DEMO-15-2179 . Pe titinto. DEMO
-1 ►-2�! '�
`SgonF$c� Miami Shores Village ' ' ` � Demolition
10050 N.E.2nd Avenue NE ''
W01*CiasSifr t7 � I h anktl
�•'• "'"'" Miami Shores,FL 33138-0000
Permit PIC?YE
= �` Phone: (305)795-2204 x
�LORIDP
1"" Date.8l3��010 Expiration: 03{01/2016
Project Address Parcel Number Applicant
1420 NE 103 Street 1132050310030
MARC AND ANNE LITZENBERG
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
MARC AND ANNE LITZENBERG 1420 NE 103 Street
MIAMI SHORES FL 33138-
1420 NE 103 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone � $~400.00
Valuation:
AIRTROL AIR COND CO INC (305)226-7542
Total Sq Feet: 0
Type of Demo:Mechanical Available Inspections:
Additional Info: FREON REMOVAL FOR DEMOLITION OF HOU Inspection Type:
Classification:Residential
Final
Scanning: 1 Review Mechanical
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Invoice# DEMO-8-15-56858
DBPR Fee $2.00
DCA Fee $2.00 09/03/2015 Credit Card $ 108.60 $0.00
Education Surcharge $0.20
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $108.60
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,ROOF and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information i e and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-nam ctor to do the work stated.
September 03, 2015
Authorized Signature:Owner / Applicant act / Agent ate
Building Department Copy
September 03,2015 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-242241 Permit Number: DEMO-8-15-2179
Scheduled Inspection Date: September 09, 2015 Permit Type: Demolition
Inspector: Perez,JanPierre Inspection Type: Final
Owner: LITZENBERG, MARC AND ANNE Work Classification: Mechanical
Job Address: 1420 NE 103 Street
Miami Shores, FL Phone Number
Parcel Number 1132050310030
Project: <NONE>
Contractor: AIRTROL AIR COND CO INC Phone: (305)226-7542
Building Department Comments
FREON REMOVAL FOR DEMOLITION OF HOUSE. Infractio Passed Comments
INSPECTOR COMMENTS False
V
Inspector Comments
Passed N-1
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 08,2015 For Inspections please call: (305)762-4949 Page 20 of 44
r
Miami Shores Village AUG 5 2015
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33238
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30s)752-4949 -T4
FBC 20( k+`�
BUILDING Master Permit 15- I (2-
PERMIT APPLICATION sub Permit No.2U- t 15- 21�
❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION M EXTENSION ❑RENEWAL
[:]PLUMBING MECHANICAL n PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ( SHOP
n n CONTRACTOR DRAWINGS
JOB ADDRESS: `�-V W � I C 6 I I�-
City: Miami Shores County: Miami Dade Zio:
Folio/ParceWif:i —32Q5-() -OCA aO Is the Buffing Historitaily Designated:Yes NO
Occupancy Type: Load: Construction Type: � Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): �/JA.-y_io'�` 1���Phone#:
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email: �^ �^ ^^'
CONTRACT R:Company Name: �WW
co Phone#:
Address:
City: M(AW _State: Zip:
Qualifier Name: i Lj Phone#:Z�C6-!2(q 0q8 l
State Certification or Registration#: 10 Certificate of Competency#: ,
DESIGNER:Architect/Engineer. Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �. Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ RReeppairr//Replace (QE) olition
Desc 'ption of Work: JZl lOy� �� ^h
l�
Specify color of color thru tile:
Submittal Fee$_ Permit Fee$ CF$ CO/CC$
Scanning Fee$ Radon Fee$ DSPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ ( �
TOTAL FEE NOW DUE$
Bonding Companys Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Z;
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 NOTI OF COMMENCEMENT."
I OF
Notice to Applico condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
Co'
condition
promise in good h th a copy of the notice of commencement and construction lien low brochure will be delivered to the person
whose property is s Ject attac ment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
w I
for the first - s i n occu seven (7) days offer the building permit is issued. In the absence of such posted notice, the
0 ,
inspection nat be pp d and reinspection fee will be charged.
Signature Signature
OWNER or A4NT CONVKCTOR
The foregoing instrument was acknowledged before me this The f instrument was acknowledgedk/fore me this
ing ---7A 20 by
day of 20 by :11!—day of
who is personally known to &AUJO F b1tU?T/kb+�Who is personally I who is personally known to
me or who has produced as me or who has produced--C>-I— as
identification and who did take an oath. identification and who did take an oath.
NOT Y PUBLIC* NOTA PUB C:
Sig Sig,
t I
Pry S2 Pri
AlFly Gulman
R#Commission FF 145807
S my dommissRFF 145"80j? Se l L!"�*WOOI; Eppirm.08/23/2018_
Expires 08/23/2016
AAAPSA"
APPROVED BY Plans Examiner Zoning
St uctu4 Review Clerk
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
GACW9764
The CLASS AAIR CONDITIONING CONTRACTOR
Named below IS CERTIFIEC? , u
Under the provisions of Chapter'489 FS.
Expiration date; AUG 31,2016
!moi us:
GUZMAN,EMILIO F
MIAMI FL 33171-2808
r
ISSUED: 07/2112014 DISPLAY AS REQUIRED BY LAW SEQ# L1407210000677
000308
'Local Business Tax Re+celpt
Miami-Dade County, State : 6f florlda`
THIS 10 NOTA 1KL - DO NO1"PAY
628942 LBT
BUSINESS NAMElI.00ATgM No. EXPIRES
V-wAt SEPTEMBER 30, 2015
Must be dia0 wed at place of business
MIAMI ft 33155 Pursuant to County Code
Chapter 8A-Art.9&10
OWNER SEC,TYPE OF ISUSINOSS PAYMEW RECEIVED
AIRTROI AIR COND CO INC 196 SPEC A+1CCHANCAL C dMCTOR eY TA,cr,,,CTO,
Worker(s) 14 CAC009761 $75.00 07130/2014
CHECK21-14-038732
T1ds isc� Tax � at toe� Tex.° � a
patmlt�t+ � �� 's `aich Nis ,
1'AeREC6Fi�.aieawMtM oAsN � Qd4�5ec8s-Z16.
Farm
own & Brown Miami Page: 042
AIRTR-1 OP ID: LD
ACOR, 08117/201155
lI�` CERTIFICATE OF LIABILITY INSURANCE D 0
�� 081171
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(ies)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
BROWN& BROWN OF FLORIDA INC NAME: Alfredo Andrial
14900 NW 79th Court Suite#200 acN o_EXt)305-364.7800 F�47ct,No 305-714-4401
Miami Lakes,FL 33016-5869 ADDRESS'
Alfredo Andrial - —
INSURER(S)-AFFORDING COVERAGE NAIC S
INSURaRA.Wesco Insurance Co. 1025011
INSURED Airtrol Air Conditioning INSURERS:Brie rfieIrl Insurance Com an 10993
Company Inc. — p y --
4853 S.W.75 Avenue INSURERC;FCCI Insurance Company 10178
Miami„FL 33155 [INSURER
ERD
ER E:
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.
T�._ _
._ .
IN5R. ----
AD-L U@R _...... -..... ._.. _
LTR TYPEOFINSURANCE WV0 POLICYNUMBER —POLICY EFF POP '�—
MM!ODiYYW MMIDDIYYIDDlYVYY LIMITS
B X COMMERCIAL GENERAL LL481LITY EACH OCCURP.ENGE. $ 1,000,00
OCCUR CPP000480911 05128/2015 0512812016 PREtiti ses(E e $ 100,000
_ CLAIMS-MADE f _ -....� ....-_
it Ilj WED EXP(Ary o.e pe scn) $ 5,00
[ ....... .....
...—_._...� y
PERSONAL&ADV INJURY S 1,000,00
j GENT AGGREGATE LIMIT APPLIES PER: E
JEGT I GENERAL AGGREGATE $_ 2,000,00
POLICY'--X El LOC
j PRODUCTS S 2,000,00
OTHER: (Emp Ben. $ 1,000,000
AUTOMOBILE LIABILITYkCOMBI'BINEN
D I LE LIMIT
denfl $ _ 1,000,000
A X ANY AUTO WPPI373423 0512812015 05/28/2016 BooILY INJURY(Per person) g
ALLOWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) $
X HIPED AUTOS X NON-OWNED OP[RTY CAMA.E £
AUTOS i (PBr Bcoden)
I UMBRELLA UAB
OCCUR, EACH OCCURREN
`
EXCESSUA6 CLAIMu-MADE ! ? ' AC [GATE q
DED!,R TEn1I10N s ( ._.. S _
WORKERS COMPENSATION _
AND EMPLOYERS'LIABILITY X :STATUTE _ER tI
C ANY PROPRIETORIPARTNERfEXECUTNE Y 1 N 001 WC15A66803 05/28/20151 05/2812016E.L.F.ACFI ACCIDENT $ 500,00
OFFICERIMEMBER EXCLUDED? �� NIA
'(Mandatory in NH) El DISEASE-EA EMPLOYEE S 500,00
If yes,desobe Under __.._ _
DESCRIPTION OF OPERATIONS below j E.L.DISEASE-POLICY LIUIT $ 500,00.
I
i
t
DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additi oral Remarks Schadul e,may be att.cned if more apace is requtredl
ref:1420 NE 103rd Street Miami Shores FL. Residential building-demolition
of Air Conditioning Work.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
MiamiShoresVillage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Building Dept.
10050 NE 2Nd Avenue
Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE
I -
1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
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