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MC-15-2326 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 C_ Inspection Number: INSP-243367 Permit Number: MC-9-15-2326 Scheduled Inspection Date: December 16,2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: Pappa, Monica Work Classification: Addition/Alteration Job Address:747 NE 94 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060142010 Project: <NONE> Contractor: MDS ENGINEERING CORP Phone: (786)436-7062 Building Department Comments REPLACE DUCT WORK Infractio Passed Comments INSPECTOR COMMENTS False z l5 )5 Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 15,2015 For Inspections please call: (305)762-4949 Page 14 of 51 Local Business Tax Receipt IM hm mi-Dade Cuonly, Sw1u, of Fbarirfi-i L T B EXPiRES MOS E LER MIG CORIF SEPTELIBER 30, 2016 'Ole 60 12FAI 11?AV L 74*7 1-" Al. OWN't-41 oAvMtNI val- F,E N Nzi'. C 17; i %it '-"i A, cot,i rcTnim -, -: 1,-%N4 PRks 14 t, 7 �Ww rl': 1b. cite fhrk-ri�IrE*,AN fxw4 a A 10?k!, & rft. nrmin%7,-kvv3w-w- sr # rr Nil rcmmm=-A F@.kr,'im-mt"i-Db-* Em-,'L'z Permi Ifo. -9-15-2326 es�jOR»s cr Miami Shores Village Pet►7it Oji"e: e�it�trtical-;Residential 10050 N.E.2nd Avenue NE 1 t* isu `oefion Addition/Alteration Miami Shores,FL 33138-0000 Penn# tatus.APPROVED Phone: (305)795-2204 R" Issue Cate:911'.312015 Expiration: 03/14/2016 Project Address Parcel Number Applicant 747 NE 94 Street 1132060142010 Miami Shores, FL 33138- Block: Lot: Monica Pappa Owner Information Address Phone Cell Monica Pappa 747 NE 94th Street Miami Shores FL 33138- 747 NE 94th Street Miami Shores FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 MDS ENGINEERING CORP (78 1.6)436 7062 Total Sq Feet: 0 Tons: Available Inspections: Additional Info:REPLACE DUCT WORK Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work: Review Mechanical Scanning:3 Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# MC-9-15-57067 DBPR Fee $2.25 09/14/2015 Credit Card $50.00 $ 119.90 DCA Fee $2.25 Education Surcharge $0.80 09/16/2015 Credit Card $ 119.90 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $169.90 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 informatio ac, to all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above- ract o the work stated. September 16, 2015 Authorized Signature:Owner / Applicant on ractor / Agent Date Building Department Copy September 16,2015 1 Miami Shores Village . M BuildingDepartment p SEP 1 201 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 Y. INSPECTION LINE PHONE NUMBER:(305)762-4949 S FBC 201q BUILDING Master Permit No.pe 6 _A_�_/S 5/y PERMIT APPLICATION Sub Permit No. HC ' 15 2,r::;, ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING XIVIECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �/ � CONTRACTOR DRAWINGS -"W JOB ADDRESS: ? /°Y® e City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: _113ZO6013�z 0/0 Is the Building Historically Designated:Yes NO _ Occupancy Type: Load: Construction Type: ,�/ Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): ��AC ����/7 Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#: 1 Email:", Wn , CONTRACTOR:Company Name: iV_✓r'___> �d'�/��L��'�/�� Phone#: Address: � City: r 4'( Qm l State: �( Qualifier Name: J'L(D 1)1-xa 6 �e Phone#: :�� State Certification or Registration#: Cid C 12"50-9-56 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: C'e, Value of Work for this Permit:$ v :;z" Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New �] lace Repair/Re p ❑ Demolition Description of Work: © 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$ I ' (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. -7 -RAO-) Signature Signature OWNER or A41T CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _ day of - �f � .20 /-:5- by day of �c"�?��"�- 20 l by !�®✓��C� ����� who is personally known to who is personally known to me or who has producedzz- ��/�®��/ gs me or who has produced 064-5,119 L identification and who did take an oath. '5-3—® identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 77 Sign: Sign: Print: Prin �t11NNtIII \,1 11I Seal: c°�` `e��, ABRAHAM E.AMADOR ;los"" ABRAHAM E.AD128792 Seal r.a Notary Public-State of Florida z,* Notary Public-Sta My Comm.Expires Sep 8,2018 ?w a, My Comm.Expires ,� .• Commission N EE 128792 � ;;, �t Commission E APPROVED BY "' Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) i KEN LAWSON.SECRETARY RICK SCOTT, GOVERNOR STATE OF FLORIDAf`, EpARTINENT OF BUSINRO ES pUAND PI S RY LICENSING B AR REGULATION D a CONSTRUCTION IN s ° CMC 1250450 The MECHANICAL CONTRACTOR Named belowv sionsRoflFIED Ch Chapter 489 FS. Under the p 2016 Expiration date: AUG 31, � i DUANY, MARIO MDS ENGINEERING CORP. 211809SW 99TH AVEFNU�190 v' CUTLER BAY SEO. L1502220000765 ISSUED. 0212212015 DISPLAY AS REQUIRED BY LAW Local Business Tax Receipt t Miami—Dade County, State o -THISIS NOT A BILL-DO NOT PAY 7181834 RECEIPT NO. EXPIRES �usltuEss NAMEs►.00ATtoN NEW BSEPTEMBER 30, 2015 BUSINESS SEPTEMBER of taushrass MDS ENGINEERING CORP 7482337 Must Le displayed at P 7850 SW 132 AVE Pursuant to County Cods MIAMI.FL 33183 Chapter BA-Art.9&10 PAYMENT RECEIVED SEC TYPE OF BUSINESS BY TAX COLI-ECTON OWNER 194 GENERAL.MECHANICAL MDS ENGINEERING CORP CONTRACTOR 75.00 0 3325 015 C10 MARIO DUANY PRES CMc1250450 0224-15-003325 WOlker(s) 1 TeX.The Receipt is cat a license, Tax Ra COWI the only coaRrms PaI.,t a!the Local Boal�comP4 with acq goverame This Local Buslmiss ffiesnon al the holder a gtutli6catians to do basil Hth� iness. 0e.�ovpntmeotal regulatory laws and requfreniec which apply v Miami-Dada Code Sec Re Tho RECEIPT N0.above mus+be disPlaped on all commercial vehicles- Far moreielatmatian.visit wwwtotiatoid"a.Affftqftw maw STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COI+IIPENSATION CONSTRUCTION INDUSTRY EXEMPTION MTOCATE w¢isms TO 9E WIRT MW Fa ov" VMRXM S compamiamLAW EFFECTWE"M111172018 ptp®tATrotd DATE 1QQP2017 PEA6Oa1' DUB tdARIO FEW BUSNESS NAME AND ADDRESS: MDS ENCMEERINa CORP 21809 SW 99TH AVENUE CUTLER BAY FL 33190 SCOPES OF BUSINESS OR TRA I ,gB�R�s poll nzym Miami shores Village Building Department RNA 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 and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of �d"�� ,20 S• By �� � �� � who is personally known to me or has produced /010 � _3 s identification. Notary: ; ABRAHAM E.AMAOOR SEAL: �Iva° Notary Public-State o1 Florida P,: My Comm.Expires Sep B.2015 „ �Ftg;•' Commission#EE 128792 YY1ouc, c) 00 om MDS Engineering Corporation. 21809 SW 99" Avenue PE No 67340 Cutler Bay, Florida 33190 CA No 28051 (786) 436-7062 LEED AP CMC 1250450 Email: marioduanv(a,mdsengineerin2corp.com September 12, 2015 State of Florida Miami Dade County Before me this day personally appeared Berta (pUCma who, being duly sworn, depose and says: That he will be the only person working on the project located at: 747 NE 94' Street. Sworn to) or affirmed) and subscribed before me this day of 2015 by ,(k o Personally Known OR Produced Identification 110 Type of Identification Produced f L d(l ley-`S L CcNre- MARAA ESnp MY COMMISSION#FF 073975 Print, Type or Stamp Name of Notary 1e g€ EXPIRES:March 29,2018 Bonded Thru tJotery Puft Undervmters Ac�i✓� DATE(MMIDDNYYY) CERTIFICATE OF LIABILITYINSURANCE 09/11/2015 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 pollcy(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 NAME: MARINA SANTOS Univista Insurance-Corporate yP�HON� Exit): (305)456 622 FA Nel; {786}953-7029 8476 SW 40th St.Suite 201 E-MAIL ADDRESS: msantos@univistalnsurance.com Miami FI, FL 33155 INSURER(S)AFFORDING COVERAGE NAIC q Phone (305)456-6622 Fax (786)953-7029 INSURERA: ASCENDANT COMMERCIAL INSURANCE INSURED INSURER B MDS ENGINEERING CORP INSURER C_: 21809 SW 99 AVE )NSURER 0: NSURER E: I CUTLER BAY FL 33190 '_-- --- 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 CONTRACTOR 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 jADDUSR LTR TYPE OF INSURANCE INSRWV® POLICY EFF POLICY EXP GENERAL LIABILITY . POUCYNUMBER I )I(MM/DD/YYYY), UNITS EACH OCCURRENCE S 1,000,000.00 COMMERCIAL GENERAL LWBILITY DAMAGE TO RENTED�raon) 100000.00 CLAIMS-MADE- OCCUR N {3L-46E56-0 PREMISES reson)noe) _ $ A I � L ! I MED EXP{anyny one $ 6,000.00 01/23!2015 01/23/2016 PERSONAL BADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000.00 APOLICY ' JECT D LOC $ AUTOMOBILE LIABILITY COMBINED tj INGLE LIMIT -_ ALL OWNED �� SCHEDULED LANYAUTO ALL INJURY Per pmrsan) $ AUTOS . AUTOS BODILY INJURY Per Q=oenq $ HIRED AUTOS NON-OWNED PROPERTY Prddent�AtdAGE L AUTOS $ { or so $ UMBRELLA LA ;,,J OCCUR - EXCESS LWB EACH OCCURRENCE $ I CLAIMS-MADE AGGREGATE $ .� DED F _- I i __ ELATION$ OT $ WORKERS COMPENSATION PER OTH-' AND EMPLOYERS'LIASRJTY YIN ? STATUTE ❑ER , ry in NH) E L EACH ACCIDENT (Mandato $ E L.DISEASE-EA EMPLOYEE S AN PROPRIETORIPARTNERIEXECUTIVE 111 OFFICERR.4E0.lBER EXCLUDED NIA A' If es.descnbe under � � _- DESCRIPTION OF OPERATIONS oelow E.L DISEASE-POLICY LIMIT S i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attar h ACORD 10t.Additional l Remarks Schedule,if mare space Is required) CMC 1250450 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIB POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF,NO CE 10050 NE 2nd Avenue WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PR SIONS. Miami Shores,Florida 33183 i AUTHORIZED REPR4SENTA Fax:(305)756-8972 I; � I CORPOS TION. All rights reserved. ACORD 25(2014/01)OF The ACORD name nd logo are registered marks of ACORD