MC-16-427 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-259902 Permit Number: MC-2-16427
Scheduled Inspection Date:June 01,2016 Permit Type: Mechanical- Residential
Inspector: Perez,JanPierre Inspection Type: Final
Owner: DATORRE, FLAVIO Work Classification: A/C Replacement
Job Address:161 NE 105 Street
Miami Shores, FL 33138-2032
Phone Number (305)962-1862
Parcel Number 1121360050140
Project: <NONE>
Contractor: ARCTIC CIRCLE AIR CONDITION SERVICES CORP Phone:(305)904-2867
Building Department Comments
CHANGE OUT SAME SYSTEM A/C Infractio Passed Comments
INSPECTOR COMMENTS False
V
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-253058. need concrete slab, fix
a/c drain, seal holes in closet
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
May 31,2016 For Inspections please call: (305)7624949 Page 25 of 45
Miami Shores Village z>>
10050 N.E.2nd Avenue NE
• Miami Shores,FL 33138-0000
£
vF Phone: (305)795-2204 �` ,3� £ £ t £ ,: ,,, ......... . ... .:;,...z,= .• ,
tox Expiration: 06/2712016
Project Address Parcel Number Applicant
161 NE 106 Street 1121360050140
Juan Carlos Ruiz
Miami Shores, FL 33138-2032 Block: Lot;
Owner Information Address Phone Ceti
FLAVIO DATORRE 161 NE 105 Street (305)962-1862
MIAMI SHORES FL 33138-
161 NE 105 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 3,000.00
ARCTIC CIRCLE AIR CONDITION SER (305)904-2867
�- Total Sq Feet: 0
Tons:3.5 Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Approved:In Review Review Mechanical
Comments: Date Approved::In Review
Date Denied: Type of Work:
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80 Invoice# MC-2-16-58708
DBPR Fee $2.00 02/17/2016 Credit Card $50.00 $67.80
DCA Fee $2.00
Education Surcharge $0.60 02/29/2016 Credit Card $67.80 $0.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $117.80
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: 1 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio7:T—.i I'-- — uthorize the above-named contractor to do the work stated.=nl
February 29,2016
Autho re:Owner / Applicant / Contractor / Agent Date
Building Department Copy
February 29,2016 1
V!A
Miami Shores Village
J Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 FEB 17 2 16
Tel:*(305)795-2204 Fwc(305)756.8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762.4949
FBC 20`4
BUILDING Master Permit No. tqc - 16. 14•Z7
PERMIT APPLICATION Sub Permit No.
BUILDING [:]ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION MRENEWAL
❑PLUMBINGMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑SHOP
/ CONTRACTOR DRAWINGS
JOB ADDRESS: l ®�
Miami Shores 2 County: Miami Dade zip: f /'
Folio/Parcel#: < I — Z 3 '���� "fio� Is the Building HbYoHcally Designated:Yes NO
Occupancy Type load: Construction Type: Flood Zone: B E: A FFE:
OWNER:Name Fee Simple Titleholder). �'� � "� Phon
Address a
City: �i �►► State- �� Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: •� � one#: `� I
Address: I 1 z:-Z- r"
City: LA i i� State: 1"' 1 Ztp: G.=
Qualifier Name: L2 / 10 ( :S 0h, Phone#: .r
State Certification or Registration#: Cr � ertfficate of Competency#:
DESIGNER:Architect/Engineer. Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/UneaXer1r/R*e
:r-k.
Type of Work: ❑ Addition Alteration ❑ New ace El Demolition
Description of Work: P,,h av ---,
L)-� -
Specify color of color thru tile: r�
Submittal Fee$. Permit Fee$ r CCF$_A
! ' J0 CO/CC$ 16
Scannhgt Fee$ •, ( O Radon Fee$ DBPR$ � � Notary$ _
Technology Fee$ `t Tralning/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(ReviwM2/24/2014)
M
Bonding Company's Name(If applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City Stat 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. 1 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$25w,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 f`first inspection whic cu , ven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be app ved and a r+e' spection fee w' arged.
Signature Signature
OW ER or A C CTO
Thefo alng InstruA;mu�
s acknowledged before me this The foregoing instru7-orwAnte'.
ks acknowledged before me this
day of {� 20 .by day of by
ON Q ia41125Iwjw%is personally known too is personally known to
me or who has produced ��V012 as me or who has produced l Li
Identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Si n• Sign: �f
Print: 0�� Print: �� ( ✓�%�Ik J
Seal: � Seal: ''
t�hoe R�ero ,� t R�ero
WWW AMNOTARY.MM MAW AARONNOTARY.COMt
APPROVED BY spa iner Zoning
BVIC�w...►..«.1 p...«.+... M..d.
• Miami Shores Village
Building Department
„d, 10050 N.E.2nd Avenue
Miami Shores,Florida 33138
Tel:(305)795.2204
t� 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 sheet.Multiple units on single sheets are not acceptable.
Job Address(where the work is being done): Ib I W 6 ' ��4
W. Miami Shores Village County: Miami Dade Zip Code:.
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
AHRI DATA SHEET REQUIRED
Change disconnecting means:YES❑ NO[f ARHI Sheet Attached:YES❑ NO[Contract Attached:YES
UNIT BEING REPLACED DATA NEW UNIT
MANUFACTURER ; ;5F6
AHU or PKG.UNI i Muuf:la
COND.UNIT MODEL# I I 1\
KW HEAT 1)
NOM TONS f 1
AHU CU PKG 1)M.C.A 1 i AHU CU PKG
AHU CU PKG 2)M.O.P , AHU CU PKG
AHU Cu PKG 3)VOLTS t AHU CU PKG
PKG UNIT / / 1 PKG UNIT —1---4—
EER/SEER
YES NO REPLACING DUCTS YES NO
YES NO REPLACING THERMOSTAT YES NO
YES NO NEW rCONCRETE SLAB YES NO
YES NO NEW ROOF STAND YES NO
YES NO NEW RETURN PLENUM BOX YES NO
1. Minimum Circuit Ampaciity(Wire Size): ��fC� �"•°J ' ® S `��®
2. Maximum Overcurrent Protection(Fuse/Breaker Size): 6 0 �
3. Voltage of Circuit(208/240/480):
4. Size Disconnecting Means: •• ••• • 6
Contractor's Company Name: t ' •'
State Certificate or Registration to. Certificate of Competenry No.
Signature / ••• •*'Date; ••0Zj. Z/,!r
(Qualifier' •. . • �• . • � a
(Rev1seWZt24/2014) •:• : : •:• • •
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RICK SCOTT,GOVERNOR KEN LAMM.SECRETARY
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ISSUED: 10/14/2D14 DISPLAY AS REQUIRED BY LAW SEQ# L1410140000326
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T�taCB t� fldBTdir the isaia,
Ift ROM MUbMVAW M" aad - L1i8a-7r6
DATE(MMMWYYYY)
AC4R1> CERTIFICATE OF LIABILITY INSURANCE
02/17/2016
THIS CERTIFICATE IS,ISSI'JSD AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES`POT 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(les) 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 CONTACT
Ample Insurance Company PHONE (321 222-1488 X
PO Box 929 .MAIL . Mpeeples@ampleins.com
INSURERS AFFORDING COVERAGE NAIL tR
Oakland FL 34760 INSURER A: CYPRESS INS.CO. 10953
INSURED INSURER B: NORMANDYINS.CO.
ARCTIC CIRCLE AIR CONDITION SERVICE CORP INSURER C:
11958 SW 122nd Ct INSURER 0:
INSURER E
Miami FL 33186-5063 IN R :
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 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.
ONOR SR TYPE OF INSURANCE POLICY NUMBER POLICY POU EXP LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE �OCCUR PRE !SE occ nce $ 100,000
MED EXP(Any one person $ 5,000
A SGL 008372500 10/30/2015 10/30/2016 PERSONAL&ADV INJURY $ 1,000,000
GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X
POLICY[7JE LOC PRODUCTS-COMP/OP AGG $ 1,000,000
OTHER: $
AUTOMOBILE LIABILITY COMN
Ea ac BlW?
l LIMIT $
ANY AUTO BODILY INJURY(Per person) $
At fO OWNED SCHEDULED BODILY INJURY(Per accident) $
HIRED AUTOS NON-OWNEDPROPE E $
AUTOS er Gocklent)
UMBRELLA UABOCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $
WORKERS COMPENSATION PSER
AND EMPLOYERS'LIABILITY YIN A X ER
ANY PROF"F-TOR/PARTNER/EXECUTIVE / E.L.EACH ACCIDENT $ 500,000
B OFRCERIMEMBEREXCLUDED? �Y NIA NHFL143139 12/182015 12/18/2016
(y�InIn NH) E.L.DISEASE-EA EMPLOYE $ 500,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS i LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached O mons space is required)
*'AIR CONDITIONING INSTALLATION SERVICE AND REPAIRS.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIO
Building Dept
AUTHORIZED REPRESENTATIVE
10050 NE 2nd Avenue
Miami Shores,FL 33138 i
01'9 2014 ACORD CORPORATION.All rights reserved.
ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD
A a
CFN:20160040310 BOOK 29933 PAGE 838
DATE:01/21/2016 02:11:55 PM
DEED DOC 2,250.00
HARVEY RUVIN,CLERK OF COURT,MIA-DADE CTY
This Instrument Was Prepared By and
Record and Return To:
Karen S.Leopold,Esq.
REO TITLE COMPANY OF FLORIDA,LLC
20801 Biscayne Boulevard,Suite 501
Aventura,FL 33180
Folio#311-2136-005-0140
SPECIAL WARRANTY DEED
This Special Warranty Deed is made this 19'day of January, 2016, by FANNIE MAE a/k/a FEDERAL
NATIONAL MORTGAGE ASSOCIATION, organized and existing under the laws of United States of
America,whose mailing address is P.O.Box 650043,Dallas,TX 75265-0043("Grantor"),in favor of Juan
Carlos Ruiz and Flavin Datorre,both unmarried,as joint tenants with rights of survivorship,whose
mailing address is 161 N.E. 105th Street,Miami Shores,FL 33138("Grantee"),
WITNESSETH:That Grantor,for and in consideration of the sum of$10.00 and other good and valuable
consideration, the receipt of which is hereby acknowledged, by these presents does grant, bargain, sell,
alien,remise,release,convey and confirm unto Grantee the parcel of real property situated in Miami-Dade
County,Florida,described as follows:
Lot 14, Block 201,Dunning's Miami Shores Extension No. 1,according to the map or plat
thereof, as recorded in Plat Book 41, Page(s) 51, of the Public Records of Miami-Dade
County,Florida.
a/k/a 161 N.E. 105th Street,Miami Shores,FL 33138
TOGETHER with all tenements,hereditaments,appurtenances,rights,reversions or reservations belonging
thereto.
SUBJECT to taxes for the year 2016 and subsequent years; conditions, limitations, restrictions and
easements of record which are not reimposed by this instrument and zoning ordinances and government
regulations,if any.
1
}
CFN:20160040310 BOOK 29933 PAGE 839
TO HAVE AND TO HOLD the same in fee simple forever.
AND the Grantor hereby covenants with the Grantee that the Grantor is lawfully seized of the real property
in fee simple,that the Grantor has good right and lawful authority to sell and convey the real property,that
the Grantor hereby fully warrants the title to the real property and will defend the same against the lawful
claims of all persons claiming by,through and under the Grantor,but none other.
IN WITNESS WHEREOF,this instrument has been executed by the Grantor as of the day and year first
above written.
Witnesses as to Grantor: FANNIE MAE a/k/a FEDERAL NATIONAL
MORTGAGE ASSOCIATION
By: REO Title Company of Florida,LLC,a Florida
limited liability company, as attorney-in-fact,
pursuant to Limited Power of Attorney
recorded in O.R. Book 28950, Page 1846,
Public Records of Miami-Dade County,
Florida
r
r
Miriam Eanks By:
Name: Karen S. o
Print name of Witness Title: President
1
ly Diaz.
Print name of Witness
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
The foregoing instrument was acknowledged before me this 19' day of January 2016, by KAREN S.
LEOPOLD, as President of REO Title Company of Florida, LLC,a Florida limited liability company,as
attorney-in-fast for FANNIE MAE a/k/a FEDERAL NATIONAL MORTGAGE ASSOCIATION,who is
personally known to me.
l
My commission expires: Notary Public Miriam Banks
Print name:
%I fit).
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�J` •yo Bond;dSN��: ��