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RC-15-4 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-247115 Permit Number: RC-1-15-4 Scheduled Inspection Date: November 03,2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Building Owner: HADDAD, DILCIA Work Classification: Alteration Job Address: 12 NE 111 Street Miami Shores, FL 33161-7047 Phone Number (786)399-6979 Parcel Number 1121360040020 Project: <NONE> Contractor: ND FLOORING, CORP Phone: (305)877-1969 Building Department Comments RENOVATION IN 2 BATHROOMS & KITCHEN INSTALL Infractio Passed Comments NEW FLOORS & DRYWALL, UPDATE ALL GFI'S AND INSPECTOR COMMENTS False PLUMBING WORK 41 Inspector Comments Passed 4S/ Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 02,2015 For Inspections please call: (305)762-4949 Page 42 of 50 Inspection Worksheet ` Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-237771 Permit Number: RC-1-15-4 Scheduled Inspection Date: November 03,2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Insulation Owner: HADDAD, DILCIA Work Classification: Alteration Job Address: 12 NE 111 Street Miami Shores, FL 33161-7047 Phone Number (786)399-6979 Parcel Number 1121360040020 Project: <NONE> Contractor: ND FLOORING, CORP Phone: (305)877-1969 Building Department Comments RENOVATION IN 2 BATHROOMS & KITCHEN INSTALL Infractio Passed Comments NEW FLOORS & DRYWALL, UPDATE ALL GFI'S AND INSPECTOR COMMENTS False PLUMBING WORK Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-232193. CREATED AS REINSPECTION FOR INSP-231713. CREATED AS REINSPECTION FOR INSP-225936. Walls only Failed ❑ Provide certificate for blown in insulation Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 02,2015 For Inspections please call: (305)762-4949 Page 7 of 50 HIAMADS C� SUBMITED TO THE BUILDING&ZONING DEPARTMENT ON Date BY: RIMBAL INSULATION METROPOLITAN DADE COUNTY, FLORIDA BUILDING AND ZONING DEPARTMENT BUILDING PERMIT# JOB ADDRESS: STATEMENT OF COMPLIANCE: We undersigned,hereby certify that the thermal insulation has been installed in the above referenced building in compliance with State of Florida Model Energy Code,the approved plans and specifications,and in accordance with good construction practice,The insulation furnished and installed is of type indicated below: MASONRY WALL INSULATION: PARTITION OR FRAME WALL INS.: MFGR• cc 1/0 12 X MATERIAL: C� �� 42 X THICNESS: DENSITY: R-VALUE: #BAGS/100 SQ FT: .3 ROOF/CEILING INSULATION: ] INSULATION(OTHER) MFGR 14©1,"1 'M A\A MATERIAL: 4 E THICKNESS• q f/Z im a nau afioa DENSITY: QU 1 g & n R-VALUE: /2. 30 .33054' #BAGS/100 SQ FT: INSTALLED BY: RIMBAL INSULATION 152566 7 LICENSED C RACT R INSULATION CONTRACTOR CC#: 16686 CERTIFIED BUILDER: COMPANY NAME LICENSED CONTRACTOR SIGNATURE BUILDING CONTRACTOR CC. CERTIFIED ON: DATE Le� Miami Shores Village V Building Department JAN 65 2014 Q� g p 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 _ 2- INSPECTION INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 �® BUILDING Master Permit No. � PERMIT APPLICATION Sub Permit No. -ViBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 12,k 1E L i I S+ 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): , CA 0, a 8- Phone#: -3-81410 q tolei Address: U U E Ill Isf- City: til.IdL4I kcae_C State: ( Zip: 33 r (0 1 Tenant/Lessee Name: Phone#: Email: ..� q /� [� '1 C� CONTRACTOR:Company Name: P `�• I vim+ � G-01 Phone#: 3C 5 ®� 7 -r l Address: /9 3-7-0 Co/l4-�s 4 y e City: &0.vm! -,/eS gWA State: ��®��� zip: Qualifier Name: 1u G -+a�dA-JSP Phone#: State Certification or Registration#: 0 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 ❑ Repair/Replace ❑ Demolition n Description of Work: ?('1444 �k LIL Tt�we-c:7 Specify color of color thru tile: 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$ 11 1 1 -I 15101 (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. Q&a �Sigflature- Signature OWNER or AGENT ONTRACTOR The foregoing instrument was acknowledged before me this The foregoinvistrument was acknowledged before me this day of fAQQ99�4,r 20 1 `� by �day oof,D20 by who is personally known to , )�� I P r 1—���`�r who ispersonally known to 0 me or who has produced as me or who has produced`F � 69l G�r as identification and who did take an oath. identification and who did take an oath. NOTARY PUB C: =00y"P*, Notary Public State of Florida NOTARY PUBLIC: Javier Fajardo My Commission EE134673 o►R° Expires 09/291,2015 Sign: Sign: Print U( �� "' nt: Seal: Seal: s®gyp pyp, Notary Public State of Florida Joanna M Feliciano My Commission FF 082753 INC,ofrM1o� Expires 01/12/2018 J APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 5goe>l�s� ..i. Miami shores Village Building Department fi RiDp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption 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. 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.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore,you may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contractor Print Name: �'1 `� �I a r Print Name: V �a Signature: - Signature: ' T o ° Vb" iuo3 N 1 N � cP°11 Notary Public State of Florida o 3 g State of Flori ): Javier Fajardo State of Flo 'da o My Commission EE13467 3 N Countyof Mi i n I Expires 09/29/2015 County of Miami-Dade) m�'a Sworn to andSworn to and subscribed before me this CP day of of vu A @ 20 15 day of ��� 20 W Q By (SEAL) (SEAL) Type of Id6tticati4n produc T Identification roduced !k \ Z 3 �c F fi •. � ^ �. 'a � fit. t} r r� 33 k ry IMF al on Won lot 1 1. Do E � 2L t ;i IBM, a .... .... z r K c � SK R, N gkI Al fig me APO in R h E•., fir,. '1' �S a � / j � � A -. �.. a �� ,£�` IP;.. •' � �k ➢ '. ���a,: ai$4�^ � p �; E s PCE baa UJ K \� i Ey E��„it viii"'„I'E�111 FSI ��� ��: �,a►q .so "o- lAlak L,I-tY tosQ(2AN(%.T-- �L L,A,SA UT`s NsvRANC'E ♦SgO I L �•� p...� Miami Shores Village L-� Building Department LQRIDg► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT#: I S DATE: J Q`v` I, l CIL' � ��C o Contractor (NAME) Owner ❑Architect Picked up 2 sets of plans and (other) Cn;, Address: l2- NY-& t k S+6?-k(2� .NUC From the building department on this date in order to have corrections done to plans And/or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: (Signature) PERMIT CLERK INITIAL: DA RESUBMITTED DATE: PERMIT CLERK INITIAL ♦S��RFS G eggs Miami shores Village Building Department lOR[D� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT* PC I DATE: J(7 0 ❑Contractor (NAME) 7r Owner ❑Architect Picked up 2 sets of plans and (other) Address: 12 N U 11 I t"" �fizc-- From the building department on this date in order to have corrections done to plans And/or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. � 0.'u"'` ' Acknowledged by: 11-1 (Signature) PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: gBon>E� Miami shores Village � ,xG Building Department logo nail� 10050 N.E.2nd Avenue ¢ ,: Miami Shores,Florida 33138 r Tel: (305)795.2204 A R Fax: (305)756.8972 Permit No: f C 15- � Page 1 of 1 Structural Critique Sheet 1 0 3 fie. pro . ' ,rL423 Ls Q . �, "-,.A +- AL;s l� STOPPED REVIEW Plan review is not complete,when all items above are corrected,we will do a complete plan review. If any sheets are voided,remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re-submittal drawings. Mehdi Asraf 1 N.D. Flooring corp. -gig Scope of Work: ' Dilcia Hadad 12 Ne 111 St. Miami Shores, FL 33161 All - Install durrock over existing wood floor - Install new porcelain tiles on all floors - Install new drywall in walls and ceiling in living room, dining room, bath rooms, kitchen and closets - Plaster walls and ceilings to a smooth finish - Install new baseboard - Paint all interior walls and ceilings Bathrooms - Install new vanity - Install new toilet - Install new shower pan and shower valve - Install tile in shower walls Kitchen - Install new cabinets - Install new counter tops - Install new sick and faucet Electrical - Install new GFI outlets - Installed new light fixtures - Installed new smoke detectors - Installed new TR outlets A/C - Install new a/c machine - Install new termmostat Plumbing - Install new shower pans - Install new sinks and faucets - Install new toilets - Install new kitchen sink and dishwasher 1 lie U, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-231385 Permit Number: MC-1-15-14 Scheduled Inspection Date: April 01, 2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: HADDAD, DILCIA Work Classification: A/C Replacement Job Address:12 NE 111 Street Miami Shores, FL 33161-7047 Phone Number (786)399-6979 Parcel Number 1121360040020 Project: <NONE> Contractor: FREEZING MECHANICAL CORP Phone: (305)630-4777 Building Department Comments EXACT CHANGE OUT 5 TON UNIT Infractio Passed Comments INSPECTOR COMMENTS F qse G Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-226000. missing exhaust fan in bathroom, revise plans for replacement duct flex Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. March 31,2015 For Inspections please call: (305)762-4949 Page 33 of 36 x 77 Miami Shores Village r ITYTA 'i�eChlani 10050 N.E.2nd Avenue NEWor3cl5slc�n. Miami Shores,FL 33138-0000', , potmil SUNS:A"R" x; h � Phone: (305)795-2204 aK 3!'13!215 Expiration: 09109/2015 Project Address Parcel Number Applicant 12 NE 111 Street 1121360040020 DILCIA HADDAD Miami Shores, FL 33161-7047 Block: Lot: Owner Information Address Phone Cell DILCIA HADDAD 12 NE 111 Street (786)399-6979 MIAMI SHORES FL 33161- 12 NE 111 Street MIAMI SHORES FL 33161- Contractor(s) Phone Cell Phone Valuation: $ 4,528.00 FREEZING MECHANICAL CORP (305)630-4777 Total Sq Feet: 00 Tons:5 Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Approved:In Review Comments: Date Approved::In Review Date Denied: Type of Work:EXACT CHANGE OUT 5 TON UNIT Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 Invoice# MC-1-15-54067 DBPR Fee $2.38 03/13/2015 Credit Card $ 180.24 $0.00 DCA Fee $2.38 Education Surcharge $1.00 Permit Fee $158.48 Scanning Fee $9.00 Technology Fee $4.00 Total: $180.24 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 AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructionn zo ing. Futhe re,I authorize the abpe-named contractor to do the work stated. 1� „(tel March 13,2015 Aut orized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 13,2015 1 2015-03-09 15:28 mayra solis 123 >> 1 800 685 7530 P 1/1 111.�aDATE(MMffiDIYYYY CERTIFICATE OF LIABILITY INSURANCE 3/9/2015 ' 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 CNTNOS C Margy 8uniga Gil, Garden, Avetrani Insurance Group 2938 PHONE (305)630-4777 PAC 430532'19-3022 10689 N. Kendall Drive E-MAIL ,mzunigaliggaig.aom .Suite 208 1 NSURERjaj AFFORDING COVERAGE NAIC9 Miami FL 33176 INSURERAN819CO Insurance Cozopany 02468 INSURED INsuRERe:Retail First Insurance Company 10017 Freezing Mechanical Corp 11646 INSURERC: 5064 NW 74th Ave INSURERD: INSURER E: Mlaml FL 33166 INSURER P: COVERAGES CERTIFICATE NUM8ER:CL152306311 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 V%HICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSLTR TYPE OF INSURANCE ADDLE BR POLICY NUMBER POLICYEPP POLICYEXP MIDDIMwD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,00c,000 X COMMERCIAL GENERAL LIABILITY DAMAGE 10 WN-T—EU PREMISES Ea aocurrence $ 100,000 A CLAIMS-MADE a OCCUR P1137656 O1 1/18/2015 1/18/2016 MED EXP(Ary one arson) S 20,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPA00 $ 2,000,000 T POLICY 71 PRO ECj LOC $ AUTOMOBILE LIABILITY E aocltlem I 2,000,000 A X ANY AUTO BODILY INJURY(Per perecn) S ALL OWNEDSCHEDULED P1137658 01 1/18/2015 1/16/2016 AUTOS AUTOS BODILY INJURY(Per aocOwl] $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Peraccidenl $ UMBRELLA LIA9PIP-Baalu $ 10 000 OCCUR EACH OCCURRENCE $ EXCESS LIA9 CLAIMS-MADE AGGREGATE $ DED RETENTION S B WORKERS COMPENSATION WC STATUOTH- ANDEMPLOYERS'LIABILITY -, ANY PROPRIETORIPARTNERIEXECUTIVE FIR YIN E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? ❑ NIA (MsndatoryInNHJ 20-47735 /12/2014 /12/2015 ee, If E.L.DISEASE-EA EMPLOYE $ 500,000 ytleacrlbe untler DESCRIPTION OF OPERATIONS be E.L.DISEASE-POLICY LIMITT$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (A11acl,ACORD 101,Addrlonal Remarks senedula,If more apace Is required) CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSIIRED LICENSE 0 : CMC1249923 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Bldg Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami, Fl 33138 AUTHORIZED REPRESENTATIVE Ernesto Sariol/MARGY ACORD 25(201 W05) C 1988-2010 ACORD CORPORATION. All rights reserved. INS026(z01alao5).o1 The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department I JAN 0 2614 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 20 Q� BUILDING Master Permit No. % S PERMIT APPLICATION Sub Permit No. 5 - 197, BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL ❑PLUMBING X MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: %1 2 �E / /h� I City: Miami Shores County: Miami Dade Zip: 33/ Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: /- FFE: OWNER:Name(Fee Simple Titlehol r): / ��z /7- d� � Phone#: �5� jam/��(✓9 Iq Address: 12 //P_ /W r City: 14 -State: Zip: 33I Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: ,cf Q �@�ic��� 0-W12 Phone#:-3es Address: !N +° City: State: Zip: 3-3® Qualifier Name: /�Ci �C/w L Phone#:39.✓2•7,g State Certification or Registration#:52WC'/2 Y"/ G Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Val -Wor s r � Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ,� ❑ New W Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ Permit Fee$ - � SbE illCCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ rr`` TOTAL FEE NOW DUE$ 9V . (Revised02/24/2014) 4 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 s en (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ap ved and a r spection fee will be charged. Signature Signature ER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day1 ,of ��c� �°►'b(' 20 ' -I4 .by d� day of D 4t c e t, �� 20 by 14--d who is personally known to 1 C•��/ ;n%I e. , who is personally known to me or who has produced as me or who has produced as identification an ho d' take an oath. identification and who did take an oath. NOTARY PUBL NOTARY PUBLIC: ao�ppr v`e4� Notary Pubiic state of Florida Javier Fajardo Vg off ExpMy es 09Commission9 20151346.,-3 Sign: o n ign: MANE MA 04r.4 Print: Q \ Q'r rPrint: Wa Seal: Seal: °•+ Carbo 0 FF 1101768 Also. APPROVED BY CA Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 15t►OR93FS�� Miami Shores Village Building Department p... nmm 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Rw 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 2 1 & I ' ' �I►`� City: Miami Shores Village County: Miami Dade Zip Code:V V0 I 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 O NO❑ ARHI Sheet Attached:YES NO ❑ Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT C MANUFACTURER AHU or PKG.UNIT MODEL# Q COND.UNIT MODEL# KW HEAT l® �Ly NOM TONS H 'C-Uj PKG 1)M.C.A HU C PKG el�HJQ PKG 2)M.O.P U U PKG H CU PKG 3)VOLTS U CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES N YES NO REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLABE NO YES NO NEW ROOF STAND YES O 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: Contractor's Company Name: ,.��/ Phone: , State Certificate or Registration J c.._//77etc Z V Certificate of Competency No. Signature Date: (Qualifier's sign re) (Rev1sed02/24/2014) This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service ® between Feb 17,2009 and Dec 31,2013. Certificate of Product Ratings AHRI Certified Reference Number: 3632308 Date: 4/1/2013 Product: Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number:24ABC660A**30 Indoor Unit Model Number: FX4DN(B,F)061 Manufacturer: CARRIER AIR CONDITIONING Trade/Brand name: COMFORT 16 PURON AC Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent,third party testing: Cooling Capacity(Btuh): 55500 EER Rating (Cooling): 13.50 SEER Rating(Cooling): 16.00 Ratings followed by an asterisk(*)Indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(q)gated on the Certificate and makes no worts,warranties or guarantees as to,and assumes no responsibmty for, the product(s)fisted on this Certificate.AHRI expressly disclaims all Robglty for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations Rated hi the directory at www.ahndirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRL This Certificate shall only be used for Individual,personal and confidential reference purposes. The contents of this Certificate may not in whole or In part,be reproduced;copied;dlsseminated;ordered into a computer database;or otherwise utilized,In any forth or manner or by any means,except for the usees Individual,personal and confidential reference. CERTIFICATE VERIFICATION The Information for the model cited on this certificate can be verified at www.ahridirectory.org, Air-Conditioning,Heating, dick on"Verify Certiflcate"link and order the AHRI Certified Reference Number and the date on ® ® and Refrigeration Institute which the certificate was ,which is listed above,and the Certificate No,which Is listed below. 02013 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 130092952368292983 j Best Quality.Bert Service Kesidential Proposal ECI1,41WCALInvoice Conditioning •Refrigeration 520 WEST 53 TERR4CE HIALE4H FLORIDA 33012 Date: f PHONE:305-299-3737—FAX.•305-231-4818 Proposal# � E-1114IL:FREEZINGAIECH.4R'IC.4LCa)GAI4ILCOAI License:CMC-1249923 Bill to: ^ , r� Service Location: Address: B�. - �` - �- F - Address: r Telephone: ,,r - .% - `i Telephone: E-Mail: - - '�a �� •-`:a f` F �o;� � �. Payment Terms Salesperson %Down Pa�mlent, %When the job get done - Visa MC AE Disc CC# Exp Date: Verf Code:," Description DEMOLITION&DISPOSE MATERIAL,DUCT,PIPE&FITTING Demo.Existing Package Unit Reconect to Existing Piping New Set Cooper Lines 7 Demo.Existing Condensing Unit ` Flush R-22 Cooper Lines "' Flush PVC Dranage Lines Demo.Existing Air Handling Unit : ' Reconect to Existing Plenum Reconect to Existing Electrical Demo.Other EQUIPMENT INSTALL&START-UP Pkg.Unit Model -' Float S,.Aitch `` Vibration Pads SEER: TONS: BRAND: UV Light Tie Downs Condenser Model# �"r �� �" 3 ,'''" ` a �� � - Condenser Slab Condensate Pump SEER: ;f 4-1 TONS: BRAND:' ` Condenser Stand Air Handler Model# Air Handler Stand —,.Heater Model» =- _ c =�� i Gold Frame 10 Years Warranty Filter Digital Thermostat %• =� 4fi':%rte t ;'m;Y�%-14 fZt Duct Cleaning Others: ��- ' �/fie �� �e� �,±�..9�".,Q�ss''�'�'?� 6'-''4�_ >'G`'�.- ts�`t'!<'..'_��`r `�,_', .7,�£� ��9�`-'s �': "�-� C�r�,!� v � •�i Warranty(Compressor,and Parts by Manufacturer,Labor by F.M) Proposal Price r- Years Compressor, `` Years All Parts, Year Labor Job Total Price: $ Extended Wty: $ -- City Permit Fees is❑IncludedNOT Icluded in The Price,If F.M pulls city Grand Total: $ --" permit customer to pay permits fees plus$ to freezing mechanical for the senices FPL Rebate: $ I have authority to order the work as outlined above.It is agreed that the seller will retain title to any equipment or material that may be furnished until final payment is made.In case the total charges are collected by suit or upon demand Manuf Rebate: $ of an attorney,the purchaser hereby agrees to pay attorney's fees and court cost for the making of such collection.I Costumer Paid: $ hereby accet the above service and conditions or sale on reverse side as being satisfactory.Homeowner must register the Gov Tax Credit: $ --— new equipment within(60)days as indicated on the RXI invoice,Homeowner contact KM representative with questions concerning online registratlon.The above Warranty is valid only with the equipment manufacture registration. Final Price: $ Costumer Name: -- Do«m Payment: $ Amount Due: $ Costumer Signature: ` ' ' Date: WWW.FREEZINGMECHANICAL.COM -- PHONE:305-299-3737-- FAX'305-231-4818 SNORES G, S �t u••� Miami shores Village LIvrav so,, eye n(� Building Department RIDp' 1 �`" ��� 10050 N.E.2nd Avenue N-e�-G �� Miami Shores, Florida 33138 ( I 1 1 0 1 p Tel: (305) 795.2204 �ervl �'l w : (305)756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. v COPY OF QUALIFIER'S STATE LICENCES B. V COPY OF LOCAL BUSINESS TAX RECEIPT C. 0� COPY OF LIABILITY INSURANCE* D. ✓ COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. BU INESS NAM E: l Ik e t CU CP r SLa* Za&& BUSINESS ADDRESS: k d t08 Q N kerma I/Nciii M I Q m STATE ZIP .33 CO BUSINESS PHONE: 63b-4777 FAX NUMBER(305 ) 2 — 3022 CELL PHONE( ) QUALIFIER'S NAME:F(-CEZI 1A MEc HA NICALCO(e-P QUALIFIERS LII,NUMBER: C M C- STATE OF FLORIDA r '4" DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 r FINALET,VICTOR HUGO FREEZING MECHANICAL CORP 520 W 53 TERR HIALEAH FL 33012 I, Congratulations! With this license you become one of the nearly - -- one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range . STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, 7 DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL:REGULATION Every day we work to improve the way we do business in order to CMC1249923.p ISSUED: 06/18/2014 serve you better. For information about our services,please log onto vvww.myfloridalicense.com. There you can find more Information CERTIFIED MECHANICAL CONTRACTOR about our divisions and the regulations that impact you,subscribe FINALET,VICTQR HUGO to department newsletters and learn more about the Department's FREEZING MECHANICAL CORP initiatives. r Our mission at the Department is:License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the-provisions of Ch.489 FS. and congratulations on your new license! Exphatlon date:Auc at 2 16 u406i8 1422 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CMC1249923 The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 FINALET,VICTOR HUGO FREEZING MECHANICAL CORP 520 W 53 TERR .. . . .. .., HIALEAH FL 33012 y ISSUED: 06/18/2014 DISPLAY AS REQUIRED BY LAW SEG# L1406180001422 305906 Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOTA BILL — DO NOT PAY LBT 6338347 BUSINESS N"E/LOCATION RECEIPT NO. EXPIRES FREEZING MECHANICAL CORP RENEWAL 520 W 53 TER ' 6605415 SEPTEMBER 30, 2015 HIALEAH FL 33012 Must be displayed at place of business Pursuant to County Code t Chapter aA—Art.9&10 OWNER SEC.TYPE OF BUSINESS FREEZING MECHANICAL CORP 196 GENERAL MECHANICAL CONTRACTOCAYMENT RECEIVED Workers) 1 CMC1249923 Y TAX COLLECTOR $45.00 08/07/2014 CHECK21-14-045139 This Local Business Taft Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, Permit,or a certification ofthe holder's qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0,above must be displayed on all commercial vehicles—Miami—Dade Code Sec ma-276. For more information,visit MaMmiernidade aavRoxcollector Freezing Mechanical Corp 305-231-4818 p.1 f CERTIFICATE OF LIABILITY INSURANCE DATE[#IMIDDlYYYY) 1/5/2015 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 tNSURER(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 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 Garden, Eapoada-Saadino Gj-lr Avetra1:13. Insurance Grp COMEAC Yem PHONE _ (305)630-4777 FAX 10689 N. Kendall Drive E-bU41L o:(3051279-3022 Suite 208 INSURE S AFFORD94GcoVERAGE NAIC0 Miami FL 33176 INSURERA W@SCO Insurance Company 0050 INSURED 1NsuRERa;RetailFirst Insurance Comapany 10700 Freezing Mechanical Corp INSURER C 520 West: 53rd Terrace INSURER D: INSURER I-: Hialeah FT, 33012 INSURER F COVERAGES CERTIFICATE NUMBER:CL1412204868 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 SR TYPE OF INSURANCE POU N E PwD EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,D00 X COMMERCIAL GENERAL UAB:LITY ° NTEDn s 50,000A A CLAIMS MADE OCCUR P1137656 00 /18/2014 1/18J2015 MED EXP(Any ore Bison) S 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN:POLICY ATELIMITAPPLIESPEIL PRODUCTS-COM PIOPAGG $ 2,000,000 X POLICY RO- LOC E X70Mp�LE LIABILITY EeM�6rIN� SINGL LIMIT 11000,000 A ANY AUTO BODILY INJURY(Perpersan) $ ALL ED AUTOst,LED 1137658 OG /18/2014 /18/2015 BCDILY INJURY(Par accident) $ HIRED AU-OS AUTOSNON-OWNED omp Deductible $500 AUTOS PROPERTY AMA E $ ]L Comp X Coil Coll Deductible $500 Per IGent UMBRELLA Lf,4B OCCUR PIP-Basic- S 10,000 EACH OCCURRENCE $ EXCESS UAB EACH AGGREGATE $ DED RETENTIONS I $ $ WORKERS COMPENSATION VTATO- OTH AND EMPLOYERS'LIABILITYAVY PROPRIETORIPARTNERMXECUTIVE YIN OFFICEWME-ABER EXCLUDED7 NIA E.L.EACH ACCIDENT $ 500 000 INlandatoryhl NH) 6184300SZ I /12/2014 /12/2015 or. under E.L DISEASE-EA EMPLOYEE S 500 000 If descr!'Ge . DESCRIP7ICN OF OPERATIONS below E.L.DISEASE-POUCY LIMIT S 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 901,Additional Remarks Schedule,If Apra spnca is requMettl A/C Exact change out CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miammi Shores Village Bldg Dept ACCORDANCE VWTH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores, Fl 33138 AUTHORIZEDREPRESENTATIVE ACORD 25(2010/05) 09988-2010 ACORD CORPORATION. All rights reserved. INSII2SMMrat5lAt Th-Af`J1{7Il n.r and Inns nne►v+nic4aral mar4c of Cr`f1RI]