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MC-14-1930 ' Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-257041 Permit Number: MC-9-14-1930 Scheduled Inspection Date:April 18, 2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: MURILLO,SHIRLEY Work Classification: Addition/Alteration Job Address:147 NW 109 Street Miami Shores, FL 33168- Phone Number Parcel Number 1121360030200 Project: <NONE> Contractor: T&S COOL AIR CORP Phone: (786)718-0968 Building Department Comments NEW MECHANICAL FOR ADDITION Infractio Passed Comments INSPECTOR COMMENTS False V Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-219030. not ready Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. April 15,2016 For Inspections please call: (305)762-4949 Page 35 of 37 1 b Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 SEP 0 5 2014 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 BUILDING Master Permit No.-V614_ q_so PERMIT APPLICATION Sub Permit No. q , lq— 19_3 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING % MECHANICAL [—]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 1 t , CONTRACTOR DRAWINGS JOB ADDRESS: 1�`f N W loci y City: Miami Shores 1 County: Miami Dade Zip: �� l Folio/Parcel#: k\—.A JlD xQ03— WOO Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 5 ` o Phone#: 19(a io l )05j Address: 114 � Wi to City: 1 o(t J State: Zip; Lo® Tenant/Lessee Name: Phone#: Email: (� 1 CONTRACTOR:Company Name: �t COOL Aa` /7/51�p Phone#: 38 "329"'0%68 Address: � 97.T3 City: iV_1;fn2r State: )C�L Zip: Qualifier Name: AS /--o{ Phone#: 9-1369 769 State Certification or Registration#: 1'9( -7751 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ `7 Square/Linear Footage of Work: Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace U Demolition Description of Work: Vatj tj?CLAn,rCA( k*x, 4,)d iO�7 Specify color of color thru tile: Submittal Fee$ c Permit Fee$ x-10 CCF$ CO/CC$ _ Scanning Fee$ Radon Fee$ �' cam--' DBIPR(,$ Notary$ Technology Fee$ �� Training/Education Fee$ 4 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$` A ' (Revised02/24/2014) <IV 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. d Signature J& q Signature OWNS or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this f day of b-6v5f- 20 iby _ a day of 20 by who is personally known t- Dwho is personally known to me or who has produced as me or who has produceom"Q?3(Aoul� 7�4a identification and who did t t e tification and who did take an oath. . CINTHYA COPLIN NOTARY PUBLIC: COMMISSION#EE1141 ARY PUBLIC: • EXPIRES July 20,2015 Sign: c4E)1�3f1801`53 FW1da*WrA—te-WT Sign: Print: Print: JZ Seal: COMM MWWW Seal: ;Claudia Niedwiadowiez ^= rY COMMISSION# Commission#EE049734 J*28,2M Expires: DEC.16,2014 °, BONDED 1 HItU ATI Ah(IC BONDING CO.,INC. rrlp�'idaPa�i ty8ltgica APPROVED BY PI s Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) CReceipt Miami—Dade County,State of Florida TWISNOTAOU-DON"PAY 4 716M LBT 9753 SW 1 R CORP mss MS ST w-wo5 SEPTEMBER 30, 2014 AAli MI,FL 33157 fillust be dbpfryWatp1mof bugkim Pursuant to County Code urea-Art 9&'t9 Ovwwwk SM.TYPE T8 s COOL AIR CORP E�se FUUMnAW CMECHANICAL IESS PAYMUff C/O T+OMAS RODRMIEZ Q INRANA BY TAX t�RifeCT� tf, CONTRACTOR 75.E {$) i CACIS17754 0222-i US tldsioaalB sTaaf3e toslYBill I 0111111OL0401111811healsx-Rafteeiphssta Permit we ondbeftuslaxl „ '- mds�aLap.I mm ear arossaxd ""SP*t gw NO MOP11 Ke.eimmat6r 0189 000080101 sates-Ili eGodsSw&.V6. l�smrs • om cm3 a f STATE OF FLORIDA DEPART OF BUSINESS AND a� � �� PROFESSIO14AL REGULATION CAC1817754 t?7/Q912t}14 � jk' CERTIFIED AHS CENRQNTR �I RODRIGUEZ AKA,, T&S COOL AIR C-Ol � y IS CERTIFIED under the provisions of Ch.489 FS. EVIRO1datB AUG 39,2016 L1407070 —. ----_ ACORO® CERTIFICATE OF LIABILITY INSURANCE D/27/201/DD/Y 8/27/ 4 4 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(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 CT Cynthia Catano Sharp Insurance Agency PHONE (305)825-8580 FAX (305)825-8581 6175 NW 153rd St ate 200 E INSURER(S) AFFORDING COVERAGE NAIC 11 Miami Lakes FL 33014 INSURER A'Ascendant Commercial Insurance INSURED INSURER B:Castle int Florida Insurance T & S Cool Air, Corp. tNSURERC: 9753 Sw 191 Street INSURER D: INSURER E: Miami FL 33157 INSURER F. COVERAGES CERTIFICATE NUMBER:CL1482706102 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. INSR TYPE OF INSURANCEADDLSUBR POLI Y EFF POLICY EXP L� POLICY NUMBER M MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000,,000,000 X COMMERCIAL GENERAL LIABILITY 3 RENTED PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE a OCCUR =346074 9/30/2013 /30/2014 MED EXP(Anyoneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000 X POLICY F]JECT L1 PRO LOC $ AUTOMOBILE LIABILITY i Ea a t ANY AUTO BODILY INJURY(Per person) $ AUL OWNED ESCHEDULED LBODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLALJABOCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ B WORKERS COMPENSATION 7TMSTATU- AND EMPLOYERS'LIABILITY Y I N _UMTS1 IV ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEM13ER EXCLUDED? 1:1NIA (Mandatory In NH) P761267201 /22/2014 /22/2015 E.L.DISEASE-EA EMPLOYEE $ 1.000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) CERTIFIED AIR CONDITIONING CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Villas ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 Ne 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 Elio Alfonso/ANIVER ACORD 25(201(/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 rgrttnrsi n1 Tho A(`npn names and Irwin aro rcniefarnrl marls of Ar`(1Rrt