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MC-14-511 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 no Inspection Number: INSP-241299 Permit Number: MC-3-14-511 Scheduled Inspection Date:August 17,2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: MARTINELLO(PRESIDENT),CHRISTEL Work Classification: A/C Replacement Job Address:1329 NE 105 Street Miami Shores, FL 33138-2136 Phone Number Parcel Number 1122320270060 Project: <NONE> Contractor: UMC MECHANICAL CONTRACTOR Phone: (786)715-1447 Building Department Comments NEW A/C UNITS AND CONDENSING UNITS 2 UNITS= 2 Infractio Passed Comments TONS AND 2 UNITS=3 TONS INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-240874. CREATED AS REINSPECTION FOR INSP-209087. Failed 1 Correction l� Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid August 14,2015 For Inspections please call: (305)762-4949 Page 20 of 33 ` Miami Shores Village g Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 7wip Tel:(305)795.2204 Fag:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit PERMIT APPLICATION Master Permit No.P=:t Permit TnwO&UNAMM JOB ADDRESS: /3A9 N S 10S . City: Miami Shores County: Miami Dade _ Zip: 33 16/ Folio/Pa=l#: !►- 2 2 3.1.- 0 Jt01- 00 9 Q Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): CA a c&OV t C LLC phot: 3-44 O 3 Address: /07-6 N C "9 a4 . City: 71&SC%7 0VC psr u. state• F/• zip: 33/6/ TenantlLessee Name: Phone#• Email: CONTRACTOR:Company Name: Cali tt9KP1Z Phone#:1%--2115-1444 Address: Q&2% (obi ST T-IV City: N thrtl State: AL zip: 3's►tT3 Qualifier Name: MRMtl&t. N1U IsMl- Phone#: 78fo -71-Fa- 144.7 State Certification or Registration#: GMC I WO Certificate of Cornimlency#: contact Phone#: ',iS&•1 is- 14.9 Email Address: WWU NOZl MC.Q Q01- CQtA DESIGNER:ArchiteWEngineer. Ge4O C A. G ani Phone#: 3 O S-7'4.0.791 9 Value of Work for this Permit:$ Z Ct-TOQ-DO- Square/Linear Footage of Work: Type of Work: OAddress OAlteration ®New ORepair/Replace ODemolition Description of Work: IV tw A:f ti-••d<<t �s��t �-�-�••t �" dw�:.. �s.�.: t. Submittal Fee$ + Permit Fee$ v CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Tmining/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$, C?A 112 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 UL 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 deltvere4 to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must posted at thejp site for the first inspection which occurs seven (7) days cater the building permit is issued In the absence of such SignatureSignature sue n lice, the i coon will not be approved and a reinspection fee will be charged s Owner or Agent \Fontractor The foregoing instrument was acknowledged before me this 't The foregoing instrument was acknowledged before me this day of ,201&by dQ Mpggx•r&JeU D. • day of 2014 -�f,�ytU l�fl Ai who is j!g guAllyJw~ft me or who has produced who is personally known to me or who has produced As identification and who dit�p Uh ii M�() to •W41 identification and who did take an oath. ��� NOTARY PUBLIC: -A NOTARY P L �• o ?Id ®®a t Sign: — — Sign: Y P(j #EE8806 % ° it GARM •'o� . MYG�IiEE82118 Print: . Print: �' •' .....••• �� .�� ecember 0,2018 My Commission Expires: per— T* ��� `�O` My Commission Expires: ''q�� Wad Th Nfty Sw4km �,�sr,�,�r�s►,►��a,►,r*,r,►*,t,�r,raro,t,��,w�*aa**,��,�,� �,t�a � ,�,� o*a,��**r�,�+►,a,�*��r,��a«s►***a*,rar*,ria,t+�+�+�+�,�*,�+�,t,�a,�,�*,��*,�*,t APPROVED BY Plans Examiner Zoning Structural Review Clerk Revised 3/12/2012XRevised 07/10/0Wevised 06/1 2009)(Revised 3/15/09) Miami Shores Village .a. Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tef.(305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications.Each unit change-out must be on its own data street.Multiple units on single sheets are not acceptable. Job Address(where the work is be ft done): 132-9 A'c t a s 54-L44 City: Miami Shores Vtllap County: Miami Dade Zip Code. 7-w 3 8 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.MA MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI(AHO DATA SHEET REQUIRED Change Disconnecting means:YES ❑ NO® ARHI Sheet Attached:YES❑ NO Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER Pkis AHU or PKG.UNIT MODEL# ILA4L.a2sat 2 -o TxW) COND.UNIT MODEL# 241 KW HEAT Cal NOM TONS zlitz 2 AHU CU PKG 1 M.C.A AHU CU PKG AHU CU PKG 2 M.O.P AHU CU PKG AHU CU PKG 3 VOLTS AHUGWU3.WPKG PKG UNIT / / PKG UNIT / / EERISEER YES NO REPLACING DUCTSS NO YES NO REPLACING THERMOSTAT NO YES NO NEW 4°CONCRETE SLAB NO YES NO NEW ROOF STAND YES YES NO NEIN RETURN PLENUM BOX YES 1. Minimum Circuit Ampaaty(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/40: 4. Size Disconnecting Means: LL Contractor's ams: UAC UA Phone: State Certificate or R4 12-50601 Certificate of Competency N. Signature Date:_'2-,��� to f� etre a�►i STATE OF FLORIDA DEPARTMENT or BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 � ~ 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MUNOZ, MANUEL UMC/MECHANICAL CONTRACTOR CO 15212 SW 46TH LN APT B MIAMI FL 33185 i Congratulations! With this license you become one of the nearly one millio 'u' Floridians licensed by the Department of Business and Professional Regulation. Our professione,s and businesses range STATE;OF FLORIDA from architects to yacht brokers,from boxt{trs to barbeque restaurants, - DEPARTM.. F BUSINESS AND and they keep Florida's economy strong. PROFE3, I- '. GULATION Every day we work to improve the way we, do business in order to CNIC1250007 U ��109/08/2014 serve you better. For Information about ot.x services,please log onto .• �`�" www.miffloridalleense.com. There you,,::an find more information .-CERTIFIED OR about our divisions and the regulations that impact you,subscribe MUIVOrZ,MA to department newsletters and learn more about the Departments -UMG/ME(1H�. `O initiatives. Our mission at the Departrr 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, -,is;CERTIFIED,unde�t to provisions of-CK 489 FS and congratulations on your new license! -' e AU.G 3 X016 - L1409080001289 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY ! _ STATE OF F- RIDA. " j DEPARTMENT OF BUSINESS AND-'ROFESSIONAt.REGULATION i CONSTRUCT�O ;INDUSTRpf}LICE�ISINGeBOARD: CM6125000t Tje MECHANICAL CONTRACTOR Name,4.beJow IS CERTIFIED '`0ndef q6,pro"visions of Chapter�4-89 Expir"a torr date Alii 31,2016 d`,. 'F u..r'"r.J°� y. .m... �...,,,� .: •'�.WM,^agsy.., V •,.''•,e\lam"''p.�'� �����y�..'q S�, t• .,MUROZ-7,MAN.0 ELL�... -- w '� y4 ♦j ., ,��;,L S; t l -!e ,,"am MEC_HANIG 1L C '~ �•,`a�'�''�, 8� ' ``e, , QW 46. fbl QW IAM `'L Lo�al•BusinessTax Receipt; .. � ' Hl a Miami--Dade Cnunty',Sxate'. �I`ori a „' s -THIS NOT A BILL bO.NOT p Y r 6810155 Iiz t3USINESS NAIVIIiA.00ATION t.RECEIPT NO � PIa�S 1 UMC,MECHANICAL RENEWAL SEP EM85R`30,,2015 CONTRAd'toR,CO 708$652 Meat ba is layad t;plfiCe of business 15,212.SW 46.1N APTIS pursuant to Count-V code; MIAMI,Fl - 3,- 8 ;.' CF?aoter 8A Art:9 rie 16; OWNER SEC.TYPE OF BUSINESS ,• PAYMENT RECEIVED UMC,MECHANICAL CONTRACTOR 196 GENERAL MECHANICAL BY TAX COILUCTOR C0 CONTRACTOR 10 MANI IFI Ml IN07 PRFR 75:00 09/12/2014 "rker(s) i CMC1250007 0224-14-008957 This Local Business Tax Receipt only confitm payment at the Local Business tax.The Receipt is not a license, permit.or a,certification of the,holder's quolitications,to do business.Holder must comply with any governmental -i or nongovernrientai regulatory laws and requirements which apply to the business. '' , The RECEIPT NO above must be dispilved on all commercial vehicles-Miami{Dede Code Sec 89.216. M® �' For more information'Tuilt r3momidadeooyHa �1- LO CERTIFICATE OF LIABILITY INSURANCE DMAW 01/20/2015 'THIS ATE M MSUED AS A MATTER OF BIFOIWATION ONLY AND CONFERB NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIR MATWELY OR NEGAWELY AMEN% EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW TMG CERTIFICATE OF MSURANCE DOES NOT CONSTITUTE A CONTRACT BETVMEEN THE WOUN G INSURERS),AUTHORIED TATTVE OR PSR,AND THE CERTIFICATE HOLDER. 0101ORTANT: N the cw=cft holder Is 41 ADWIONAL UISURE%the poNcytles)must be orad. N SUBROGATION M WAIVED,subject to the tonna and condWorm of the pal►,cwbdn policies m9►(require an andormommuL A abdonumd on this ate does not confer rigida to the mate hoe'In Neu of such orAkweemaW PROWJM 786-573-4485 786-573.4488 Irmurance NOW Agency 7 786-57 12915 SW 132 Street suiteFROMM 4-B Mlaml,FL 33186 APpamera face e e UMC NWhanical Contractor CO. a: 15212 SW 46 Lane#B laumac., Ham!.FL 33185 eMINIHt E COVERAGES CERTWICATE NUMBER: REVISION NUMBER: THIS IS TO CERTFY THAT THE POLICIES OF WSURANM USTED BEI.OW HAVE SEEN WUED TO THE MIRED NAMED ABOVE FOR THE POUCY PERIOD WMCATED. NOrOMSTANOM ANY REQUIREMENT,MW OR CWMMON OF ANY CONTRACT OR OTHER DOCUMEN'r WRH RESPECT TO VMM TENS CERTIFICATE MAY BE ISSUED OR MAY PERTABI,THE IMBURAMM AFFORDED BY THE POUC(ES DESWISED HERR M SUBJECT TO ALL THE TEM. EXCLUMNS AND CONDn10NS OF SUCH POLICIES.UWS 8WWM MAY HAVE BEEN REDUCED BY PAN)CLANAs. ffm rincr mawmLama 410HPAL UAea.rrr EACH OCI NCE $1 A DFORMTORERnw- COMMERMAL GENMUL UAMUN ra $ MA,MS•1AM ©OCCUR MEDaw(anyom $ CPP 0014805 00 08/2412014 08124/2016 pawNAL a mw uamy s GENERA!.AGGIWaATE $ GEM AtNEREOATE UMfT APPUES PM PRODUCTS•Q0UPW AW s P my Loc s Mrrcma=&LVJNUTV Comma siNME uMR $ tEaearid� AWAM BODE Y NAW(F*pmwm s ALLOVAMAUTOs 90ON.rM6RAt Twacdq $ SCHEMA DAJTOS Pf�ovERTr aNsfaaE s HIREDAUTOS (PWealds�q NON4WWAUTOS $ a taL LAf�Im OCCUR EAgi� t Lae C<Aem MADE A«EIEOATE s D atwn&E $ TrowcEna eommaNSAmm �i AND 'UABLmr Tim REM,- ANY NIA EL EACHACCMW E NaddarmNN) E.LDE ME-EA EMPLOYEE s tt desarbe EL WMW-POLICYUMfT i FHIaoaR[Pt1oNOPUPWAVOWILOCATION51VENOW~A90 PM.Addl§mdR fdodMT,N,p osawk qW4 License#CMC 12500017 CERTIFICATE HOLDER CANCELLATION Miaml Shores ViNage Building Dep. GHC=AWOFTMAOMOESCRMWPOUCMSWCANCEUJWBEFKM 10050 NE 2nd Ave. THE WMA ION DATA , NOT= W&L BE DElJVEPlED IN ACCORDANCE VWTH YM POLICY PR NS. Ham[Shores,FL 33138 AUflgRaEe W ANNNOWTWE Mayleen ma+ @ ms-2006 ACORD CO . AN rig ACORD 25(2006106) The ACORD dame and logo are regleum d marks of ACORD � R •�� JEFF ATWATER we 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: 5/21/2013 EXPIRATION DATE: 5/21/2015 PERSON: MUNOZ MANUEL FEIN: 264550233 BUSINESS NAME AND ADDRESS: UMC/MECHANICAL CONTRAC 13428 SW 62 ST 1-104 MIAMI FL 33183 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 by filing a certificate of election wider this section may not recover benefits 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 or election to be exempt and certificates of election to be exempt shall be subject to revocation If,at any time atter the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meaft ire requirements of this section for Issuarm of a certificate.The department shah revoke a certificate at any time for failure of the person named an the kertlfikete to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 M Miami Shores Village VigoBuilding Department �,Cpg�A 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 acknowledges 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.. Therefore,you may be personally Liable for the worker compensation iniuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contractor Print Name: A A•Q —1•If;L-L o S$ Print Name: Signature: Signature: State of Flallda) State of Flori ) County of Miami-Dade) \�,p i i uinCounty of Mia i-Dade) Sworn to an subscribed before me tl*' I n����� Sworn to and s scribed before me this�_ day of 6 --c ,20 "" /ss''�, day of ,20 �5 By i�'`dL"T1u.v 6p��` cGu By a1JARAMILLO M uUMMI 160535 (SEAL) s, ��� (SEAL) �.` � 18 Type of Identification pr Type of Iden' cah Ftofe Se"Am•com' `0R I 0 N ������``� +111111%\ a a Miami,January 20,2015 To whom it may concern With this affidavit,I state that I am going to be the person working in this project as mechanical contractor located at 1329 NE 105"'street,Miami Shores, FL. Resp y anuel M noz Med nical Contractor CMC 1250007 I�