GEN'LAGGREGATE LIMIT APPUESPER. POLICY PRO -EI❑ LOC JECT PRODUCTS - COMPIOP AGO g $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ee aoddesd BODILY INJURY (Per prison) g ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per amddesd) g PROPERTY DAMAGE g (Pm acddestt) HIRED AUTOS NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE g AGGREGATE g EXCESS UAB CLAIMS -MADE D RETENTIONS g WORKERS COMPENSAn(ON ANDEMPLOYERS'LIABIMY X PER OTH- STATUTE ER EL EACH ACCIDENT $1,000,000 ANY PROPRIEfORIPARTNERIEXECUTIVE YIN A (F ndatwY B�EXCLUDED9 ❑ WA 76 WEG DF7479 05/13/2014 05/13/2015 EL DISEASE -EA EMPLOYEEJ1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT g 1 0 0 0 0 0 0 DESCRIPTION OF OPERaflOWS I L6�AM NS/VEHICLES (ACORD 101, Addwosml RernerM Schedule, may be aifeabe I M mora space Is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION ©1988-2014 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 City of Miami Shores BEFORE THE , NOTICE WILL BE DELIVERED N ACCORDANCE ORD EXPIRATION CE WITH THDATEEOFE POLICY PROVISIONS. AUTHORIZED REPRESENTAT E Building Department 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD PAYCE= INSURANCE AGENCY INC PO BOX 33015 SAN ANTONIO TX 78265 City of Miami Shores Building Department 10050 NE 2ND AVE MIAMI SHORES FL 33138 ACORD 25 (2014101) AcoRnr CERTIFICATE OF LIABILITY INSURANCE �..►� DD 12//4/24/2DA01144 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 Gil, Garden, Avetrni Insurance Group a COME:NTACT Yami1@ Corral NA PHONE .(305)630-4777 630-4777 FAX . (305)279-3022 10689 N. Rendall Drive Suite 208 EApNDWIL INSURERS AFFORDING COVERAGE NAIC 9 Miami FL 33176 INSURER AAccident Insurance Co. INSURED INSURER B INSURER C: AIR SYSTEMS A/C LLC INSURER D: 4698 NW 133 STREET INSURER E: $ INSURER F: 10pa Locka FL 33054 COVERAGES CERTIFICATE NUMBER --14/15 GL Certificate 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 SUR POLICY NUMBER POLICY FF M/DD POLICY EXP D LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLPJMS-MADE Fx_1 OCCUR CPP000962801 8/16/2014 8/16/2015 EACH OCCURRENCE $ 1,000,000 PREMISES occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. X POLICY PRO- LOC PRODUCTS -COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Me accident BODILY INJURY (Per person) $ BODILY INJURY (Per acdderd) $ PROPERTY DAMAGE er accident $ $ UMBRELLA LIAR EXCESS LUU3 HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIE ECUTIVE OFFICER/MEMBER EXCLUDED? El (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- OTH- TORY LIMITS EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT J $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) CAC033544 Miami Shores Building Department 10050 NE 2nd Avenue Miami Shores, Florida 33138 ACORD 25 (2010/05) INS095 t,>nim-n m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZE REPRESENTATIVE Avetrani/YC -- -- ©1988-2010 ACORD CORPORATION. All rights reserved. The ARnRn name anA Innn ars rsntale►ed ma**a of Annan CERTIFICATE OF LIABILITY INSURANCE R022 12/%Zo 4 THIS CERTIFICATEIS 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 pollcy(les) must be endorsed. If SUBROGATIONIS 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 Ileu of such endorsement(s). PRODUCEIt PAYCHEX INSURANCE AGENCY INC 210705 P: F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: P"HONE,Ext). (Ac,Nn} (888) 443-6112 DDR ADDRESS: INSURER(S) AFFORDING COVERAGE NAICC INSURERA: Twin City Fire Ins Co 29459 mmtRFD AIR SYSTEMS AC LLC 4698 NW 133RD ST OPA LOCKA FL 33054 INSURER B: INSURER C: INSURER D: INSURER E: NSURERF: COVERAGES CERTIFICATE 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. 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 TYPEOFINSURANCE ADDL SUER POLWYNUMBER POLIEFF POLICYEXP LvvM COMMERCIAL GENERAL UABIL ITY EACH OCCURRENCE g MADE OCCUR CLAIMSEl DAMAGE TO RENTED PREMISES (Ea ocaBrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER. O LOC POLICY � JE PRODUCTS -COMP/OP AGG g $ OTHER: AUTOMOBILE LIABILITY COMBINEDdeldINSINGLE LIMB $ (Ea ecd BODILY NJURY (Per parson) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY (Per aodderd) $ PROPERTY DAMAGE (Per acddem) $ NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA I A LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR d CLAIMS -MADE OED RETENTION $ $ WORHE&S COMPENSATTON ANDEMPLOIP-WLIABIL/" ANY PROPRIETORIPARTNER/EXECUTNE YM X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 A OFFICERIMEMBER EXCLUDED? (WarMat-Y In NM ❑ wA 76 KEG DF7479 05/13/2014 05/13/2015 EL DISEASE -EA EMPLOYEE $1, 000, OOO If yes, deaWbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY UNIT 1$1,000,000_ DESCRIPTION OF OPERATTONS /LOCATIONS /VEHICLES (ACORD 101, AddMonol Remarks Seheduhl, may be etlaahed If more space Is required) Those usual to the Insured's Operations_ License # CAC033544 CERTIFICATE HOLDER CANCELLATION (P IBBB-2014 AGORO GORPOKAIION. An ngnre reserves. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Miami Shores BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORfi®I?PRESENTATM ` Building Department 10050 NE 2ND AVEC_ MIAMI SHORES, FL 33138 (P IBBB-2014 AGORO GORPOKAIION. An ngnre reserves. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD PAYCHEX INSURANCE AGENCY INC PO BOX 33015 SAN ANTONIO TX 78265 Miami Shores Building Department 10050 NE 2ND AVE MIAMI SHORES FL 33138 ACORD 25 (2014/01)