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RC-15-551 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-244336 Permit Number: RC-3-15-551 Scheduled Inspection Date: October 05, 2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Building Owner: LOWMAN, MARCI Work Classification: Alteration Job Address:75 NE 101 Street Miami Shores, FL 33138- Phone Number (305)981-4477 Parcel Number 1132060131550 Project: <NONE> Contractor: HOME OWNER Building Department Comments REPLACE KITCHEN CABINETS. REMOVE SECTION OF Infractio Passed Comments NON-BEARING KITCHEN. REPLACE KITCHEN INSPECTOR COMMENTS False COUNTER. TO CLOSE PERMIT#RC-13-2504 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-244223. Must pass final electric Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 02,2015 For Inspections please call: (305)762-4949 Page 13 of 31 yam .. �sH° �iMiami Shores Village s 29 # �n 10050 N.E.2nd Avenue NE / 1 1 Miami Shores,FL 33138-0000 3 ti fiC'° W Phone: (305)795-2204 Expiration: 09/27/2015 Project Address Parcel Number Applicant 75 NE 101 Street 1132060131550 MARCI COWMAN Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell MARCI LOWMAN 75 NE 101 Street (305)981-4477 MIAMI SHORES FL 33138- 75 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 7,000.00 HOME OWNER Total Sq Feet: 110 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved: : In Review Window Door Attachment Date Denied: Framing Type of Construction:REPLACE KITCHEN CABINETS. RE Occupancy: Insulation Stories: Exterior: Drywall Screw Front Setback: Rear Setback: Final PE Certification Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted: Certificate Status: Review Building Certificate Date: Additional Info: Review Planning Review Electrical Bond Return: Classification:Residential Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Structural Review Mechanical CCF $4.20 Invoice# RC-3-15-54782 DBPR Fee $3.15 03/31/2015 Check#: 1176 $230.50 $0.00 DCA Fee $3.15 Education Surcharge $1.40 Permit Fee $210.00 Scanning Fee $3.00 Technology Fee $5.60 Total: $230.50 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 AF a fy that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a zo n F hermor ,I authorize bove-named contractor to do the work stated. March 31, 2015 Authorized ur wn / Applicant / Contractor / Agent Date Building Department Copy March 31, 2015 1 Miami Shores Village Building Department LIAR 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2_0t 0 BUILDING Master Permit No. PERMIT APPLICATION sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ^'�` II CONTRACTOR DRAWINGS JOB ADDRESS: --5 '`�F- !0 I f*ee f City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 11- 32o(- D)3- )5'5'0 Is the Building Historically Designated:Yes NO Occupancy Type: 3FV Load: Construction Type: C Q f Flood Zone: A BFE: FFE: OWNER: Name(Fee Simple Titleholder)`: Marti Lowmryl Phone#: 305 981-' /z/U Address: 45 G 1 0 1 J t City: Miami' honf State: EL Zip: ,.31)0 p Tenant/Lessee Name: O A Phone#: Email: MLS 1 notnd Lowrnp4. corn CONTRACTOR:Company Name: 0,!A �40mo Wf w Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration#: OLA Certificate of Competency#: DESIGNER:Architect/Engineer: OLA Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 000 Square/Linear Footage of Work: ))V T,t Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 1�C " 0- 1 " 2504, dbn I i n t cji4o, C SS Q o-'�- �Park coM lc-k4. Qu i s ct r . J noh-�0to'ril' �Ci�-�I 'R0Ic.0 rA' .:,.tea i • . Specify color of color thru tile: f S Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 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) A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) C o 1 er Home Lpm Mortgage Lender's Address 37oi Reop r 1311A �✓1 � 9of) City rv'),g State 'r/` Zip -�0 63 a 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 exiceeding$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 O or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this � day of 20 S by day of 20 by l' I VVC i I—V WMM who is ersonally know to who is personally known to me or who has produced �/A 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: Si Sign: Print. iN Print: Seal: a°�;••�:;' CMIDYKN/ Seal * * MY COMMISSION}FF 142M EXPIRES:&4y 15,2818 �j''eoF it��! BandedlMi tW�etNwry SMriNt APPROVED BY rJ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) S�;Os Miami Shores Village eggse Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT n NAME: 1' I OU'Ct L O W m wA DATE: 12 d©1 S ADDRESS: -45 NE 10l S-ly-ect Map,; Sbarri 3313 Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,F.S 489.103(7). And I have read and understood the following disclosure statement,which entitles me to work as my own contractor;I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor.You have applied for a permit under an exception to the law.The exemption allows you,as the owner of your property,to act as your own contractor even though you do not have a license.You must supervise the construction yourself.You may build or improve a one-family or two-family residence.You may also build or improve a commercial building at a cost of$25,000.00 or less(The new form states 75,000).The building must be for your own use and occupancy.It may not be built for sale or lease.If you sell or lease a building you have built yourself within one year after the construction is complete,the law will presume that you built for sale or lease,which is a violation of this exemption.You may not hire an unlicensed person as a contractor.It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances.Any person working on your building who is not licensed must work under your supervision and must be employed by you,which means that you must deduct F.I.C.A and with- holdings tax and provide workers'compensation for that employee,all as prescribed by law.Your construction must comply with all applicable laws,ordinances,buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner-builder permit under an exemption from the law.The exemption specifies that I,as the owner of the property listed,may act as my own contractor with certain restrictions even though I do not have a license. Initial 4'4- 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. 1 understand that,as an owner builder,I am the responsible party of record on a permit.I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial_ 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may also build or improve a commercial building if the costs do not exceed$75,000.The building or residence must be for my use or occupancy.It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease,which violates the exemption. Initial 5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction. Initial 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence.It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. v Initial /' ^� 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtai an owner-builder permit that erroneously implies that the property owner is providing his or her own labor and materials.I,as n owner-builder,may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed pers n or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner-builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done.Any person working on my building who is not licensed must work under my direct supervision and must be employed by me,which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act(FICA)and must prove workers compensation for the employee.I understand that my failure to follow these may subject to serious financial risk. Initial 9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity;I will abide by all applicable laws and requirement that govern owner-builders as well as employers.I also understand that thle Construction must comply with all applicable laws,ordinances,building codes, and zoning regulations. Initial 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service,the United States Small Business Administration,and the Florida Department of Revenues.I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http:/twww.mynoridalicense.com/dWr/pro/cilb/indeex.h✓tmi Initial ✓� 11. 1 am aware of,and consent to;an owner-builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: 15 NE 101 ,�f� M o►ni Aorel 331,78 Initial 40-- 12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the information that I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public.If you contract with a person who does not have a license,the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court.It is also important for you to understand that,if an unlicensed contractor or employee of an individual or firm is injured while working on your property,you may be held liable for damages.If you obtain an owner-builder permit and wish to hire a licensed contractor,you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued,this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit.A copy of the property own4's driver license,the notarized signature of the property owner,or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this I`�- day of M0i , 20 �S BY—M` t OV ► L O WMaA who w personally know o me or who has Produced there License or �/ as identification. OWNER RY �rar no a°, •; CINDY KIM * * MY COMMISSION#FF 142M EXPIRES:July 15,2011 N�,TEOF Fl 44, Bv&d lhru Bulges Nobry Sorvius Miami Shores Villages` E 10050 N.E.2nd Avenue NE •• "•"�' Miami Shores,FL 33138-0000 s ;. �t� Phone: (305)795 2204 lQRjpP +T M „ rY Expiration: 11/01/2015 Project Address Parcel Number Applicant 75 NE 101 Street 1132060131550 MARC! COWMAN Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell MARCI LOWMAN 75 NE 101 Street (305)981-4477 MIAMI SHORES FL 33138- 75 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 4,500.00 JOSE C YANE AIR CONDITIONING& __.m.... Total Sq Feet: 0 Tons: Available Inspections: Additional Info:A/C CHANGE OUT KITCHEN HOOD VENTILA Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved: : In Review Review Mechanical Date Denied: Type of Work: Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 Invoice# MC-4-15-55380 DBPR Fee $2.37 DCA Fee $2.37 05/05/2015 Check#: 1192 $ 173.24 $0.00 Education Surcharge $1.00 Permit Fee $157.50 Scanning Fee $3.00 Technology Fee $4.00 Total: $173.24 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 AFFIDAVI hat the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z in F erm , I authorize the above-named contractor to do the work stated. May 05, 2015 Authorized Signatu p scant / Contractor / Agent ate Building Department Copy May 05, 2015 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-243876 Permit Number: MC-4-15-1025 Scheduled Inspection Date: September 23, 2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: LOWMAN, MARCI Work Classification: A/C Replacement Job Address:75 NE 101 Street Miami Shores, FL 33138- Phone Number (305)981-4477 Parcel Number 1132060131550 Project: <NONE> Contractor: JOSE C YANE AIR CONDITIONING &APPLIANCES SERV IN( Building Department Comments A/C CHANGE OUT KITCHEN HOOD VENTILATION 3.5 infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 22,2015 For Inspections please call: (305)762-4949 Page 25 of 35 .00- L? �� Miami Shores Village Building Department app 29 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 �13Y: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 �o BUILDING Master Permit No. Gi-S —5�� PERMIT APPLICATION Sub Permit No._I ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION FfRENEWAL ❑PLUMBING IMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: n'�S 1 y E lot t S+e.Q City: Miami Shores County: Miami Dade Zip: 3313? Folio/Parcel#: r 11 ' 5*20` V>� IS50 Is the Building Historically Designated:Yes NO J Occupancy Type: r Load: Construction Type: Cif -FloodZone: A BFE: FFE: OWNER: Name(Fee Simple Titleholder): ' ' +��'� �y wrnA-1 Phone#:300 9P- `157? Address: If /9f LS— 10i ,(�/�1 A rni DIY✓ (' / City: 1 '/ ,f h State: I Zip: 33�� Tenant/Lessee Name: ►`! Phone#: Email: CONTRACTOR:Company Name: TQ-5e(-YC-Anes Air �n 1 0111 Phone#: Address: City: N M i A MCI State: I L— Zip: 331,0 g�yrQualifer Name: , o State Certification or Registration#: C-A-C )81S 93'7 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �r so Q Square/Linear Footage of Work: Type of Work: ❑ Addittiion/ ❑ Alteration ❑ New % Repair/Replace '/ ❑ Demolition Description of Work: AJC C Cl�al r ®•� l !4 Cin Womp I�010jelf Specify color of color thru tile: Submittal Fee$ Permit Fee$ 2° CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 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 NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this oMC 6 day of ,�) 20 Js by oC day of fl I 20 LJ by 1'IOV'Cl LoNM(M who iiAss, arson ally kno to �Oc�e � OIR'� ,who is ersonally know to me or who has produced �A 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: Sign Sig Print: In t Prin • Ih� iM Seal: Seal: CINDYKIMI a°;•••; CINDY KIM * * MY COMMISSION f FF 142293 * * My COMMISSION!FF 142293 EXPIRES:July 15,2018 EXPIRES:Jury 15,2o18 Bonded TMu Budget Notary Services rFK n ck Bonded Thru Binet Notary Services APPROVED BY V Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department memo •••l" 10050 N.E.2nd Avenue Miami Shores, Florida 33138 �ioRm� 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. 0 Job Address(where the work is being done): 7 S N E f a) �J eeJ City: Miami Shores Village County: Miami Dade Zip Code: '23)30Q 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 ❑ 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: i Contractor's Company Name: 11 (�,Sc �A n� l�-i� G^dl 611 ,G Phone: State Certificate or Registration No. Certificate of Competency No. Signature Date: ( s signati (Revised02/24/2014) "`` CERTIFICATE OF LIABILITY INSURANCEF4/ 27/D27/201lDD/Y5 5 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). PRODUCER5�CTJosset Jordan Torres Insurance Agency Inc. PHONE , (305)512-5880 FAX (305)512-5881 6135 NW 167 STREET # E25 E-MAIL .jjordan@torresinsuranceagency.com INSURERS AFFORDING COVERAGE NAIC/ Miami Lakes FL 33015 INSURER A:MAPFRE INSURANCE COMPANY INSURED INSURER B Jose C Yanes Air Conditioning & Appliances INSURERC: 1021 NE 132 Street INSURER D: INSURER E North Miami FL 33161 INSURER COVERAGES CERTIFICATE NUMBER:CL14111422145 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 ADVIL SUBR P L1CY EFF POLICY EXP LTR TYPE OF INSURANCE WVD POLICY NUMBER tMWDDWtYYI I LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES _9 occurrence $ 100,000 A CLAIMS-MADE F OCCUR 4250140018856 1/13/2014 1/13/2015 MED EXP one son $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/0P AGG $ 1,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED identl JL 100,000 AH ANY AUTO BODILY INJURY(Per person) $ ALL OWNED rU71 SCHEDULED 4150120006143 /17/2014 /17/2015 AUTOS AUTOS BODILY INJURY Per accident) $ HIRED AUTOS AUTNON-OWNED PROPERTYDAMAGE $ PIP-BASIC $ 10,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION S WORKERS COMPENSATION WC STATU- I JOTH. AND EMPLOYERS'LIABILITY YIN JORYIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICER/MEMSER EXCLUDED? NIA A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS be E.L DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Air Conditioning Installation Blanket Additional Insured apply to General Liability policy # CP-000323760-3 as required by contract- CG 2033. * Inland Marine: Small Tools $5,000/ $500 Ded, 1008 Coins. B)Commercial Auto: Veh 1: 2002 Ford/ Econoline E250 Vin# 1FTNE242X2HA51198 ***(No Comprehensive & Collision Coverage)*** ; Veh 2: 2005 Chevrolet Silverado Vin# 2GCE13T651126819 ( Comprehensive & Collision bed $500) ; Veh 3: 2006 Chevrolet Express Vin# 1GCHG39V761132433 ***(No Comprehensive & Collision Coverage)*** CERTIFICATE HOLDER CANCELLATION jd@kimanlowman.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN j Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25(2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. j INS026(201005).Ot The ACORD name and logo are registered marks of ACORD ! i Page 2 of 3 email. I resent email to my dad regarding the wire but still without phone so I am trying to get a hold of him today so I can borrow friends jeep and pick up money. If I do not hear back today then I will ask for an advance on the painting/redesign job for the condo I'm working on as without a phone and dealing with this has been very stressful. » -W >>William Dunne >>Jon Goodriian Entertainment, LLC >> Consultanj >> Intrface IT' >>Account Executive >>wdionne(a)Umail.com » I >> On Sep 126 2014, at 11:58 AM, Allison Cotter<allisoncotter(cD_aol.com> wrote: >> I really expected you last night with the rent and was amazed you did not show or commute >>Allison Cotter 305-282-5753 >>> On Sep 10, 2014, at 5:42 PM, Will Dionne <wdionne(cDgmail.com>wrote: >>> Alisson, >>> I know I skid I'd be there Monday as I was to pick up the wire. Unfortunately for me due to roamino data charges while traveling last month I didn't know my phone was getting shutoff and needed the info code that was sent via text but I didn't receive it because my phone was off to pick up the cash via from Walmart. I was counting on the wire with extra cash as well so I expect to have the code resent via my email this evening when I my Dad gets home from work in Colorado Rocky Mountain time. Once I receive that With my friends jeep In go get the full rent tomorrow and turn my phone on. I asked my friend Melissa to check on Thor as she did yesterday and is going today and asked hertake him for a long walk this time till I get home from pAinting and redesigning on repainting a condo on 71 st. >>> You and I should be all caught up tomorrow after I leave in around 6 and head to Walmart.. I'm sorry if you thought I wasn't communicating on purpose but I just haven't been able to cdmmunicate with anybody until via email as of now.l look forward to this being cleared yp rent, phone and everything tomorrow afternoon evening. >>> -Will >>> William Dionne >>> Jon Goodrhan Entertainment, LLC >>> Consultants >>> Intrface IT >>>Account Ecutive >>> wdionne(cDmail.com >>> T >>> On Sep 10` 2014, at 8:52 AM, Allison Cotter<allisoncotter(a-)-aol.com>wrote: >>> Will >>> You promised to pay all if the rent I only received $700 you said you would pay the rest Monday It ip now weds and nothing from you and you have not bothered to call me >>> I tried yourlphone disconnected. Your dog has been crying and crying now for 2 days >>> I need you oto connect >>> Me you ne*d to pay all of the rent >>> You are boxing into a corner I can not afford to have a tenant who does not pay his rent then make promises he does not for fill I can no longer depend on your word https://mail.aol.com/3884 -117/aol-6/en-us/Suite.asnx /1-)Q-1 Apr.21.2015 03:31 PM Jose Yanes Air Conditioni 305 895 3565 PAGE. 1/ 3 RICK SCOTT,"GOVERT40R.........._. _...._...._............ . . .. _ r . KEN LT1N§�ONu,SECRETi4�Y STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD50 �IM CA01815974 The CLASS B AIR CONDITIONING CONTRACTOR T Named below IS CERTIFIED Under the provisions of Chapter 489 FS. "'` Expiration date: AUG 31, 2016 1�y O YANES, JOSE CLEMENTE JOSE C YANES AIR CONDITIONING&APPLIANCES SERVICES INC 1021 NE 132ND ST NORTH MIAMI FL 33161 ■ ISSUED: 08/14/2014 DISPLAY AS REQUIRED BY LAW SEa# L1408140001384 JOSCY01 OP ID:ACE CERTIFICATE OF LIABILITY INSURANCE DATE 04127/201 YY) Q4127l2015 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 CONTA NAME;cT Evergreen Insurance Agency Evergreen Insurance AgencyPHONEFA 583 105th Avenue N,Ste 2 IC No E,10:561-966-8883 Arc No: 561-964-8885 Royal Palm Beach,FL 33411 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 INSURERA:Retail First Insurance Co. 10700 INSURED Jose C Yanes Air Conditioning INSURER B: &Appliance Services Inc. INSURER C: 1021 NE 132 St. N. Miami, FL 33161 INSURER D: INSURER E 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. IAUUL UU1611 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE El OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ PGEOTHER N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑PRO LOC PRODUCTS-COMPIOP AGG $ JECT : $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE 1R AND EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNERIEXECUTIVE YIN X 0520-49557-0 12/22/2014 12/22/2015 E.L.EACH ACCIDENT $ 100,00 OFFICERIMEMBER EXCLUDED? N I A (MandatoryIn NH) E .DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certified Air Conditioning Contractor Contractor License#CAC1815974 CERTIFICATE HOLDER CANCELLATION Miami Shores Villa a MIASH01 Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD