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MC-15-1826 r Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239547 Permit Number: MC-7-15-1826 Scheduled Inspection Date: August 31,2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: GODOY GONZALEZ, ILEANA Work Classification: New A/C System Job Address: 166 NW 100 Terrace Miami Shores, FL 33150- Phone Number (786)390-9503 Parcel Number 1131010230280 Project: <NONE> Contractor: ATLANTIC AIR CONDITIONING Phone: (305)885-9523 Building Department Comments INSTALL AC UNIT 3 TON 16 SEER 10 SUPPLY AIR Infractio Passed Comments GRILLS AND 3 RETURN AIR GRILLES 1 EXHAUST FAN INSPECTOR COMMENTS False FOR BATHROOM Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 28,2015 For Inspections please call: (305)762-4949 Page 5 of 26 AMA 19 Miami Shores Village ; �� ) 10050 N.E.2nd Avenue NW yUc�rk Claftart tent Miami Shores,FL 33138-0000 y y e�1i` ED Phone: (305)795-2204 � Expiration: 01/3012016 Project Address Parcel Number Applicant 166 NW 100 Terrace 1131010230280 Miami Shores, FL 33150- Block: Lot: ILEANA GODOY GONZALEZ Owner Information Address Phone Cell ILEANA GODOY GONZALEZ 166 NW 100 Terrace (786)390-9503 MIAMI SHORES FL 33150- 166 NW 100 Terrace MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 5,905.00 ATLANTIC AIR CONDITIONING (305)885-9523 (305)216-2675 Total Sq Feet: 0 Tons:3 Available Inspections: Additional Info:INSTALL AC UNIT 3 TON 16 SEER 10 SU Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Electrical Date Denied: Type of Work: Review Mechanical Scanning:3 Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 DBPR Fee Invoice# MC-7-15-56416 $3.10 07/21/2015 Credit Card $50.00 $181.48 DCA Fee $3.10 Education Surcharge $1.20 08/03/2015 Credit Card $ 181.48 $0.00 Permit Fee $206.68 Scanning Fee $9.00 Technology Fee $4.80 Total: $231.48 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,MEC NICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin uth e,I authorize the above-named contractor to do the work stated. August 03, 2015 Authoriz d S gn ure:Owner / Applicant / Contractor / Agent Date Building"Department Copy August 03,2015 1 a Miami Shores Village Building Department JUL 1 20 5 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 1° INSPECTION LINE PHONE NUMBER:(305)762-4949 /� F BC 20 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING F_� ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING 0 MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 166 NW 100 Terrace City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Ileana GOdoy Gonzalez Phone#:786-390-9503 Address:166 NW 100 Terrace City: Miami Shores State: Florida Zip: 33166 Tenant/Lessee Name: Phone#: Email: imgggonzalez@hotmail.com CONTRACTOR:Company Name: Atlantic Air Concl R Rafrj,T Phone#: 305-885-9523 Address: 10670 N.W. 123 Street Rd. Bay 101 city: Medley State: '171 nr i da Zip: 3 3 1 7 8 Qualifier Name: Gregorio Gonzlaez Phone#: 305-885-9523 305-21602675 Cell. State Certification or Registration#: rACQ57704 (� ��s Certificate of Competency#: DESIGNER:Architect/Engineer: - Vx1Lft�I" Phone#: Address: IV t✓ 2Ad City: 1ar" State:F(— Zip: 33 111q Value of Work for this Permit:$ 5,905.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition Description of work: Installb.tion 1 a/c unit Rheem 3.5 Ton 16.00 S E E R 10 KW Neater, 10 supply air grilles, 3 return air grilles. 1 Exhaust fan for bathroom 110 CFM. Specify color of color thru tile: Submittal Fee$ Permit Fee$ � CCF$ • CO/CC$ Scanning Fee$ 1o Radon Fee$ � � DBPR$ _Notary$ Technology Fee$ Training/Education Fee$ ) Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$II (Revised02/24/2014) r 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$2500,the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) da s after the building permit is issued. in the absence of such posted notice, the inspection will not b pproved and a reinspec n fee 11 be charged. Signature e` Signature OWNER or AGEN NTRACTOR The foregoing instrument as acknowledged before me this The foregoing instrument was acknowledged before me this �® day of 20 /5— .by day of ! 7 by � 'l�lr��iyvho i ersonally know ooh l`d �✓ �.who i4,20 sonally know to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: if SiD gn Sign: ItiliII&IIii R * tary P Stat Fri Print y�0 Print ` OF ci `� Seal: OF Bonded Through National Notary Assn. Seal: ��%F -a' Commission#ff 024ry '��,4;�� Bonded Through National Notary Assn. APPROVED BY la xaminer Zoning Structural Review Clerk (Revised02/24/2014) • FLORAIR-02 ONAPOLES '4�Rte$ CERTIFICATE OF LIABILITY INSURANCE DATE D/YYY1O 1/6/2015 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 CONTACT Collinsworth,Alter,Fowler&French,LLC PN ONE FAX 8000 Governors Square Blvd A!c No Ext:(305)822-7800 AIC,No):(305)362-2443 Suite 301 E-MAIL : Miami Lakes,FL 33016 INSURER(S)AFFORDING COVERAGE MAIC 0 INSURER A:Scottsdale Insurance Company 41297 INSURED INSURER B:Business First Ins Co 11697 Florida Air Conditioning&Refrigeration,Inc.DBA:Atlantic A/C&Refrigeration INSURER C: 10670 NW 123 St Rd INSURER 0: Bay 101&102 INSURER E: Medley,FL 33178 INSURER F: 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. LTR TYPE OF INSURANCE ADL POLICY EFF POLICY EXP POLICY NUMBER MM/DD MM/DD OMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE T OCCUR CPS2134955 01/04/2015 01/04/2016 DA10APREMISET Ee RENTED re $ 50,00 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY El ❑ PRO- LOC PRODUCTS-COMPlOP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per ecc dent $ UMBRELLALIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION TH AND EMPLOYERS'LIABILITY —X—[—PER STATUTE ER B ANY OFFICERPRIETORIPARTNER/E ECUTIVE Y� NIA 9136200 12/29/2014 12/29/2015 E.L EACH ACCIDENT $ 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 Dyam, IPTION under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CAC057704305-885-9523 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E.2 Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 n AUTHORIZED REPRESENTATIVE J*L ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD RICK SCOTT, GOVERNOR KEN LAWSON,SECRETA. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC057704 The CLASS AAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 GONZALEZ, GREGORIO w� ATLANTIC AIR COND & REj GE,RATI,ON 10670 NW 123 STREET ROAb - BAY 101 MEDLEY FL 33178FRI z ISSUED: 07/03/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407030000724 001174 ------------- --- — Local Business Tax Receipt Miami—Dade CountW State of Florida —THIS IS NOTBILL — DO NOT PAY LBT 1476704 A BUSINESS NAMMOCATION RECEIPT NO. EXPIRES ATLANTIC AIR CONDITIONING&REFRIGERATION RENEWAL SEPTEMBER 30, 2015 10670 NW 123 ST RD 101 1476704 Must be displayed at place of business MEDLEY FL 33178 Pursuant to County Code Chapter BA—An.9&10 OWNER SEC.TYPE OF BUSINESS FLA AIR COND&REFRIGERATION INC 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED CAC057704 BY TAX COLLECTOR Worker(s) 10 $45.00 07/28/2014 CHECK21-14-036882 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holders qual�catioos,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to thebasin- The RECEIPT N0.above must he displayed an all commomief vefIr6joF 1 Iami—Dade Code Sec tie-276. For more information,visit mww mia g"uv/taTc`rdlfecfaf x