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MC-14-2584 �q Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-223906 PermitNumber: MC-11-14-2584 Scheduled Inspection Date:April 13,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: GUGUEN,ALICE Work Classification: A/C Replacement Job Address:10601 NE 6 Avenue Miami Shores,FL 33138- Phone Number Parcel Number 1122310120020 Project: <NONE> Contractor: AIR SYSTEMS AIC LLC Phone: (786)208-3484 Building Department Comments MECHANICAL WORK FOR MASTER SUITE Infractio Passed Comments INSPECTOR COMMENTS False 1� Inspector Comments Passed P9_ Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 12,2016 For Inspections please call: (305)762-4949 Page 1 of 49 Miami Shores Village 10050 N.E.2nd Avenue NE • � Miami Shores,FL 33138-0000 Phone: (305)795.2204 � � ��ti �� ,i�'� ' � �� '` s r Expiration: 02/2412016 Project Address Parcel Number Applicant 10601 NE 6 Avenue 1122310120020 ALICE GUGUEN Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ALICE GUGUEN 10601 NE 6 Avenue MIAMI SHORES FL 33138- 10601 NE 6 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 5,700.00 AIR SYSTEMS A/C LLC (786)208-3484 Total Sq Feet: 571 Tons: Available Inspections: Additional Info:MECHANICAL WORK FOR MASTER SUITE Inspection Type: Classification:Residential Final Approved:In Review Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 Invoice# MC-11-14-53702 DBPR Fee $3.00 08/28/2015 Credit Card $224.10 $0.00 DCA Fee $3.00 Education Surcharge $1.20 Permit Fee $199.50 Scanning Fee $9.00 Technology Fee $4.80 Total: $224.10 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 AFFIDAVI certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z Futhermore,I authorize the above-named contractor to do the work stated. August 28,2015 Authord6d Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy August 28,2015 1 Miami Shores Village Building Department �c� t � 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 AUG 96 a01J Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 _ FBC 20 BUILDING Master Permit No. 9C�k-1Lk -X50 PERMIT APPLICATION Sub Permit No. G / `Z S 67 F1 BUILDING ❑ ELECTRIC ❑ .ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑i MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: k0(00% bj-E LO iSg, City: Miami Shores County: Miami Dade Zip: %7"W Folio/Parcel#: 111 23u% d a 667n Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 44110Z C Phone#: Address:`` r�, City: f�/l i am i G 1'j&S State: P L Zip: ssl 9.16 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �s( �JU1S�-emr1S �,�..�. Phone#: S05 (4%k Icub Address: 410919 MUJ I S'3 S+-• City: a'Q % ug'.Y'm State: '� (_, Zip: 30J Qualifier Name: K.ou V Q2Qt�P2 ,�..��``,,11 Phone#: 30S Wst logo State Certification or Registration#: C Ac. s ss5 "7 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: �- City: State: Zip: Value of Work for this Permit:$�. �'— Square/Linear Footage of Work: S� Type of Work: ff �Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: tXi Ly– (} SPU f LWf-I "'DUCT` CPO f-r-- Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ �ee TOTAL FEE NOW DUE$ V (Revised02/24/2014) 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 on estimated value•excdedtng$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 ofthe 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 a proved and a reinspection fee will be charged. Signature Signature ell OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this nSO day of 20lam_,by (.Q day of 4 20 LS ,by i—}�;t►� �1�uQ� ,who is personally known to \ um ,who is personally known to me or who has produced LA InIn � as me or who has produced h L *&I as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Si dG Sign. Print: n� Print: Pc Seal: J%y REBECA M PASTRANA Seal: , REBECA M.PASTTR" MY COMMISSION 0 EE87Z624 My tOMMISSION# EXPOW.S:F MMM 07,2017 P?MIRES:Febnmy 07,2017 r 0*7 T-�_; APPROVED BY lans xaminer Zoning Structural Review Clerk (Revised02/24/2014) DATE(MMfDDNYYY) A�V CERTIFICATE OF LIABILITY INSURANCE 8/28/2015 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 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 CO E T Martha Salazar Gil, Garden, Avetrani Insurance Group PHONE (305)630-47771 No:(305)279-3022 10689 N. Rendall Drive ADDERS:msalazar@ggaig.com Suite 208 INSURER(S)AFFORDING COVERAGE MAIC# Miami rL 33176 INSURERAAccident Insurance Co. INSURED INSURER B: AIR SYSTEMS A/C LLC INSURER C: 4698 NW 133 STREET INSURER D: INSURER E OPA LOCRA FL 33054 1 INSURER F: COVERAGES CERTIFICATE NUMBER-CL1581907324 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 RADDLSUBREDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER MMID EFF M�MILIDDY EXP LIMITS LTR B COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE OCCUR PREM SES Ea occurrenceAGE TO RENTED $ 100,000 CPP000962801 8/16/2015 8/16/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ' GENERAL AGGREGATE $ 2,000,000 B POLICY F-1 JECT 71 LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINULE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peracddent UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETORMARTNERIEXECUTIVE YINN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddMonai Remarks Schedule,may be attached K more space is requh ed) Mechanical Contractor or Air Conditioning Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami. Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Joe Avetrani/MAYRA ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD iN9025 onun„