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MC-15-688 l2C A�- 3 2 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-231102 Permit Number: MC-3-15-688 Scheduled Inspection Date: December 07,2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPlerre Inspection Type: Final Owner: MARKUS, DAVID Work Classification: Kitchen Hood Job Address:1190 NE 92 Street Miami Shores,FL 33138- Phone Number Parcel Number 1132050270460 Project <NONE> Contractor: DEDICATED COOLING LLC Phone: (786)326-0911 Building Department Comments ROUGH IN DUCT FOR EXHAUST HOOD TO BE DUCTED infractio Passed Comments TO EXTERIOR INSPECTOR COMMENTS False l 2 � C Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 04,2015 For Inspections please call: (305)762-4949 Page 3 of 28 Miami Shores Village , 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 Phone: (305)795-2204 Expiration: 11/0812015 Project Address Parcel Number Applicant 1190 NE 92 Street 1132050270460 DAVID MARKUS Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell DAVID MARKUS 1190 NE 92 Street MIAMI SHORES FL 33138-2935 Contractor(a) Phone Cell Phone Valuation: $ 875.00 DEDICATED COOLING LLC (786)346-4571 Total Sq Feet: 00 Tons: Available Inspections: Additional Info:ROUGH IN DUCT FOR EXHAUST HOOD TO B Inspection Type: Classification:Residential Final Approved:In Review Rough Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# MC-3-15-54953 DBPR Fee $2.25 05/12/2015 Check#:3105 $ 115.10 $50.00 DCA Fee $2.25 Education Surcharge $0.20 03/26/2015 Credit Card $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 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 AFFIDAV : 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 z in F rmore,I authorize the above-named contra or to do the work stated. aA- JA May 12,2015 Auth Signatu er / Applicant / Contractor / Agent Date Building Department Copy May 12,2015 1 Miami Shores Village MAR 26 2015 Building Department ��, 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762.4949 FBC 20 �® BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No o ❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING [MECHANICAL ❑PUBLIC WORKS ❑CHANGE OF ❑CANCELLATION ❑SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1190 /V ky- )— City: Miami Shores County: Miami Dade Zip-, FolIO/Parcel#: l ��.7-O�� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 71 y1-> AfA3 4!.5* Phone#: Address; 1190 ��:= a ` i— city: -_A4 fPA l State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:�C41E7> CIOL-IAL L.LC Phone#:�I 3({ Y-5,7 Address: jQk) I I'1 44A.. CAOE City: AtAK\ State: PL ZIP: Qualifier Name: l-IJ t S ,z-- Phone#: State Certification or Registration M Certificate of Competency#: DESIGNER:Architect/Engineer: bE�'fi CWPEL Phone#: Address: C. ( fyL/til •�91-L—" City:A!'� 3Y-7ftt= {-State: r=L Zip:33308 Value of Work for this Permit:$ ✓��� Square/Unear Footage of Work: k� $-4.)-7-, Type of Work: ❑ Addition 0Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 801261 6- 1 tJ '1UQ- fc2 £ sT ik20>, --fl GSE XC:t t> Specify color of color#hru tile: Submittal Fee$ Permit Fee$ LMCCF$ CO/CC$ Scanning Fee$ _...._ --_ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ _ Bond;Z (Revco- 02/24/2014) 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 AFFIDAVR: 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$250,the appilcant must promise In good faith that a copy of the notice of commencement and construction Hen law brochure will be delivered to the person whose property is subject to attachment. Also,a certlfled 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 a d a reinspection fee will be charged. Signature Signature_ OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this -22 day of T20 !S_ by day of t/( 11c-�Is 20 b Qy dS wh Is personally known to I OL l -s02.t� L sonally known to me or who has produced s pro as me or who had -�-� --- produced as Identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: n 1 1 Sign: Sign: Print: Print: � .•••••�— L018EPPER Seal: * * My COk OS 7E If FF 045244 Seal: �°:«••�c LOISTEPPER FF 045244 EXPIRES:September 9,2017 * COMMISSION* IN # AOFRL��� BondedThM BtNoleryServices m� EXPIRES:September 9,2017 APPROVED BY Ins minerFu Zoning - - Review Cl (RevMd02/24/2014) 03-26-'15 13:30 FROM-Allied Kitchen 954-564-2676 T-356 P001/001 F-275 vtrvttcnyre ISW„ P�l,a? CR�IAKY $Wr=OF ',01 910 '• DEPARTME, 7'OF BftEg.$AN `I� OEE34NI�L'tZEGULAVIO(V C 'NQUS 7`tli? $ R'GOND'ITOM—IN CS CONI'RAGT r .UnIie w L`fTi a: fBr' h� p►!sisionsh P3X9 FS: ExpifliIT tete:'.A1�13 '!;'Z�.16 F�..% >.•: '�. • r..�py �.j ...: �� �� 't°t,” °•, ■tel D u u 1''^`.''�.....•o.,,''ti�';'. 1'•�`•, + t !P..+{''���� , , r„ •♦.:'` A• :.Y�tM�_.•��A,Y�... •,���a h,.♦ :�,,t � � x.r.♦ ♦'.� ? . '3� •4.•'t'`,',•^` a ',I d i ».8;.,J"' .'»'w.p ♦" 'r,. 'aaA3 �•PW'3�'T. " v. •ak y ♦ �: •�•: a':\ �`•. .-L'♦• . .,1.. :,t: r+' r ,,.. •. '"+,'e' a d, t .✓°6 v .!°♦;.. + �, ,,,:...ww'«.•!! ,'• .: t •<' . tit 'a'�1 ,•`. Z S':,a,♦1,, ♦ gvA•`.a ♦ ••j t• ' G♦.J.,.dw.n'.....�..s A•w.....ti♦,ww♦.^:_r..r'_ "v .«' '. :: .e = ''�';�, t `S tis «.,•� ♦� ., ISSUED' OW2/LtW4 DISPLAYAS REQUIRCE)BY LAW sEq# L1448220000as8 Ery' .:y _.. •':" •.•:' �-`Ts"J�1=.,•t,'.Y..l:�/tii.'t1°' "i&. •�A°:�w.�T��,,i , !F � it i j ,'.e>` -•+. _ ... ... '•aa'e. Wa•.:�.i::'.<> "•%i::.•.;.a•:.,_:.. i .v of r ••f"1 o•J .•a •x�•S" i• 1 i + s SGC., qt BuB4NES9s > 'i Ii�•COOI ING LLC; 196 SpE °' AIVIIuAt C I A�I R, T LE&ro''' {. •.�, r ";i 7' `; This ''` t�iap • Vol boY' rmepa'I`ntoftlio. alBusiii®$aT•. I6aotal i ' ?_.•»r:••. _s/t!'z_ -:�:•T:. »,. ''a' 0�YB 8 nft8dtl fO 406 858,H011(4 y enta ry fig teem tglli,,�}�appIvtotlie{r,o �"�16I 'h 'iECEIP7i Q,bDovemo�j�pie s *I d1 ${d alY86talAs�,14�1ta �agitaSa48 8 .. FQrlf,Qf,�'":i�jf'`�irtatton,vT�t�•fdiwWefltleaeae�'v(gYrjl%�[�jy�`. . . -------­---------------- ------v-_----_---_•••raw---\-rr.war.. -___-__r-___Lq_ ,._�t•-----r,.�-----_--_ AT I IWF ------------ f $T goo. ?-�RiDA RTi41VT tag; la,Fs;�,aitc►ar$aroa !AIKI NIENT'41"jNANctA.,v$ie ' ` •`sc on Saga r 'py>iitrg: c�6c�a� I :, ig9fCbOh , 91Clrisoa�bitsar bvrsrON OF wows•CoMp643A oN , �►,r>� - �F COI�rSPR([CTIONINS<7t1STtZYGX17VtF*TtC} �p ww at4tpstt2l as.9:erua�tuLotetadionm Old itl fnthCSg d Cy8,6ustflsSS Or&ado :i LIiSsd+on8tsrtyff9:a�elsD�o(Imb8 ed8tt� e s 9nwMMr&'r a9M3Wnn D :. to, or4dw.6111 ,F8,HOd4eaotetec>ianmoe ��astsa'at�Ier .moa EFFEC71VEt)A7E .'kN2aF4 [XPIRN40DlOA??: 2!8/2G98 f' 4 t�lbe r QB24rs+oeatlariL 9R me' IJis�tl"M1)fenofice rE ums rt�z , N or i nce9>flhe ore 8a+ r } rpLO[oe(DAga16+KtIgQq!x [aquEcs+rleot fditf h FENI 4WIT868 rpizs vxg ac8td1,1� 'dep Wkwq,fw1CWo0 a 141,11firrBt tlmetaTuillvuaf0re ohaai�lsdbatha 13USINC98 NAME AND ADDRESSt .. . �' l3EDICl p vgok!NP LLC I { DEDICATED COOLING 8264 NW 174*M LANE i 1 NIALUM FL 33018 r f; SCOPES OF SU8INESS OR TRA ' r �I•smN'• m• { 02-13-'15 13:50 FROM-Allied Kitchen 954-564-2676 T-305 P002/002 F-079 OP ID:AEC CERTIFICATE OF LIABILITY INSURANCE `Mmwff ) 0211012015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOE$ NOT AFFIRMATIVELY OR NEGATIVEi.Y 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)Inust 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 eartificate does not Confer tights to the certificate holder in lieu of such endorsements ClawUCER osrr Compdny.Inc CT Shills Koons 2781 Executive Park Drive,fib PHONE 954389.030 FaX 954-389-0452 Weston,FL 33331 ON nDDRess- 19RIou:DEDIG-1 INSURERS)AFFORDING COVERAGE NAIL 0 Luis Per INSURED d Cooling LLC INSURERA:A-rlcanEmpire lns,Co. Luis Perms 8964 NW 174th Lane INSURERS: Waleah,FL 33018 INSURERC: INSURER D: INSURER E t INaURER F: COVERAGES CERTIFICATE NUMBER: R61/ISION N MISER: TH1318 TO CERTIFY THAT THE POLICIES 01=INSURANCE LISTED BELOW HAV!: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. rwF TYPE OF INSURANCE LICIT NUMBER MMJ L UM1TS GENERAL LUWMU1Y EACH OCCURRENCE Is 1,000,0001 • A X COMMERpALGENERALIIABIU7Y 14CG0177265 02108/2015 02/0812016 PREMU SEname $ 100,00 ClA►MB MAGE �X OCCUR MEA EXP 0 ate anon) S 1,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 21000,00 GEM=PX POLICY 4GATE 1M1TAPPLIE$PER O_=_ tAO PRODUCTS.COMP/OPAGG S 1,000100 AUroMDBnE LraelurY ' COMBINED SIDLE LIMB $ ANYAUTO (FA—ddmO ALL OWNEOAUT08 BODILY INJURY(Pet"I's on) S SOHEOULEDAUTOS BODILY INJURY(Fersatdent) S U REOAUTOS PROPERTY DAMAGE $ (PER ACCIDENT) NON-OIADIEOAUT� $ tIMBR6LLA L01BOCCUR - EXCESS LIAR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ OEDUCME RETENTION $ 1ANDEMPSCRRVLIA N E YIN 1A' A pR_ $ AND EMPLOYERS'LIABILITY . V,=my ANY CLUDEDT NIA E.L.EACH ACCIDENT $ l ,=myr,NN) 0yt�S tlesotitbu or e.LDIS6ASE-EAEMPLOYE $ OEStiRIPTION�OPERATION3 Dalow E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPMAZONe/LOCATIONS/VEHICLES(Aper,):ACORD 101,Addttlenal Rereatkg Sdteattl®,V mom Space Is rst{ulree) A1C Contractor CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village TKII EXPIRATION DATE THERSOF, NOTICE WILL BE DELIVERED IN Building Dept, ACCORDANCE W11•N THE POLICY PROVISIONS. 10050 NE 2nd.Avenue AUTHOMMREPRESENTATIVE Miami,PL 33138 ®1988 2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered manta of ACORD t JEFF ATINATER CHIEF FINANCIAL OFFICERSTATEOF•FL•ORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPtNSATION *"CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW'" CONSTRUCTION INDUSTRY EXEMPTION This oed fies that the inclMdual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 2/8/2014 EXPIRATION DATE: 2l MIS PERSON: PEREZ LUIS M FEIN: 453417866 BUSINESS NAME AND ADDRESS: DEDICATED COOLING LLC DEDICATED COOLING 8964 NW 174TH LANE 4 HIALEAH FL 33018 SCOPES OF BUSINESS OR TRADE: z s HEATING,VENTILATION, AIR-GOND = Pursuant to Chapter 440.OS(14),F.S.,an offer of a carpmagon who elects exmnption from gds chapter by On a oadocate of ete¢Non under itds section may not rseover benefits or wmpeaw ion under eft dmpler.Pure1,0011 to Chapter 440.05(12k F.S.,Cer0cates d ekaw to be exempt...apply o* YAM the soap*of @te.buslam or treda•Reted on•the nafte of elecom to be exempt.Pursuant ID Chapter440.0RM.F.S.,NdM of eleow to be exerrtpt•and of election to be exempt shag be mrbled to revocation ff.at any ong after ft fi"dlim nuke or pre Issuance of the , lute person named on the nWke or ce floe no IaW meets the ode of INS sedtonforb of a cefgliCate.The deparbata shall revoke a e DFS-F2-DVVC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 z Y f 1, C T t Date: F,Ga2UA" /(V"�;MS State of_ +-M - County of Before me this day personally appeared_ L✓ls d�Ft2�z deposes and says: who,being duly sworn, -r--t LU I S f-::� O ©Nu4 ©NO�F- -,bOiAIG- N Sworn to(or affirmed)and subscribed before me this Lday of 1�vm-x20 I PkF R fr' /--b Y Personally know Or Produced Identification Type of Identification Produced ` J Print,Type or Stamp me of Notary l►AY PU�i L0197MM A.v a Ri�w sua t�mry98�vk�s ago a�.� Miami Shores Village Building Department R 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of _ workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.. Therefore.You may be personally liable for the worker compensation iniuries of any person allowed to work under this hermit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contractor VSignature- Signature: .019 State of Florida State of Florida County of Miami-Dade � County of Miami-Dade The forego' was acknowledge before me this The foregoing was acknowledge before me this lS- day of AV U yrx 20 l, ". day of J� v.�i ,201' By PA-c,t,o vS BY Z iir<- who is personally known to me or has produced who is personally known to me or has produced as identification as identificatioi Notary: Notary: .* L0187EM SEAL: * * W COWk%ON#FF 045244 SEAL: * * 0A9a 100Nt FF0044 EXPIRES:Segember 9,2017 r EXPIRES:September 9,20t- TkoRji+.d