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MC-15-2779 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-258502 Permit Number. MC-10-15-2779 Scheduled Inspection Date: June 06,2016 Permit Type: Mechanical- Residential Inspector: Perez,JanPlerre Inspection Type: Final Owner: SUB LLC,SRP TRS Work Classification: Addition/Alteration Job Address: 10540 NE 2 Place Miami Shores, FL 33138- Phone Number (954)671-1400 Parcel Number 1122310130540 Project: <NONE> Contractor: UNITED BREEZE CORP Phone: (305)262-2530 Building Department Comments DRYER VENT RELOCATION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-246986. need metal duct for dryer Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid June 03,2016 For Inspections please call: (305)762-4949 Page 13 of 31 - ' hl Miami Shores Village gam , 3 €ttI 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000' Phone. (305)795-2204 Expiration: 05/01/2016 Project Address Parcel Number Applicant 10540 NE 2 Place 1122310130540 SRP TRS SUB LLC Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell SRP TRS SUB LLC FL (954)671-1400 1999 harriosn Street oakland CA 94612- Contractor(s) Phone Cell Phone Valuation: $ 200.00 UNITED BREEZE CORP (305)262-2530 -._.. _...�..-......_�.._ ...._�.. Total Sq Feet: 0 Tons: Available Inspections: Additional Info:DRYER VENT RELOCATION Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work: Underground Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# MC-10-15-57619 DBPR Fee $2.25 11/03/2015 Check#:5306 $ 115.10 $50.00 DCA Fee $2.25 Education Surcharge $0.20 10/30/2015 Check#:5303 $50.00 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $165.10 In consideration of the issuance to me of this permit, I agree to pet'irm the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, ents or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by it myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOW ,D S,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informat i rate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-na nt ctor to do the work stated. November 03,2015 Authorized Signature:Owner / Applicant / C or / Agent Date Building Department Copy November 03,2015 1 (/��• Miami Shores Village77 _ e� Building Department OCT 3 ® zoi5 10050 N.E.2nd Avenue,Miami Shores,Florida 33138' Tel:(305)795-2204 Fax:(305)756-8972 ! _ INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2010 BUILDING Master Permit No.11kc Is- %z f PERMIT APPLICATION Sub Permit No. !4G IAE�- 2-7 7-q ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ;N MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP ,7 CONTRACTOR DRAWINGS JOB ADDRESS: SD-57�1O &'47 ®Z n�/°'IGC /�/ i0/�5 3�(✓,�� City: Miami Shores County: Miami Dade Z)p: �✓�" Folio/Parcel#: /�—Z �D/3�Syy Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: t OWNER:Name(Fee Simple Titleholder): g��,00 773-5 Phone#: g�Jy G7��7Qd Address: Z70Q /.C6S 4W-14 44W W171'1- hIlY City -�/� �� State: Zip: 10 Tenant/Lessee Name: Phone#: Email: �1��`7D/�J.�S�ii'D?1�J•�rd� CONTRACTOR:Company Name: Namey:� 9121 led �/�Ca� �f/�� Phone#:.���Z" ZS�o Address: ik�/-7 / ��/� ® Z 4ee City: '071,77/• State: Zip: Qualifier Name: 94/��x7/f/�/�/�r-� Phone#: a215_9417 State Certification or Registration M L! ��l ZZ� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ .0//� ' ®® � Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ pair/Replace ❑ Demolition Description of Work: /J �/ 12'� *Iae'4Re4M Specify color of color thru tile: Submittal Fee$ @ Permit Fee$ 'b CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (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 an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a ref on fee will be charged. Signature Signature E or AGENT CONTRACTOR The foregoing instrumen was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20 A5 .by g�?,? day of OO 20 A5 by is personally known to �li/r l/%/�� who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: t r Sign: Print: Print: ���� 71 e2t Seal roe' ' °� GREIDY MARTINEZ 1. :'"�°y°�.. GRE:IDY MARTINEZ, Seal: =•i MY COMMISSION#FF153840 'i MY COMMISSION#FF153840 EXPIRES August 24,2018 `° of o?°' EXPIRES August 24,2018 407 398.0163 FloridONrAn 9orvie®.0®m 407 39®=0163 flori(Jallota2S@rvice.com ffiffiffiffiffiffi### ff ffiffiffiffiffiffiffiffiffiffiffiffiffi###ffiffiffiffiffiffiffiffiffiffiffiffiffi ffiffiffiffi APPROVED BY L Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ..................-............ 004481 w 3' Yi 1 tix%4;5E%:'.,'„i3,§'� !;k,,i,.t. .ey „'xPV�`•k�T�8, •w,:Y' �3:Er`??�':,"�'.`tsaz�..i 'k'4'• Ora^.w a:x•."^>� t.. .°n i t3.'� P,G•',.'.'+• 1i%!};`'.ai'� q' �u`'E Ali•%P�.i�'.{9• *n>inS�•� `':..::v:'�:,h�'`,�Y�'�.:>�` ci Q. ,•�, .'M'�•'� }�Y• F"a�sRr z;s K y t.'> So�..Nb '�,�}w5�.'y.�,cty���<�i'•' %"� ro SSh�y'S,<�.d� >`. Je 9 3c^h. �'hY R• 5 p� ,�t•..�+y..0 g:�S-.c�' ' /$,,��.:�• 9�sp..µ, •�•,,k "y,�f�5 r�/�C�q`.> �v��?. i%<?� � n��.,$ti�'`�'2i�.,: '}'•�'>V'. •: N, f��c�;az�''���CNyu'"} A �t<.. .+x°.�'. 1^d:`... .. ..N' ni. 3•' Sy y,'��,��.,. dv. A•t'.yo . ''R�'`Fi`' �:,%.'�"'r°,w,<,N�tX<,• S �'%.t:i`da�x••t•, YYYYY �S�,�n�''.+ ' Owma - BEtC. @ OF , CORP ;.. 88 SPE*'ME �1 00 . '� x 5.00 22/2RON ' -' ECK2 15-102801 i 4�!F,. B�wiee¢eTtuG 7be ionota r f own the of H sure to the b t bawl be an an a.OWN 9 i A D® CERTIFICATE OF LIABILITY INSURANCE DATE(MAr/DD/YYY1� 10/26/2o1s 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 endomement(s). PRODUCER CONTACT NAME: Automatic Data Processing Insurance Agency,Inc. E-MAIL FA ac No 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURERS)AFFORDING COVERAGE NAIC B INSURER A: RetailFirst Insurance Company 10700 INSURED UNITED BREEZE CORP INSURER B: DBA:United Breeze Corp INSURER C: 931 E 9TH ST INSURER D: Hialeah,FL 33010 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 407541 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. LTR TYPE OF INSURANCE INSD POLICY NUMBER MMIDD A013L POLIEFF MMIDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ TEIY CLAIMS-MADE FIOCCUR PREMISES a occ nos $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITYO(Eaaccident)I T $ ANY AUTO BODILY INJURY(Per person) $ AAILL 001SWNED SA�OSULED BODILY INJURY(Per accident) $ HIRED AUTOS AUTOSWNED F�PE DAMAGE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X I PER AND EMPLOYERS'LIABILITYY/N STATUTE EORTH ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBER EXCLUDED? ❑Y NIA N 0520-47610 05108/2015 05/08/2016 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ DMen under RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is nxRdred) License#CAC1817220 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 No 2nd Ave Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE C 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD DATE(MMIDDIYYYY) ACC'>RV CERTIFICATE OF LIABILITY INSURANCE 10/28/15 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 CONTACT Xamet Barreras Temax Insurance Inc PHONE (786)539-5989 FAAfCX No,. (305)356-1235 7990 SW 117 Ave E-rrAIL xamet@temaxinsumnce.com Suite 113 INSU 3 AFFORDING COVERAGE NAIC B Miami FL 33183 INSURER A: Capacity Insurance Company INSURED INSURER B United Breeze Corp INSURER C: 6979 NW 82 Ave INSURER D: INSURER E: Miami FL 33166 INSURER F: 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. INSR TYPE OF INSURANCE ADDL SUER POLICYNUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1+0w,ow 1�C COMMERCIAL GENERAL LIABILrrY DAMAGE TO RENTED $ 100 Opp CLAIMS-MADE R✓ OCCUR MED EXP oneperson) $ 5,000 A CLM01002278B 9/25/2015 9/25/2016 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2+000+000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2+000+000 %X POLICY PRO- Loc $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIM OCCUR EACH OCCURRENCE $ EXCESS LU1B CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TnRV LIMITS FR ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ Nyyeess describe under DES(:RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarics Schedule,H more apace is required) CAC 1817220 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD IM r t��1V@ 6_W3