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MC-13-392 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 inspection Number: INSP-218936 Permit Number: MC-2-13-392 Inspection Date: September 03,2014 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: HOLT,JAMES Work Classification: Addition/Alteration Job Address:361 NE 97 Street Miami Shores, FL 33138-0000 Phone Number Parcel Number 1132060135760 Project: <NONE> Contractor: RESULTS AIR CONDITIONING CO Phone: 305-886-2534 Building Department Comments MECHANICAL WORK FOR INTERIOR REMODEL AND Infractio Passed Comments ADDITION INSPECTOR COMMENTS False Inspector Comments Passed drain pan ok Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 September 03,2014 Page 1 of 1 Miami Shores Village Building Department 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 201 BUILDING Permit No. 02C, �3 3�_& PERMIT APPLICATION Master Permit No.RC 13-391 Permit Type: MECHANICAL JOB ADDRESS: 361 NE 97th Street City: Miami Shores County: Miami Dade zip: 33138 Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): Jim Holt Phone#:828-781-0563 Address:361 NE 97th Street City. Miami Shores State: FL Zip: 33138 Tenant/L.essee Name: Phone#: Email: CONTRACTOR:Company Name: Results Air Conditioning Co. Phone#: (305) 885-2634 Address: 7451 NW 72nd Ave City: MedleyState: FL Zip: 33166 Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: (305) 785-7983 Email Address: resultsairco@belisouth.net DESIGNER:Architect/Engineer: Ruben Travieso Phone#: 786-250-7522 Value of Work for this Permit:$8=800.00 Square/Linear Footage of Work: 4,300 Type of Work: ✓0 Addition DAlteration ❑New ORepair/Replace ❑Demolition Description of work: New pipes, additional bedroom, relocate pipe in existing bathroom. Addition roof terrace over new veranda. Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 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 ELECTRICAL WORK,PLUMBING, SIGNS. WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 u building permit with an estimated value e_rceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to tlhe person whose property is subject to attacluneni. Also. a certified copy of the recorded notice of commencement must be posted at the job site for the,first inspection whic curs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be appro a wh a r inspection fiee will be charged. Signature Signature Agent—\' Contractor The foregoing Inst,- mens was ac ledged f fw me this-ter The foregoing instrument was acknowledged before me this A" l day of f ,20 ,by �%1 a/���� day of eS ,20 13,by r ��f t /I who is personally known to the or who has producedwho is personally known to me or who has produced w� GLIINt f°t fi denthi¢ th6h. — aidentd � ZSZ 4IGUEOZhp o s a ,r. l�t#teE205347 �'A�tY �_ ratood�#NolSSlwwoo�w -. .€ NOTARY PUBLIC: �/Ci0MM1SS :o. a; T . OI331 JJO» M3avN '.'aid; ° EXPIRES July 08,=6 Sign: _ 1 Sign: �" Print: ° �� ! �� �'-� Print: di 4d Al a�f Oe?, Myrommission Expires: My Commission Expires: 6�1444t 4a �s��r>r>$���� APPROVED BY / Plans Examiner Zoning Structural Review Clerk Revised 3/12/2012 q Revised O71tOA)7NRevised 06110/2009ttRevised 3113140, OP ID:SYCR CERTIFICATE OF LIABILITY INSURANCE F DATE(RgMI08/155/13113YY) 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 All Safe Insurances 305 262-5244 Jorge Pena 7171 Coral Way 08� ; 786-388 7244 :305262-5244 No):786 88-7244 Miami, Pena PIAM CPIA ADDRESS.certificates@_)asiflorida.net PRODUDER Ds RESUL-1 INSURER(S)AFFORDING COVERAGE MAIC# INSURED RESULTS AIR CONDITIONING i INSURER A:WESTERN WORLD 13196 COMPANY INSURER B:Brid efield Employers Ins. 10701 7451 NW 72 AVEC ; MIAMI,FL 33166 INSURER C: INSURER D: INSURER E: I 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. ILTSRR TYPE OF INSURANCE DIKvJPOLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY NPP8030190 10/x/12 10/28/13 PREMISEs occurrence $ 100,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,= X BI/PDED DED$500 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY Ll PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONWC STATU PER EMPLOYERS'LIABILITY TORY LIMITS X ER B ANY PROPRIETORIPARTNERtEXECUTIVE Y/" 30,35672 01/26/13 01/26/14 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? El NIA (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 DAC SCSI TROT RS l NS I LOCATIONS I VEHICLES(Attach ACORD 101, ddidonal Remarks Schedule,If more space is required) I I I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMEN11 i ACCORDANCE WITH THE POLICY PROVISIONS. 10060 NE 2 AVEI MIAMI SHORES,FL 33138 AUTHOR®REPRESENTATIVE ©19882009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/(19) The ACORD name and logo are registered marks of ACORD 000875 Local Business Tax Receipt Miami-Dade County,State of Florida THlS IS NOT A BILL—DO NOT PAY FL 323923 BUSINESS NAME/LOCATION RECEWT NO. EXPIRES RESULTS AIR CONDITIONING CO WAEWa- SEPTEMBER 30, 2014 7461 NW 72 AVE .323M Must be displayed at Place of business MEDLEY R 33166 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS PAVW1 NJe $'L','r'J NTRACTOR sY ' RESULTS AIR CONDITIONING CO 196 SPEC MECHANICAL COTe CAC057653 Worker(s) 10 S43.CC ';/�,�13 iXI S; -0?.363 Tbis Luca!Busing Tax BMW only tmntirms paymeat of*a local Business Tex The flee ipt permd w a certdleatiaa of tee Imider's quaNficetian%to do business.Noldar m�eaamly vaith :;^_ *r`aantal or nmlgureromeaml raBalatory laces aad tegairemems which apply to the business. _ The RECEIPT NO.above must be displayed on all comm inial aefucles Fur more Intarmation,visit www: STATE OF FLORIDA DEPAR774KNT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 T9i OAHASSSTHEE P�SONROS STREET AFL 32399-0783 CORBERA, JOSE ALEX RESULTS AIR CONDITIONING COMPANY 774451 NW 72ND AVENUEMIAMI FL 33166 sticrE ox�taneoa AC# 6,2 7 I,6 tioi. Congratulans! With this license you become one of the nearly one million DSP OIC`$USI lsSS :ANII R7NENT ' Floridians Rinsed by the Department of Business and Professional Regulation. p Mr�GULATION Our professionals and businesses range from architects to yacht brokers,from �r boxers to barbeque restaurants,and they keep Florida's economy strong. CAC057653•. V_' �2 110434078 Every day we work to improve the way we do business in order to serve you betterr For information about our services,please log onto www.mytloridaUmertse cora. ( . ...CERT -F.IET _ h There you can find more information about our divisions and the regulations that ! CO88ERA,: impact you,subscribe to department newsletters and learn more about the 1 :: RESOLTS DING COMPAAiY Department's initiatives. 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,and congratulations on your new license! Mkim ' tna p:oviaili e" 1>iI4 9 ra _ 3ly `aor-n : znesosz4 -- DFTQ(;[I HERE — - --------- THIS DOCUfAENT HAS A COLORED BACKGROUND-MICROPRiNIING-LIN EMARK-PATENTE D PAPER A-r# 62-746-11 ------- Ar62:746-11 a, STATE OF_FLORIDA'. DSP iRT (9F S P.. MSIONAL`REGULATION DNSTBIzDRY L�CENs NG 8 SE( _Li2081601424 LICENSE 7 7i T1Ye CLASS :BR �CONDIT" ONNG tT1C Aiamed-:� I- r F 3. 'CE tTIFI J:'' e s rt7zzder the 'provisioama of "Chapt _.. Expiration date: AUG 31,. 2014♦° i r, s .- RESULT0 AIR -COi iITIQNWG COD 11240 SW 29 STREET -` MIAMI iZILK--`SCOTT 1= LAWSON t�0'VE`RNOR SECRETARY 171.S0t AY At,RF61 IIRFf1 RY I AW