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MC-15-2093 Inspection Worksheet Miami Shores Village ✓ 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-241642 Permit Number: MC-8-15-2093 Scheduled Inspection Date: April 04,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: FERNANDEZ,STEPHANE Work Classification: Addition/Alteration Job Address:1148 NE 105 Street Miami Shores, FL Phone Number Project: <NO.NE> Parcel Number 1122320280140 Contractor: AIRE DISCOUNT INCORPORATED Phone: (954)394-2843 Building Department Comments RELOCATE DUCT AND INSTALL 2 REGISTERS. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. April 01,2016 For Inspections please call: (305)762-4949 Page 3 of 35 y Miami Shores Village 10050 N.E.2nd Avenue NE ration' '• Miami Shores,FL 33138 0000 5 Phone: (305)7952204 11 ` 9120 Expira tion: 0 /27/2016 Project Address Parcel Number Applicant 1148 NE 105 Street 1122320280140 Miami Shores, FL Block: Lot: STEPHANE FERNANDEZ Owner Information Address Phone Cell STEPHANIE FERNANDEZ 1148 NE 105 Street MIAMI SHORES FL 33138- 1148 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 900.00 AIRE DISCOUNT INCORPORATED (954)394-2843 _.. _ Total Sq Feet: 0 Tons: Available Inspections: Additional Info:RELOCATE DUCT AND INSTALL 2 REGISTE Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Underground Date Denied: Type of Work: Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# MC-8-15-56756 $2.25 08/18/2015 Credit Card $50.00 DCA Fee $2.25 $259.10 Education Surcharge $0.20 09/29/2015 Credit Card $259.10 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Work without Permit Fee $150.00 Total: $309.10 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 AFFIDAVIT: I certify that a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and Futherr�ar ,I a thorize the above-named contractor to do the work stated. September 29, 2015 AutpoRied Signature: er / Applicant / Contractor / Agent ate Building Depa ent Copy September 29,2015 1 Miami Shores Village - - - � d Building Department , JAUUG8 ZU15 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 PermitNo.p—n—o 13-3-3 PERMIT APPLICATION Sub Permit No.�A O°- 19- 2(fT-3 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING (r MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP r r f GCONTRACTOR DRAWINGS JOB ADDRESS: I `t 0 �J ST— City: Miami Shores County: H— Miami Dade zip: 33f 3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): !;TE0AAAtlje - ,_ qAM Dez Phone#:I�5-- I�� fig lA Address: \14T r* i�rc City: MS.AAlt State: fz' Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: .L, L��(I I f_ov Phone#: Addre /C- City: State: ]� �+ L' Zip: 31-71>7 Qualifier Name: Phone#: State Certification or Registration#: /T Z Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Cto® Square/Linear Footage of Work: Type of Work: ❑ Addition ji�l Alteration ❑ New 'Repair/Replace ❑ Demolition Description of Work: RZ-L0 C-A,1e-1- AAjD f A)ST A uLr �;k. a0Q(Sl�S N 19 Specify color of color thru tile: Submittal Fee$ C0(211' Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 1-04 (Revised02/24/2014) Bonding Company's Name(if applicable) e r 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. Signature Signature OWNER or AGENT XKNTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 1 , by /-2— day of i 20 J by n� s er n DNOl'C. N R I'ty,who is personally known to (1EgDr who has produced as me or who has produced r-10-4,loot 19,61t/ /4'11A i4as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print. •• N Print: Seal: r� Seal: ®.• Ari ��qi o EVIM SMCNEZ #EE 21M ;Q $ Notary Public,State of Florida Comm�iori#FF 31875 ��#P#�a�Qdi x*xx�x�xx*�x*�xx Uc ST"'�.�, APPROVED BY q, t4 tpl�aminer Zoning Structural Review Clerk (Revised02/24/2014) �:••• nm Miami Shores Village "=�'� Building Department ��RNA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. /COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ................... ............. ........�p. ........... ....�........................ ..... BUSINESS NAME: e� �,N BUSINESS ADDRESS: I �� 3 �ITY ATE.L 1— � ZIP 3 BUSINESS PHONE: � �Y '- FAX NUMBER( CELL PHONE ( QUALIFIER'S NAME: L_� �� QUALIFIER'S LIC NUMBER: tT"N s � f 41STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY UCENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE ' FL 32399-4783 BARCLAY,DONOVAN DE CORDOVA AIRE DISCOUNT INCORPORATED . 2831 SUNRISE LAKES DR EAST UNIT 303 SUNRISE FL 33322 — orwmfr Florid fico by the DeRrhment of&ups and Prothsobnal Rin. Our professionals and bjWn8ssw range from architects to yacht-brokers,from boxers to due restaurants, and they heap Florida's ecorwmy strong. Every day we work to bnprove the way we do business in order to serve youbefter. For InIbmmtiar about our services,please log onto ww�v myflo cam. There you can tbrd mwre brlan dlon about our divisions and the nuittions that knpact you,subscribe Z=:.nent nwisletters and team more abaft the Depa tmenCs Our mission at the Dhpartrnerrt is:License Ethderilly.Regulars FaW We constantly strive to serve you better so that you can serve your customers. "thank you for doing busbuess in Florids, and con akdations on your naw lic ensel DETACH HERE RICK SCOTT,GOVERNOR KEN tAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC1813954 The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 a-� L BARCLAY, DONOVAN DE CORDOVA AIRE DISCOUNT INCORPORATED .. 2831 SUNRISE LAKES DR EAST UNIT 303 SUNRISE FL 33322 m �. tMED: 07117=14 DISPLAY AS REQUIRED BY LAW SEs# L140717 1 EWt_ --- - - - BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT Ft -1t000 Lauderdale, FL 33301-1895 115 S.Andrews OCTOBER 1,201.5 THROUGH SEPTEMBER 30 2016 R@C@Ipt " -1371 HEATING/AIRCONDITION CONTRAC�R Business Name'AIRE DISCOUNT INCORPORATED Boniness Type:(AC CONTRACTOR) Business opened:04/25/2004 owner Name:BARCLAY DONOR DE CORDOVA State/Courlty�CerUReg:CAC1813954 Business Location-41 NW 43 TE Exemption Code'' PLANTATION Business Phone:954-394-2843 Rooms Seats Employes Machines Protessl°°ale 4 For Vel Bus6teas only Number of Machines: Vending Type: Penalty Prior Years Cotlec oon Cast TotaV Tax!277 wtt Transfer Fee NSF Fee 0.00 0.00 .00 0.00 0.00 0.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet aA County and/or Municipality Planning WHEN VALIDATED and zoning requirements.This Business Tax Receipt must be transferred when tine business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: Receipt X138-14-00009718 BARCLAY DONOVAN DE CORDOVA pa:Ld 08/07/2015 27.00 41 NW 43 TERR PLANTATION, FL 33317 2015 - 2016 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/13/2015 PRODUCER I I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION A.M.C. INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. BOX 15880 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PLANTATION, FL. 33318 (954) 581-5800 INSURERS AFFORDING COVERAGE NAIC# INSURED AIR):a', DISCOUNT INC. INSURERA: CAPACITY INSURANCE CO. INSURER B: 41 NW 43RD TERR INSURER C: PLANTATION, FL 33317 INSURER D: 954-240-6121 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I aR WIYL POLICY EFFECTNE POLICYEXP IRA TION LTR NERD TYPE OF IN RANCE POLICY NUMBER DATE MM/DD DATE MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,OOO 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oacurence $ 100,000 CLAIMSMADE X OCCUR MED EXP(My one person) $ 5,000 A CLM01009868A 2/18/2015 2/18/2016 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY 7 PRO--JECT F77] LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ EXCLUDED ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ EXCLUDED SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ EXCLUDED NON-OWNEDAUTOS (PeraocideM) PROPERTY DAMAGE $ EXCLUDED (Peraccident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ EXCLUDED ANYAUTO OTHERTHAN EAACC $ EXCLUDED AUTOONLY: AGG $ EXCLUDED EXCESS/UMBRELLA LIABILITY IFACH OCCURRENCE $ EXCLUDED OCCUR CI CLAIMSMADE AGGREGATE $ EXCLUDED $ EXCLUDED DEDUCTIBLE $ EXCLUDED RETENTION $ $ EXCLUDED OTH WORKERS COMPENSATIONAND TORYLIMffS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ EXCLUDED ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ EXCLUDED Iiyes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ EXCLUDED OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS AIR CONDITION REPAIR & INSTALLATION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO MIAMI SHORES VILLAGE DATE THEREOF,THE 18SUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN BUILDING DEPARTMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 10050 N.E. 2 AVENUE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE I SURER,ITS AGENTS OR MIAMI SHORES, FL 33138 REPRESENTATIVES. F305-756-8972 AUTHORIZED REPRESENTATIVE ACORD25(2001108) © CORD CORPORATION 1988 y PLEASE CUTOUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE........................................................... OFF ---------------------------•-----•--- .- -R---�--------------------------WMAW------------------------ s , FLORIDA Furwant to Chapter 440. 14),F.B.,an of6oer a a ompo�fon ; DEPARTMENT OF FINANCIAL SERVICES 1Nh0° IbebWo �' a oerff»cate a DMSION OF WORKERS'COMPENSATION ^; on cbn bm somay tit benefds or F r CONSTRUCTION INDUSTRY EX mpnON '' •,�*° 'O PumuaMto ompter44a. �2)),F.B., ofe�onto ' be exempt apply oNy wfgdn ff+e eoppe the bLmbw a or Craft L Ibtea on the rtof�e offbn to be exempt a` ttoarow m mpTmaat n .D ' pwmm to 0440.6( F.B. Notioea a elaadon to be ' exempt and a n tobe A be tB+FaoTNS DAT& Brl1/1p16 WMATM DOW 5MJ2M7 ' tD rwoonom:K et any afro of itt, of the MUM ; I'I ortfie Wean ofthe osmicate theperson nanrod on ft , MOM MRC AY 00NOYMI i E rMw or awMaate no W4W melt the i 80ftn far beauWM of a omtiNoete.The ddeepau rk iu WW e Fm �oeesaes ;R �,r 'wm t'win a*a po an tm BUSINESS NAIVE AND ADDRESS: E tothe f equtremwts AIRE DISCOUNT INCORPORATED 2831 SUNRISE LAM OR EAST 11i3c13 t , SUNRISE FL 33322 SCOPES OF BUSINESS OR TRA } ;HEATING,VENTILATION, FAIR-COND --------------------------------------- ................................................................................ r DFS-F2-DVVC-282 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08.13 QUESTIONS?W"13.18W F t P' n 't J 4 ' s r 7 I I AIRE ED DISCOUNT i ?_ °` N ES 303 i D F � 7 all SUNS, M 3332 9M 394 2-943 Froar. WVDVM ll" y ,1 4/�aZ, �� ✓ ���� /O `` VA �6"ll'Pubil�o ss 017 1 Florida �ammii � PF 91672 UT My so 2097 Miami shores Village Building Department RtUp' 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 1 workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. I Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of 20__� By sonall known to me o as produced s identification. Notary: .••....., :y �•� qq Ct��, SEAL• tP�* AK k #EE21W llty 1 I Miami shores Village � 1oR43, !� �� Building Department ]KIN111 , MIN 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 -%IvaW DA► Fax: (305) 756.8972 August 17, 2015 Permit No: Mechanical Critique— Manuel Salzard � yu TD Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re-submittal drawings.