MC-15-695 Miami Shores Village ° )
10050 N.E.2nd Avenue NW
Miami Shores,FL 33138-0000
Phone: (305)795-2204
Expiration: 11125/2015
Project Address Parcel Number Applicant
66 NW 107 Street 1121360070060
ERNEST DIGERONIMO III
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Celt
ERNEST DIGERONIMO 111 66 NW 107 Street (786)200-3494
MIAMI SHORES FL 33168-
66 NW 107 Street
MIAMI SHORES FL 33168-
Contractor(s) Phone Cell Phone Valuation:
$4,400.00
AIR SYSTEMS A/C LLC (786)208-3484 Total Sq Feet: 0
Tons: Available Inspections:
Additional Info:PROVIDE&INSTALL ONE NEW MINI SPLI Inspection Type:
Classification:Residential Final
Approved:In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work: Underground
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00 Invoice# MC-3-15-54962
DBPR Fee $2.31 03/27/2015 Credit Card $50.00 $119.62
DCA Fee $2.31
Education Surcharge $1.00 05/29/2015 Credit Card $119.62 $0.00
Permit Fee $154.00
Scanning Fee $3.00
Technology Fee $4.00
Total: $169.62
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 AFFIDA I 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 ni Futhermore,I authorize the above-named contractor to do the work stated.
May 29,2016
AZor&A Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 29,2015 1
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-231152 Permit Number: MC-3-15-695
Scheduled Inspection Date:January 20,2016 Permit Type: Mechanical - Residential
Inspector. Perez,JanPierre Inspection Type: Final
Owner. DIGERONIMO III,ERNEST Work Classification: Addition/Alteration
Job Address:66 NW 107 Street
Miami Shores, FL 33138- Phone Number (786)200-3494
Parcel Number 1121360070060
Project <NONE>
Contractor. AIR SYSTEMS AIC LLC Phone: (786)208-3484
Building Department Comments
PROVIDE&INSTALL ONE NEW MINI SPLIT A/C. Infractlo Passed Comments
INSPECTOR COMMENTS False
( 2L
Inspector Comments
Passed
Failed '
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
January 19,2016 For Inspections please call: (305)762.4949 Page 5 of 56
Miami Shores Village REcEM -D
Building Department MAR 27 NO%
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
—
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 Q_
BUILDING Master Permit No�� IGJ ��
PERMIT APPLICATION sub Permit No. mC`I!.;- �;q5
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING aMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: [0 99`cs-+
City Miami Shores County: Miami Dade Zip: ?
Folio/Parcel#: 0 � 21SJ? 6C:r+ OC:ld Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): _t fncileYln Phone#:
Address: (O(Q "1A`^N, 617
City:. q nab k �`�U`l� State: Zip:
Tenant/Lessee Name: Phone#:
Email-
CONTRACTOR:Company Name: •i Sy&le iv. �L LL( _ Phone#:
Address: ALoq s t33 5'T_
City: bm�n ct<p< State: r' Zip: 33®S
Qualifier Name: fo\ yA 2 6 U,.D 2 Phone#: 30Y 6$1 10 4 O
State Certification or Registration M C A cc 33 r5 L1 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �w a Square/Linear Footage of Work:
Type of Work: F Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:��vaJ �w�S. jPW OC,W 'kW A C.RAT Ak
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ '"V CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 1113 - 2,
(Revised02/24/2014)
�r g.
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.....
0
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.
_ia'vSignature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing Irume t was acknowledged before me this
_day of Q(O .20 by ��day of ,20 1S ,by
b.
Z7�- pc,� InPCC1f'YY10.who is personally known to a A 110 (A2Z ,who is personally known to
me or who has produced 1�- as me or who has produced 33,- W:F as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: 1 Sig
Print: Print:
W� ,
Seal: "'!�b REBECA M.PASTRANA Seal: " EBECA M.PASTRAM
My COM OSS10N#EE872624 My COMMISSION S SEM24
EXPIRES:February 07+2017 MIRES.Fabry 07+X17
OF
***************************** ***** ** *****************************************************************
APPROVED BY Sans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
ACC>RbP CERTIFICATE OF LIABILITY INSURANCE 5/2/2015
THIS CERTWICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY 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(ias)must be endorsed. If SUBROGATIONIS,WAIVED,subject to the
,lents and conditions of the Policy,certain Policies may re"ire an andorsenient. A statentent on this certificate does not confer rWft I*the
certificate holder in Mu of such endorsemerit(s).
PROVO= CONT
NAME'
PONE
PAYCHEX INSURANCE AGENCY INC H
wc,Nm Exl� (888) 443-6112
E-VA1
210705 P: F: (888) 443-6112 AMITIM-1
PO BOX 33015 NsURMM)AfFoRoftm COVERAM NAMA
SAN ANTONIO TX 75.265 INSUM A- 'Twl.n C.*:.,-.y 1".re
RVSUM
IIAWRER C:
AIR SYSTEMS AC LLC
4698 NW 133RD ST
OPA LOCKA FL 33054
COVERAGES CERTIFICATE NUM1IER- REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO! 6Y 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.
I(INSW rypr or LvSVZVvCz 40M SUM PVLWYZFF POLKIrt"
COMMEAMAL 0911119IIAL I.MfLITY EACH OCCURRENCE
CLAW-MADE FIOCCUR DAMAGE TO RENTEDPREMISES(Ea omuffence)
MED EXP(Any one Person)
PERSONA/.&ADV INJURY
GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
POLICY PRO.[--]LOC PRODUCTS-COMPIOP AGG
[7 JECT
OTHER,
AUTOMOBILE LAMUTY COMBINED SINGLE LIMIT
(Ea accident)
ANY AUTO BODILY INJURY(Per person)
ALSCHEDULED BODILY INJURY(Per 8001dent)
AULOWNED
AUTOS I AUTOS
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
AUTOS (Pwwckhnit)
UMOREELIA LIAO OCCUR EACH OCCURRENCE $
S
LIAH CLAIMS-MADE AGGREGATE
IRETENTION S
..................
I
OTH.
w0AM"CvAfiq9v"7z" x =Tl-rl CORTH
ANY PROPRIETORIPARTNERIEXECU17MIN E.L EACH ACCIDENT $1, 000, 000
OFFICERANEMBER EXCLUDED? IWA
A (ftodalm in A" KE�n- DF74*79 E.L.DISEASE-EA EMPLOYEE I'l r 0 0 0 0 0 0
If yw,dusadbe undorEL,DISEASE-POLICY LIMIT I'l 0 0 0 0 0 0
ON
DESCRIPTIOF OPERATIONS below
0EWWr1W0F0PMAMW1L=ATWW/VEKXMMW 100,AddMwW Romw*s Selmdub,may be aftchad If mamspaw to rmpkod)
Those usual to the Insured's Operations. License # CAC033544
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE
Miami Shores DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
Building Department AUThVRWW ROWSOMATII&
10050 NE 2ND AVE
MIAMI SHORES, FL 33138 -7J �4^jv�
a 10&2014 ACORD CORPORATION.All rights rworvi
ACORD 25(2014101) The ACORD nanu and logo we registered ffIarks of ACORD