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MC-15-508Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235382 Permit Number: MC -3-15-508 Scheduled Inspection Date: May 27, 2015 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: RESPONDEK, ALLAN Work Classification: AIC Replacement Job Address: 1162 NE 105 Street Miami Shores, FL 33138-2108 Project: <NONE> Phone Number Parcel Number 1122320280150 Contractor: COOLING BY (THE) BOOK LLC Phone: (305)233-0717 ewiama vepartment comments REPLACE AIR CONDITIONING SYSTEM (CHANGE OUT) INSPECTOR COMMENTS False IV sl�2l s Passed Inspector Comments Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 26, 2015 For Inspections please call: (305)762.4949 Page 26 of 26 ,s'Im h Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 ` Phone: (305)795.2204 Project Address Parcel Number Applicant 1162 NE 106 Street 1122320280150 CAROL RESPONDEK Miami Shores, FL 33138-2108 Block: Lot: Owner Information Address Phone Cell ALLAN RESPONDEK 1162 NE 105 ST MIAMI SHORES FL 33138-2108 Contractor(s) Phone Cell Phone COOLING BY (THE) BOOK LLC (305)233-0717 5 Info: REPLACE AIR CONDITIONING SYSTEM (CH ion: Residential In Review Date Denied: Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge jAn Permit Fee Scanning Fee Technology Fee Total: Date Approved:: In Review Type of Work: Valuation: $ 10,437.09 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC -3-15-54725 03/10/2015 Credit Card $ 50.00 $ 352.83 03/12/2015 Check #: 6204 $ 352.83 $ 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 accur to and that all work will be done in compliance with all applicable laws regulating construction and zorji,g. Futheryno%, I authorize the above-named or),,10 the work stated. March 12, 2015 Authorized Signatures Owner Applicant / Cdnftra for / Agent uate Building Department Copy March 12, 2015 1 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: (305) 762-4949 ❑ BUILDING ❑ ELECTRIC ❑ ROOFING MAR 10 2015 FBC 20 16 Master Permit No. Mo— Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:—//4z A145- 1,R6- S ET Com: Miami Shores County: Miami Dade zip: 33/38 Folio/Parcel#: a" —0/. is the Building Historically Designated: Yes NO _ Occupancy Type: Load: yjC�onstruction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): STI'tul 4-&Lrn� �.QS 178(1 ,% Phone#: Lao s Address: City: State: Zip: 3:5/ 3 I Tenant/Lessee Name: Email: t4Z JIA.f CONTRACTOR: Company Name: 2*Q lei/S J • ���(% Z Phone#: Address: ZoC 1'491 P A/ City: A " Qualifier Name: ds State Certification or Registration #: Zip: 3 1? z�� Z- Phone#: �etC� L334 O °f/f Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: �7 City: State: Zip: Value of Work for this Permit: $ A9_ �� / • Square/linear Footage of Work: 415?z Type of Work: ❑ Addition ❑ 'Alteration ❑ New • gRepair/Replace Demolition Description of Work: F®.® a CA -Y � O �OA�fil/y .5ieX Pel �( l.� P 10010 Specify color of color thru tile: Submittal Fee $ M d 1� Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ $ CO/CC $ DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $�� • t� 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 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 �Ylf A � OWNER or AGENT The foregoing instrument was acknowledged before me this day of N-t&rCK , 20 15 by �1lil' IBJ Pdn" `who is personally known to me or who has produced I— R2IS 0.573 identification and who did take an oath. NOTARY PUBLIC: r Signature CONTRACTOR The foregoing instrument was acknowledged before me this 10 day of 220 ' , by &ho is, r-onally known to me or who has produced—B -.ie1ter- identification and who did take an oath. NOTARY PUBLIC: Sign: " ' Sign:_ Print: U &VaVPrint: Seal: 4 o GRACENyATT Seal: Nagy Skh of Ronda r� FF 1943t� 1' X1919, 2r 1, 1 a APPROVED BY QV� �Pns Examiner Structural Review (Revised02/24/2014) o , Notary Public State of Florida Sindia Alvarez My Commission FF 158750 or p Expires 09/03/2018 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):_ % l ��✓ �' �'� City: Miami Shores Village County: Miami Dade Zip Code: _33(3s 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 Mean Contractor's Company Name: State Certificate or Registratiol Signature 4Date: 3 fel r (Qualifier's signs ure) (Revised02/24/2014) 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 Mean Contractor's Company Name: State Certificate or Registratiol Signature 4Date: 3 fel r (Qualifier's signs ure) (Revised02/24/2014) 11/08/2009 13:45 3052330297 ■ ' STATE OF FLORIDA DEPARTMENT OF BUSINESS CONSTRUCTION INDUSTRY I 1940 NORTH MONROE STREI TALLAHASSEE FL 32399 GONZALEZ ANDRES FELIX COOLING BY (THE) BOOK LLC 12781 S.W. 209TH STREET MIAMI FL 33177 COOLING BY THE BOOK PROFESSIONAL REGULATION r-ruw5wonal I%egulauon. Uur professionals and businesses r nge from architects to yacht brokers, from boxers to barbeque res uranh and they keep Florida's economy strong. Every day we work to Improve the way we do business in ord r to serve you bef er_ For Information about our services, please I onto www mytiottdalicense.com. There you can find more info atlon about our divisions and the regulations that impact you, subbe to department newsletters and learn more about the Depertm nt's Initiatives. Our mission at the Department is: License Efficiently, Ri We constantly strive to serve you better so that you can customers. Thank you for doing business in Florida, and congratulations on your new licensel ... "`. fi1CK SGOTf;-GOvERNaR• ... .. .. - _ {' STI DEPARTMENT OF BUSIA CONSTRUCTION CAC1818141" . The CLA . AIR CONDITIONING CONTRACTOP`--..1. - Nalmed•below IS CERTIFIED Undt:f the -provisions of Chapter 489 FS_ Expi'raiiori data: AUG -21, 2016 0�112ALFZ: Arm -RES• F4i COOQNG BY (THE B .,:.� -27ai.Svu�oS:I-I :. ICg11Pn' fKMIOnIA r11C01 AV L Fairly. NG BOARD HERE PAGE 01 (850) 487-1395 STATE OF FLORIDA DEPAR. , BUSINESSAND PROF ULATION CAC1816141'r ' �' •: ' 5/11/2014 3 N + .•. i•< CERTIFIED A Joe :•:-: GON2AI:EZ. COOLING IS CERT11RIE•9.•untler th'e provisions of Gh.4B9_FS."; XVb aiondQW: AUG91,.2MB" laRa511000I1895•. 2•.fw:._ _I. r•:W::x. O..:+'.. • ,: =.G` �a 4A,x.,,.,•T'"•-0".9 �'90.:'i'.:!.'rY.iS�J,A3�:NifY1C/lYii�h'Pl• f'»� �r " • CEN tAWSON 'SECRETARY• • _�,• ••.-•-r,. ..+. r...a-�. ,_��.. , .++•...+,...+.,, .�r.r. ,rr+r�r „rw.r��a,.r+r+.��,w.-, �r..+rv.r+..r...r 9++. "E OF FLORIDA SS AND PROFESSIONAL REGULATION WUSTRY LICENSING BOARD 9 ` ■ ■ ME C or-ri1110C11 ov 1 AIAr am is �.ne��nnnnnns 12:013 3052281525 CITINSURANCE PAGE 01/01 9R --P, CERTIFICATE OF LIABILITY INSURANCE DATE MWINM 031031201 MS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION OX"02 Aosivcr CORP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE: HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND WEST FZAGZZR RT SUXTZ 213 ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL VZ 33144 ..'428-1533 INSURERS AFFORDING COVERAGE coozxmG Dr Tzzu Booic, zzc INSURER A: GRANADA XK5UjLW0Z COMWIffrY `7 INSURER 8: 12781 SK 109TH STREET 0 a- INSURER C: A(X"X, PZ 33177 INSURER 0: WYOLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANUI -A, YVIREQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR.* �A Y - PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUpa-' ICIES. AGGREGATE LIMITS SHOWN MAY HAVE APPM PF:nl If -PM VIV MAIrl ^ MRAO LTPA-f- TYPE OF INSURANCEFoucy POLICY Numarm DATEFFEGrIVE Expim DATE TE TION LIMITS ;GENERAL UAWLffY - EACH OCCURRENCE 31, 0 0 0, 0 0 0 COMMERCIAL GENERAL LIABILITY F!;;i FIRE D*M(39 (Any one Pre) S 100,t 000— I I MED EXP (" am p2rmn) S 5, 000 CLAIMS MADE I ld'6 I OCCUR 0185FL00038160 0LI-03-14 00-03-15 PERSONAL &ADV INJURY $1, 000, 0001.'' • QENGPAL AGMOATE 51, 000, 000. AGGREGATE LIMIT APPLIES PER; PRODUCTS - POLICY F 69u; umury AUTO COMN90 SINGLE LIMIT (Es acclderA) ALL OYMOAUTOS SCHEDULED AUTOS BODILY INJURY (Porperscn) HIRED AUTOS ED AUTOS BODILY INJURY (peracowdril) P Til - (P 19 LtAWt.ATY AUTO ONLY - EA ACCIDENT 8 ANY AUTO OTHER THAN EAACC $ AUTO ONLY. AGG S EXCESS UA131LITY EACH OCCURRENCE 6- OCCUR F—ICLAIMS MADE AG 9 DEDUCTIBLE RETENTION Cowi!N�TION- ANDOTH- QYERfrlUAINuTy AftPurs I I 9R E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT 08-03-14 Ve-03-15 $500 PD ONOrOPPAA?IfW-qfi CO=X2'XOAtXXG CONZRACTOR ZOAC1816414 HOLDEN I I ADDITIONAL XXANX offoRZo vxzzAGE BI7,rDXDKG JDZPAJt2'JWy2r 10050 XX 2 AVE. .MIAMI -qJF0JtR5, FL 33438 =vj-r.7= LETTER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POUCIM BE CZANCELLED BEFORE THE EXPIRATION' - .j... DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS wlirrr@q-, NOTICE TO THE CERTIFICATE HOLDER NAMW TO THE LEFT, BUT FAILUMTO oo go [MKk5r; NO OBLIGATION OR LlABILrrY OF ANY 19NO UPON THE INS ITS AGENTS OLK f - REPRESENTATIVES. JR7!— AUTHORIZM REPRESENTATIVE IDAGO CORPORATION 11/08/20091313: 45 'A 4 , - -OF 7F - M270 3052330297 JEFF A�= . U OfAcm • CERTIFICATE OF ELECTION To B, CONSTRUCTION INDUSTRY EXEMPTION This OertffieS that the individual fisted !.slow ties lea EFFr=CTPmDATff-. 71MM3 PERSON-' GONZALEZ FEIN: 203970020 BUSINESS NAME AND ADDRESS; COOLING BY THE BOOK LLC 12781 SW209 STREET MIAMI Ff. 33177 SCOPES OF BUSINESS OR TRADE! HEATiNG, VEhMLATiON, AIR -GOND 4LAW41 Fr,.. an COOLING BY THE BOOK STATE OF FLORIDA MENT or FINANCIAL SERVICES M: WORKERS' COMPENSATION 61PT FROM FLORIDA WORKERS- COMPENSATION LAW-* to be exempt from Florida Makers! Compeneation law. 21RATION DATE. 716/2015 )RM F SR MdAn 'qiEcruvt mo - W .3 PpE14EWAL. 0 20 O I"" 7 -M MIA, 3.3-417, tlbdb 8W. OWNPW. LWOTHE BOOK EW, 196 SPEC .M ECHANICAL (;ONTRA&OR PAVMzKr,.RjicEiveD.I- ' CAC1816141 W TAX ©is "C `Ft'75.00 0 .9/08/2014 �blvh apply to the hugbu*&. RECEIPT No. shave MM bo displayed an An ial -hides- Ift"de Cods San ea -2M. PAGE 02 rids 'qiEcruvt mo - W .3 PpE14EWAL. 0 20 O I"" 7 -M MIA, 3.3-417, tlbdb 8W. OWNPW. LWOTHE BOOK EW, 196 SPEC .M ECHANICAL (;ONTRA&OR PAVMzKr,.RjicEiveD.I- ' CAC1816141 W TAX ©is "C `Ft'75.00 0 .9/08/2014 �blvh apply to the hugbu*&. RECEIPT No. shave MM bo displayed an An ial -hides- Ift"de Cods San ea -2M. PAGE 02 Notice to Owner — Workers' Com Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation Insurance Exemation Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if - 1 . f: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: (G2 �M6AL(y__ Own State of Florida County of Miami -Dade The foregoing was acknowledge before me this �O day of I� (� , 20�. By CeIr a- UL t� 1yVtifov who is personally known to me or has produced F' L b L k 21 Y l 6 S' S3 5a3i identification. Notary: r V WAIT SEAL:. Q tow 1� N111Sam, 1a 20�` COOLING BY THE BOOK, LLC 12781 SW 209 STREET MIAMI, FL 33177 305-233-0717 Date: March 11, 2015 State of Florida County of Miami -Dade Before me this day personally appeared ANDRES FELIX GONZALEZ Who, being duly sworn, deposes and says: Andres Felix Gonzalez will be the only person performing the job at 1162 NE 105 Street Miami Shores, FL 33138. Sworn to (or affirmed) and subscribed before me this day of WcarAn 20A_, by��5 Personally know MANIA PACHECO Notary Public. State of Florida OR Produced Identification Commission # EE 851563 My comm. expires Nov. 14.2016 Type of Identification Produced ` L D L K Print Type or Stamp Name of Notary