MC-14-894 I� P�- C /Q - Ll
F
Inspection Worksheet
Miami Shores Village y
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-239564 Permit Number: MC-5-14-894
Scheduled Inspection Date: July 22, 2015 Permit Type: Mechanical - Residential
Inspector: Perez,JanPierre
Inspection Type: Final
Owner: RODRIGUEZ, ROGER Work Classification: Addition/Alteration
Job Address:9425 NW 2 Court
Miami Shores, FL Phone Number
Parcel Number 1131010150340
Project: <NONE>
Contractor: JA REPAIR SERVICE INC Phone: (786)229-3352
Building Department Comments
EXHAUST FAN ON NORTH BATHROOM Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed W2 CREATED AS REINSPECTION FOR INSP-239381. CREATED AS
REINSPECTION FOR INSP-211742. missing rough inspection, need to vent
exhaust to the outside, need permit for a/c change out
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
July 21,2015 For Inspections please call: (305)762-4949 Page 32 of 34
Miami Shores Village - , -7�
Building Department [ ,AY A 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972 - -----
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 0
BUILDING Permit No.k G 14- qzto
PERMIT APPLICATION Master Permit No.'�c_1 Lt-- 'i�o
Permit Type: MECHANICALf
JOB ADDRESS: `-t' D'd PLO
" L
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): / `r'POMC- 3W 04 Phone#:�
Address L-060 1
City: 4V(Ar(0-W L_ State: (Al
Tenant/Lessee Name: A3 ®IL9 le- Phone#:
Email:
CONTRACTOR:Com an Name: Pf PAI p V �P Y �, o /�- /` Phone#: 7 dp&
Address: S411 0 LO
City: / I L_'X Stater Zip:
Qualifier Name: L9 L_l eq, L_ Phone#:
State Certification or Registration#: CA e- I1/72 t9/4:�.7 Certificate of Competency#:_
Contact Phone#:7&2z .3�� -114 .4
Email Address:- 1 ���? ICS /
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit:$ /1?40 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ONew ❑Repair/Replace ❑Demolition
Description of Work: RJ +- #-- /-0 S rA—A-9 LOA9 kj®Q-tj
Submittal Fee$ Permit Fee$ (?/t�v 0 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$Z:2j6_!�_
� ,
r
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 a building permit with an estimated va exceeding$2500, the applicant must promise in
good faith that a copy of the notice of commencement and construction lien law brochure ill be delivered to the person whose property is
subject to attachment. Also, a certified copy of the recorded notice of commencement must b osted 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 tice, the inspection will not be approved and a
reinspection fee will be charged.
SignatureSi ature ,
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing ins ment was acknowledged before me this
day of MA ,20 ry,by (UJ)J ICA 14 !f day of 20�,by�J U I�� I I
who isrsonally kno o me or who has produced who is personally known to me or who has produced L '
As identification and who did take an oath.0 y0fi(p ()as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sig
Print: ° ILENA RgMFRn Print:
•. c otary Public-State of Florida �: t
My Commission Expires: My Commissi r; p R
F , Expires Oct 24,2u11 = • arY li -� Ibrid
••.,,,`,�.� mi Sion#FF 066091 of ��;=MY Comm.Expires Oct 24,2017
'••. «"•• Commission#FF 066091
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009XRevised 3/15/09)
May 02 2014 12:51 PM Us1 Insurance 3058280770 page 1
CERTIFICATE OF LIABILITY INSURANCE °A'E05/002/142A4(`" YYY'
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERMFICATE 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
REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the cert(Ncate holder Is an ADDITIONAL INSURED,the pollcy(11es)must be endorsed. It SUBROGATION IS WAIVED,subject to
the terms and eondillons of the policy,certain policies may regVire an endorsmrlerlt. A statement on this certilcate does not confer rights to the
certBlcalte holder in Neu of Bucb endorsements).
PRODUCER CONT EVELYN SANCHEZ
US-1lnauranLe rat), (305)828-7722 FAx (305)828-0770
3100 W 76th Strtfet 94VIAIL us11ns41rancealaattnet
Hialeah,FL 33018
IRSUBMW AFFORDING COVERAGENAIC#
Phone; (305)828-7222 Fax (305)828-0770 INSURER A: FEDERATED NATIONAL INSURANCE
INSURED
INSURER B-
J.A REPAIR SERVICES INC 94SURER C:
8711
-
8711 NW 151 Ter IN ER D:
MIAMI LAKES,FL 33018 (788)22-3352 INSURER E.
ERF:
COVERAGES CERTIFICATE NUMB : REVISION NUMBER:
A ' THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LI BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CER'T'IFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSU CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.i VATS S�10WN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
R TYPE OF INSURANCE ADD POLICY SFF POLICY EXP
P LICY N X18 UMrf8
GENERALLIe�elur,r MTRENTE
1,400000.00
Q/
COMMERCIAL GENERAL LIABILITY PREM18ES(Ea $ 1,000,000.00
A CLAIM84+ADE ® OCCUR GL-011039. son $ 5,000.00
01/15/2014 01/1812015 URY $ 1,000,000.00
E $ 2,000,000.00
El I.PoLiGREGATEIJMrrAPPLIESPER PRODUCTS-CCW1OPAGG• $ 1,000,000.00
❑ POLICY ❑ ❑ LOC i
AUTOMOBILE LL401UTY $
J=INGLE LEJIrI
Q ANYAuTo
LL,
A11T008 ED BODILY INJURY(Par peraan) $
❑ C] SSCHEDJLED
N N-OWNED BODILY INJU
HIRED AUTOS RY(Perecoldent) S
❑ AUTOS POPE E $
$
O
UMBRELLA A UAB ❑OCCUR
EACH OCCURRENCE $
CJ ExCE88 LIAB ❑CLAIMS-MADE
AGGREGATE $
El DED 0 RE
W�RKBRB C014PCNaATION
AND EMPLOVERV LIABILITYI eTATV 0TH-,
ANY PROPRIETORIPARTNERIEXECUTNE JN '
OIFFICER/MEMBEREXCLUDED? ❑ NIA E.L.EACH ACCIDENT $
IfyyaaeedescribeHI
uurder E.LDISEASE-EAEMPLOY $
DE9C�iIPTIONOFOPERATIONS balow E.LDISEASE-POLICY LIMrr $
i
DESOM.MON OF OPERATIONS I LOCATIONS l YMICLES (Aenon ACORD jl e1,Admgonal Remarks 8chsdule,H uwm epaw Is rqutred)
AIR CONDITION CO
CERTI KATE HOLDER CANCELLATION
MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
10p50 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS,
I;
MIAMI, FL 33138
AUTHOR=REP
1
i
ACOR6 25(2010/05)QF ®1888-2010 ACORD CORPORATION. All rights reserved
The ACORD name and 1080 era"Stored marks of ACORD
• 9 _
STATE OF FLORM
AC.# G77134
Congratulations! With this license you become one of the nearly one million DEPARTMENT OF :BIISTNESS: AND
Floridians licensed by the Department of Business and Professional Regulation. PROFESSIONAL :REGULATION
Our professionals and businesses range from architects to yacht brokers,from -_
boxers to babeque restaurants,and they keep Florida's economy strong. CAC1817 2 0 fi 08 f-17/12 120050321
Every day we-work to improve the way we do business in order to serve you better
For infb(Tnation about our services,please log onto www.myfloridalleense.com. ,`ATR' BOND CONTR
There yob can find more information about our divisions and the.regulations that GIF►, Z'yJLIO `yt
impact y®u, bscribe to department newsletters and learn more about the JA REPAIREit3tI�E°•TNG
Department's initiatives. y s
Our mission at the Department is:License Efficiently,Regulate Fairly.We
constantly strive to serve you better so that you can serve your customers. =s csxTaFasn ,maw me `Ipp4sions of Cl489 Fs
Thank you for doing business in Florida,and congratulations on you .now licenser ts� as ; AIIG: 31, '2014 L1208i7.ao303
;1 -
'•Homo nrnmimr
AC#.62771:34 . .
STATE OF FLORIDA
'-DEPARTMENT OF BIISINESS AND PROFESSIONAL REGULATION
CONSTRIICTFON INDIISTRY LICENSING BOARD
E L12081700.303
LICENSE MR--.-
} J
The
CLASS B ASR CONDITIONING CONT
RKCO�t
Named==belor IS' CR}2F�If Y '"
II>Oer the provisioaB of`_Chapt+edr,
Ex iration -date:- AIIG 31, 2014,
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GIL JOLIO � • � ;, -
JA :REPAIR E
8711 PAW. 155' TERR
MIAMI LAKES -
FL..33018
RICK SCOTT r - KEN';..LAWS.ON
GQSTERNOR '. SECRETARY`
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Local usimmss Tax:R c pt
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10SIN✓ss NIAR AMOU.. RECE[Pr NO. .EXPIRES
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8711 Imo:W SER 7W Ml$ Mu�;tbe dsp%yed otptaceof buWfiess
NIMI UMCB'F133018 Pursuant to Camty Code
Chapter 8A-Art.9&10
OWNIER SEC.TYPE OF BUSUMSS PAYMENT me"REPAIR SERVitE INC 1� SPIE MSCI tANICAL CONTRACiDR BY TAX COLLECTOR
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