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MC-15-140 J 12 Inspection Worksheet Miami Shores Village / 10050 N.E. 2nd Avenue Miami Shores, FIL Phone: (305)795-2204 Fax: (305)756-8972 inspection Number: INSP-247175 Permit Number: MC-1-15-140 Inspection Date: November 04, 2015 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: STEAD, MARC GREGORY Work Classification: A/C Replacement Job Address: 93 NW 93 Street Miami Shores, FL 33150-2232 Phone Number Parcel Number 1131010340240 Project: <NONE> Contractor: JORDA MECHANICAL Phone: (305)262-0095 Building Department Comments RELOCATE AIR CONDITIONING Infraction Passed Comments INSPECTOR COMMENTS False V� Inspector Comments Passed 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 November 03, 2015 Pagel of 1 a drV * �+�� „�'T, Miami Shores Village 10050 N.E.2nd Avenue NW Miami Shores,FL 33138-0000 i ` Phone: (305)795-2204 Expiration: 09/08/2015 Project Address Parcel Number Applicant 93 NW 93 Street 1131010340240 MARC GREGORY STEAD Miami Shores, FL 33150-2232 Block: Lot: Owner Information Address Phone Cell MARC GREGORY STEAD 93 NW 93 Street MIAMI SHORES FL 33150- 93 NW 93 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 850.00 JORDA MECHANICAL (305)262-0095 Total Sq Feet: p Tons:4 Available Inspections: Additional Info:RELOCATE AIR CONDITIONING Inspection Type: Classification:Residential Final Approved: In Review Comments: Date Approved::In Review Date Denied: Type of Work: Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# MC-1-15-54213 DBPR Fee $2.25 03/12/2015 Credit Card $ 159.10 $0.00 DCA Fee $2.25 Education Surcharge $0.20 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 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 constructior�,and zoning. A uthermore,I authorize the above-named contractor to do the work stated. March 12, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 12,2015 1 Miami Shores Village --� �.ECEI�.rEI� Building Department JAN 15 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax: (305)756-8972 BY. INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 16 BUILDING Master Permit No. RE-- 15— )0 PERMIT APPLICATION Sub Permit No.mcl_ 1c;-r--] 6 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING 12/MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �(.t/ e13 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): btl dg c- �'J7:�9-r(7 Phone#: 73"& :::G c) Address: C1 -� 4,-Lv q 3 5'�4- City: �i Y 'L'jSr1 l �g (� State: Zip: 3,31's— Tenant/Lessee 31.S—Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: , (' r'0A l7lecliell- fit- Phone#: Address: S611 A) w' I y s7 City: , XA1 -�-- / State: Zip: 3 317,G Qualifier Name: lL9��'!'- (-/C✓,1,Si4s 1,4 Phone#: 6s- "`U-0005' State Certification or Re istration#: C./r+( ��i-a K�� g' r � Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ e �� ), C-�'J Square/Linear Footage of Work: Type of Work: ❑ Addition LEO/Alteration ❑ N New ❑ Repair/Replace Demolition Description of Work• p k(-A�c- �iT 6uai4wii,1 p � L y 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$ (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 soh posted notice, the inspection will not be approved and a reinspection fee will be charged. x f Signature `�-� c Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ": (''_`y 20 by day of nb�LIAM 20 'IS by 15� �Tk�-4�, ,who is personally known toC-yc�t� who is ersonally known o me or who has produced T(.: T t.Ar-r,— me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLI MIGUEL E HERNANDEZ 1 * * MY COMMISSION#FF 033114 EXPIRES:July 2,2017 Sign:.. Sign: �r��ieRr+ a QondedYWIludgetNotary Serviae Print: ,;.V Notary Public State of Florida Print: in ra Alvarez —r Seal: ? a ,� My Commission FF 156750 Seal: 0i r< Expires 09/03/2018 ************************************************************************************************************ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY x STATE OF FLORIDA DEPART IVIEN'T OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD M CMCQ08499 x - r" The MECHANICAL CONTRACTOR Named.below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date:; AUG 31,2016 GUISA80LA, JORGE (•'. JORDA MEGHANICALCWT ACTOR 8011"NW 14 STREET, MIAMI FL < 4 t 5 ISSUED: 08/21/2014 DISPLAY AS REQUIRED BY LAW SEa# L1408210001766 001036 .. Tecel arrii=l ady Cb' ty ;# t ' a F1c rid its is NOrA, L I NQTPT#TAY 1£6,,136 truva CA—REPO" zc R 1 CKMr04L ca RIMM, 118 1tit TEM E Fsarsuarzttrs,Coo cods Cfiapter10 OWNIE a sEC.T f!Pt_ tsi v JORDR EWERPRISES INC 196 GEtuEtiAOt_MEC3u1ANICAEss PAYMENT RECEIVED COIUTFtACTOR Utloticer sj' 7O GMC008499' BY TAX COLLECTOR $45.00 07/15/2014 CHECK21--i 4-01967 7 This tgc*;Busines$Taulieceipt oaCq cnAfirms payment of the t Deet Businoss Tax.The Racetpt is not a Ctsxoss, patrii ora oertrficatraonf the hatdat iratificatiaps,ro do husinass. Holder must aampCyvuttti any governntantaF arttotlgtrvammeuttrTregatory lawsrequiremanis which appiyta the husiaes , Ttie R€CEIPTCYO,above mast ix:rdispiayed on ati eammatiai vohicias ARami made Code Sao 8a-176, Far taote nfarmatian,aisitwv miamidade aavltaxcoCgtor 006675 -..- -......- ..._ ....--. ,' � MIN Pw � i€trd 5-9 ev,T"_ m hls t �U[SAWCDtA_if kQk f?E t�'r tuc► � ` t7t3f43 AL FEt6` #Rust ire dlsptayed rit piaci isf 6uatrttts6 d'ursuant tier G#tasty Cb�ie- Ctrapt.rBA—i art.S$ tC6 OWNeck - SEC.TYp�t?P BUSYNESS OCJtSAsOt}f JORGE PE 392 PRt? S510NAE PAYNlEtuT RECEi1�E#> PE0092743 BY TAX COLLECT6R x$60.00 X77/17/2014 CHECK21-74-023.037 Thi rstvtCgusiness>aecerptoaC�t.,ppfi�spatdantottheiocatBusinass7ax. c a ThaRecePpfisnot tiactsow, Pamitt precertific8tttitt fthehotdepsquatificaG9tis,todohusiness. Hoidorraust omplyyrtithany riia +rt oyarnmantaTringp�atary tau�s. tequiremeats whiGhappiy to the h�'ness::-", fheRECECPTftffl ahovamu t8at sptayedartaE (ruaperciaCvehiata, t1 i mi=flad196dsSee ga-276. FarnnoreinCormation,vistkwww„iamidade Ira�rro'ta,•;oX '4CURL7� CERTIFICATE O F LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/20/2015 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(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 CAMNTA T NE: Steowte pl lk nwn Brown& Brown of FL, Inc. -Fort Myers PHONEFAX 3820 Colonial Boulevard (ALC.No Ext):239-274-1430 _ __--1a/c No):239-278=3379 E-MAIL Suite 200 A4DREss:swilklnson tibftmyers.ccm - For,Myers FL 33912 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A NatiQnal_Tr Trust-Ins Cc_ _ 120141 INsuRI=D INSURERS FCCI Insurance Jorda Enterprises, Inc. INSURER C; ` DBA Jorda Mechanical Contractor INSURER D: 8011 NW 14th St. -- ----.-- - - -- Miami FL 33126 INSURER E: ]] INSURER F-.------- -- — - COVERAGES CERTIFICATE NUMBER:1160588159 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 ADDL'SUBR� POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/UD/YYYY MM/DUIYYYY LIMITS A GENERAL LIABILITY Y Y GL00096726 112/31/2014 12/31/2015 EACH OCCURRENCE $1,000,000 iX COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED ! PREMISES Ea occurrence $100,000 - �__ CLAIMS-MADE OCCUR MED EXP(Any one per __t$5,000 I Ed PERSONAL&ADV INJURY — $1,000,000 j ]N'LAGGREGATELIMITAPPLIESPER: ! GENERAL AGGREGATE _$2000,000 ! r ----... ---_ .. PRODUCTS COMP/OP AGG ! $2 000,000_ f PRO- --- --- `--_ - POLICY E T LOC I A AUTOMOBILE LIABILITY IY Y CA00150336 112/31/2014 2/31/2015 COME �Ea accidents $1 000,000 ! — X ANY AUTO BODILY INJURY(Per person) ! $ icyALL OWNED SCHEDULED - BODILY INJURY(Per accident/ $ A AAUTOS UTOS ! . HIRED AUTOS NON-OWNED Ali ! PROPERTY DAMAGE TS _ AUTOS I(Per accidentZ_ A �X UMBRELLA LIAB X OCCUR Y Y UMB00099906 12/31/2014 112/31/2015 EACH OCCURRENCE $5,000,000 AB EXCESS LI ------ ---�- — CLAIMS-MADE AGGREGATE - $5,000,000 DED X RETENTION$10,000 $ B WORKERS COMPENSATION Y 001-WC14A-71535 12/31/2014 2/31/2015 IX WC STATU OTH-I AND EMPLOYERS'LIABILITY .�/N TORY LIMITS��,__ ER .. ._. .. OFFICER/MEMBER EXCLUDED? N N/A l E L EACH ACCIDENT $500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE (Mandatory in NH) E L DISEASE EA EMPLOYEE] $500,000 If yes,describe under j --" --- - __--- ----- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 SII I I i II DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 30 days notice of cancellation except 10 days notice for non-payment Contractor's License#CMC008499 I ! I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Building&Zoning ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores FL 33138-2304 AUTHORIZED REPRESENTATIVE It ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD