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MC-15-2183 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL / Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-243707 Permit Number: MC-8-15-2183 Scheduled Inspection Date: February 22, 2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: HEWITT, DESIREE Work Classification: A/C Replacement Job Address:8839 NE 4 Avenue Road Miami Shores, FL Phone Number Parcel Number 1132060460640 Project: <NONE> Contractor: QUALITY AIR SOLUTIONS INC Phone: (786)486-9432 Building Department Comments WORK ALREADY DONE::A/C INSTALLED 3 TON UNIT Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-242270. need float switch and IN ladder to get on roof Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 19,2016 For Inspections please call: (305)762-4949 Page 5 of 28 Et �sKO'! i,� Miami Shores Village Peru It Type:. eche ntt l Resid'etl i rt 10050 N.E.2nd Avenue NE Work Olassictior:AIiG Iepiacemen ; Miami Shores,FL 33138-0000 PerrWt,atatus:APPROVED Phone: (305)795-2204 f`oxioA Expiration: 02/27/2016 Issue Date:8/311201-5 Project Address Parcel Number Applicant 8839 NE 4 Avenue Road 1132060460640 I° Miami Shores, FL Block. Lot: DESIREE HEWITT Owner Information_ Address Phone Cell 8839 NE 4 AVE RD DESIREE HEWITT 6; MIAMI SHORES FL 33138-3178 Contractor(s) Phone Cell Phone rr m QUALITY AIR SOLUTIONS INC (786)486-9432 ; Valuation: $ 2,500 00 Total Sq Feet: 00 i Tons:3 Available Inspections: Additional Info: InspectioLType: Classification:Residential Final Approved:In ReviewReview M Comments: Date Approved: : In Review Date Denied: Type of Work:WORK ALREADY DONE::A/C INSTA Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# MC-8-15-56862 DBPR Fee $2.00 DCA Fee $2.00 08/31/2015 Credit Card $67.80 $50.00 Education Surcharge $0.60 08/25/2015 Cash $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $117.80 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 tnereto 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 com oliance with all applicable laws regulating construct* d o 'n rmore, I authorize the above-named contractor to do the work stated. Aug ist 31, 2015 Authorize r / Applicant / Contractor / Agent Date Building Department Copy August 31, 2015 1 Miami Shores Villa e ---- Building Department ANUG 2 6 201S 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 - INSPECTION LINE PHONE NUMBER:(305)762-4949 FBBC 20/4/ BUILDING Master Permit No.,/k/ ' 21Y3 0 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING 24CHANICAL [:]PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 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: NameFee Simple Titleholder): 6C2;� 1i� ,( p ) Phone#: �1 vT Address: 8 359 City: "1a• State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: K Phone#: �-- Address: V\)i �� 1 v� City: / L ft--VA v State: Zip: Qualifier Name: yj + r Phone#: State Certification or Registration#: �9 T �5y Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: v� C' y: State: Zip: Value of Work for thi ermit:$ L �� S re/Linear Footage of Work: Type of Work: ❑ ddition ❑ Alteration { New ❑ Repair/Replace ❑ Demolition Description of Work: t Specify color of color thru tile: Submittal Fee$ (�` � Permit Fee$ d 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) R 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. Signatur Signature NJ OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of AJU�; ,20 ( J by _day of aQQ L) 20 /r :by who is personally known to U)J'NT/j'7 ��J who is personally known to me or who has produced�� ) kk ��^N s me or who has produced e as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: r Seal: Seal: w Notary Public State of Florida oar v` Notary Public State of Florida 40 : Si a Alvarez +� �; Joanna M Feliciano y� s My Commission FF 156750 p� My Commission FF 082753 Expires 0910312018 �pd� Expires 01!1212018 APPROVED BYans Examiner Zoning Structural Review Clerk (Revisedo2/24/2014) 000317 Local Business Tax Receipt Miami—Dade County, State of ,Florida -THIS IS NOTA BILL - DO NOT PAY 6922810 BUSINESS NAME/LOCATION 1(0:j QUAAIR SOLUTIONS INC RECE1Pr Nom' LITY EXPIRES 1051 NW 87 sr �r SEPTEMBER 30, 2015 MIAMI FL 33150 Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS QUALITY AIR SOLUTIONS INC 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED Worker(s) T 11 M000493 BY TAX COLLECTOR $90.00 12/04/2014 CR ED ITCARD--15-010971 This Local Business Tax Receipt 0011 Confirms paymeot of the Local Business Tax The Receipt is not a license, partm;ora certificetloa of the holder squaUBeadoos to do business.Holder man comply whb any governmental or noegovermeam"i regnlatory laws and reqnfrements which apply to the busing. The RECQfT No.above must he displayed on all commercial vehicles-Eaiaml-pada Code Sec aa-Z76, For mere informa i m,visitgWv rtdamidade.am hmcnectar - - CTQBB Construction Trades Qualifying Board ' BUSINESS CERTIFICATE OF COMPETENCY 11 M000493 QUALITY AIR SOLUTONS INC k, ti D.B.A.: T�i k OCR WILLIAM Is cefted under the provisions of Chapter 10 of Miami-Dade County VALID FOR CONTRACTING UNTIL 09/30/2035 :9 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND _V_ PROFESSIONAL REGULATION RA13067480 ISSUED: 09/04/2013 REG AIR CONDITIONING CONTRACTOR TAYLOR,WILLIAM QUALITY AIR SOLUTIONS'INC'. (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HAS REGISTERED under the provisions of Ch.489 FS. Expireten date:AUG 31.2015 1-1308040001955 AUG-21-2015 10:42 From:Petersen Insurance 3056512391 To:3057568972 Pa9e:1/1 A� CERTIFICATE OF LIABILITY INSURANCE DATE 12015 YYY' THIS CERTIFICATE I$ 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(iss)must be andoraed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an ondorsomont. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen tt. PROgVCIM CONTACT IVAMEI PAMELA MILTON PETERSEN INSURNACE AGENCY faroC..1 • 305.653-0333ONE r"x 305-651-2391 EMAIL SFL1480J ALLSTATE.COM 20911 NW 2ND AVENUE �____._...._.. .. .._ .. ... MIAMI, FL 33169 INSURERSAFFORDINOCOVERAGE NAIC9 _.. INSURERA: CYPRESS PROPERTY&CASUALTY INSURER B QUALITY AIR SOLUTIONS INC. INSURER C: 1051 NW 87TH ST MIAMI, FL 33150 INSURER D: INSURER E r INSURER F COVERAGE$ 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES L IMITS SH0VM MAY HAVF BFFN RF,•r)UCFD BY PAID CLAIMS INSR -- --.... .. ......... .. .... JaIL Y'YPE OF INSURANCE POLICY NUMBEPR CY EFFNI WDCC-yfYEYXYY LIMIT..S GENERAL LIABILITY F•ACH OCCURRENCE. 11,000,000 FGL 500081.4 00 04115!2018 04/1512016 1r COMMERCIAL GENERAL LwiILIIY °KM�ACET� Ea �,,�� S 9c00,000 rvq CWMS•MAOE CXiCUR MED FRCP M oneperson) $5,000 A — — PERSONAL R ADV INJURY 11.000.000 -•.... r NGRALAGGREGATE 41.000,000 EIEN'L AGGREGATE LIMIT APPLIES PER ODUCTS-GOMP/OP AGG S 9,000,0(D ✓ POLICY JECIT r7 PRO. I.CX > AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ca au dent ANY AkrrOI DODILY INJURY(per mwl) S ALL O11IN'WNFt7 SCHEDULED AUTOS AUTQS PAmil Y INJURY(PnraccIdnnl) $ I GRED AUTO$ AUTOS PROPERTY DAMAGE Per tlGtldeM L E UMORELL►uAs OCCUR EACH OCCURRENCE $ Excess IJAS CLAIMS-MADE AGOREOATE S DED RETENTIONS L WORKERS COMPENSATION d 9TATU- OTH AND EMPLOYERS'LIABILITY ANY PROPRICTORIPARTNERIEXECUI IYk Y lid OFFICCRIMDMBER EXCLUDED? NIA E L EACH ACCIDENT $ (Mandatory In NH) GL.DISCASC.EA GMPLOYC IrYYaa ggaqtlbqle $ DESG`RIPTION OFUrxOrr F-RATIONS below EL.DISEASE-POLICY LIMIT S LICENSE# RAI 3067480 DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES(Attach ACORD 101,Additional Ramada;$chadule,it mora%Paco In ragnlmd) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES BUILDING DEPT SNOUL13 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2ND AVENUE 'THEE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES, FL 33138 ACCOR NCE WITH THE POLICY PROVISIONS. AUfHO R REQENTATIVE IV 1988-2010 ACORD CORPORATION- All rights reserved. ACORO 26(2010105) The ACORD name and logo are registered marks of ACORD Report Viewer Page 1 of 1 JEFFATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 12/30/2014 EXPIRATION DATE: 12/29/2016 PERSON: TAYLOR WILLIAM FEIN: 830415113 BUSINESS NAME AND ADDRESS: QUALITY AIR SOLUTIONS INC 1051 NW 87 ST MIAMI FL 33150 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-COND Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter oy filing a certificate of election under this section may not recover benefds or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt..apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation If,at any time after the filing of the notice or the issuance of the certificate, the oerson named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DM-252 CERTIFICATE OF ELECTION 10 BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 https://apps8.fldfs.com/erreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3 gH6TER6... 8/21/2015 ♦ygoR>Es D moon Miami Shores Village Building Department �LOR11)a 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to wn er - 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: 11 Owner State of Florida County of Miami-Dade ``--�� The foregoing whs acknowledge before me this q5 day of AL)Q u ,20_4 BY� S i �. C� Il p who is personally known to me or has produced as identification. .Notary• V SEAL: My Cohan. X 2®1 No. EE1670 Bonded thru Arthur J.Gallagher 6 Co. 71k n16. AIIIJ EJ DIIJ LID"M-0 11 11 ® -- L6'r RIM :17AJ. y Ci August 23,2015 State Of Florida County of Dade Before me this day personally appeared William Taylor who, being duly sworn,deposes and says: That he or she will be the only person working on the project located at: 8839 N.E.4t"Avenue Road Miami Shores, FL 33138 Sworn to (or affirmed) and su ribed before me this '15?5 day of fiIj V 20 4v, by Personally know OR Produced Identification Type Of Identification Produced Print,Type or Stamp Name of Notary WAANU R.GIN"1POW so OI ROO My 0O. ApQ 21L a.i#120PhrulA Abut J.GlI 9h4f&CO- 105 1 O.1051 N.W. 87TH STREET ® Mmml, FLORIDA 3315® o PH,. 0788, 4865-9432,