MC-14-1041 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972 L4 _3
(1 9_
Inspection Number: INSP-212801 Permit Number: MC-5-14-1041
Scheduled Inspection Date: February 18,2015 Permit Type: Mechanical - Residential
Inspector: Perez,JanPlerre
Inspection Type: Final
Owner: PALMISANO, INGRID&ERIC Work Classification: New A/C System
Job Address:1035 NE 96 Street
Miami Shores,FL Phone Number
Parcel Number 1132060143730
Project: <NONE>
Contractor: DADE SUPER COOL AIR CONDITIONING Phone: (305)233-3915
Building Department Comments
INSTALLATION OF 2 A/C UNITS ONE 4 TON AND THE Infractio Passed Comments
OTHER 5 TON INSPECTOR COMMENTS False
6
Inspector Comments
Passed IN
Failed
Correction ❑
Needed
Re-Inspection a
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
February 18,2015 For Inspections please call:(305)7624949 Page 3 of 52
i f
Miami Shores Village RECEIVED
Building Department MAY 21 '20%
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No.MC j L/ -- l0!//,
PERMIT APPLICATION Master Permit No.&
Permit Type: c
MECHANICALp
JOB ADDRESS: I35 , `I w a
City: Miami Shores County: Miami Dade Zip: 351 43 9
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
V �
2 ���oP �OWNER:Name(Fee Simple Titleholder):IL 4 I Yl id Porn I&
Address:1035 hmpSF•
City: MiOm i 5 S
State: ft— Zip: ."CJI �O
Tenant/Lessee Name: h 0 Phonek
Email �1 ` rn J
CONTRACTOR:Company Name: ,o6fr CQ)) j�j L Phone#: � 2� 3q 6,
Address: Q V l
p /�
13
City: I� t Q State: zip:.?)-5lq W
Qualifier Name: anlDnI n rr l� suo UPhone#:/ yy 227_!�-
State Certification or Registration#:RA C045:35-1 Certificate of Competency#: ll.tx 1�
Contact Phone# Z 3q r
DESIGNER:Architect/Engin Phone#:
. r
Value of Work for this Pe uare/Linear Footage of Work:
Type of Work: DAddress DAlteration ew ORepair/Replace L313 lift
Description of Work: 1 1 CM w (C 2 QC U n M. on f_ 41pn Q r�
On:C 5Mn
-7 !7 Submittal Fee$ �t��1 Permit Fee$ L- CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$ /y �
TOTAL FEE NOW DUE$ ^— CO .
../ _� I ?A
I !1 y
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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of FE Y 2011-by ,./4 X{p ?AJ.M 15#WO day of MAY .20 a by Amui,iL&--)a-l'
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification d who did tak an oath.
NOTARY PUB NOTARY P
.,
Sign: Sign.
Print ��J2 /�v PN
Print: g o B JZ?- M-90 y
My Commission eg;�r Notary Puorc State or Florida My CommiMg
I Robert Murphy
My Commission EE 201868 e of Florida
Expires Osn2nOr6 ar ,� e�wr*
APPROVED BY Tans Examiner
Zoning
Structural Review Clerk
(Revised 3/122012)(Revised 07/10/07XRevised 06/102009)(Revised 3/15/09)
1 \1 •,J.
ACORD CERTIFICATE OF LIABILITY INSURANCE o5f14R4
PROvicep Financial Insurance Brokers THIS CERTt TE IS ISSUED ASA MATTER OF INFORMA
TK IN
Fina Blue suranc Brokers
rive ers ONLY AND CONFERS NO MGM UPON THE CERTtFI'ATE
Miami,FL 33126 HOLDER.THS CERTICATE DOEs NOT AMEND.EXTEND
ALTER THE COVERAGE:AFFORDED BY 111E POLICES BEL
INSURERS AFFORDING COVERAGE MAIC#
Dade Supw Cool Air Condi o t o INSURER A:W6800Co.
13605 SUN 149 Avenue#13 INSURER&
Miami,'FL 33196 INSURER Q
INSURER D
INsuRER E:
COVERAM
THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSWD TO THE INSURED NAME ABOVE FOR THE POLCY PERF INDWATED.NO ANDING
ANYREQUIREMENT.TERRA OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTWATE MAYBE SSUEDOR
MAY PRETAIN.THE.IASt b AFFORDED BY THE POUCEB UB DESCRIBED HEREIN IS SECTTo ALL THE TERMS.ENCLUBIONS AND COOF SUCH
PODS.AGGREATE LATS SHOWN MAY HAVE BEEN REd=D BY PAID CLAiM3.
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TYPE OFE POLICY MASELam
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HVAC 1 MECHANICAL WORK
CERTMAlrE HOLD CANCELLATION
SHOULD ANY OF TIE ABOVE ONSCAM POLICE S BE CANCELLED 09FORE THE EXPIRATM
MIAMI SHORES VILLAGE BUILDING DEPARTMENT cA'mTmmw.7mmommmmwiLL itORTOmALAQiDl4YsuwP1TEN
1Q050 NE 2 AVENUE
MIAMI SHORES,FL.3313$ tancr.TCllwe nlWAIR HOLOM wMwTO Tm LEFT.MgFAi.LMTOwsoswua.
DOSE NOOBLIM"M OR LIABILITY OF AW UPON TttE W48UMR fM A SITS CR
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ACCORD CORPORATION IM
ACCORD 25(201W
amrt
ACORD CERTIFICATE OF LIABWY INSURANCE 05114/14
mwmlm 727-938.5$62 THlS CERTFICATE 18 ISSUED AS A MATTER OF INFORMATION
LION INSURANCE COMPANY ONLY ANO CONFERS NO RMITS UPON THE CERTIFICATE
2739 U.S.HIGHWAY 19 N. HooDER.Tm CERTIFICATE DOES NOT AMEND,EXTEND OR
HOLIDAY FL 34691 ALTER THE t,"OMMM AFFORDED BY T!W POLICIES BELOWmoullm .
UtERS AFFORDING COVERAGE NM#
DADS SUPER COOL AIR CONDITIONING INSURER A:LION INSURANCE COMPANY 11075
13806 SW 149 AVE,#13 INSURER a:
MIAMI,FL 33196 INSURER C:
INSURER D: -71
INSURER E:
G4VERABEa
THE poUC*$OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. ANDItG
ANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO"Vi THIS CERTIMCATE MAY BE OR
MAY PRET'AIN.THE NVS AW C£AFFORDED BY THE POLICIES DESCRIBED HMIN is SUBMT TO ALL TW TERMS.ENCLUSNONS AND OF SUCH
pouCK&AGGREATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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❑ CoMNMtMAL4WQVALLUWVrY DAMAWTo O 81 _
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tNRTiFICATE HOLDER CANCELLATION
- - 'aaroFTReAac�oF � TMEk�RAT�!
MIAMI SHORES VILLAGE BUILDING DEPARTMENT oA-m Tmmm7mmumwumcm TOMALvcAYBWmrm
10050 NE 2 AVENUE NOT=roTWC0"V40A're HOUNER HA To DOI IFT,BUTFAUMT00060 H"
MIAMI SHORES,FL 33138 *4oymcltu '"pmy" nm rmA sOR
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ACCORD CORPORATION 188$
ACCORD 25(=I=)
(� Parsons General Contractors, Inc: : Ct�t1FaG
L.J tsar sw W Ague
parsordawwrai Palmetto Bay FL:33157 uiJConfraC# : 304
t3W 259.9598 ,
Ltcsnse: Coo o ubcontract Date:0410014
(7 rF
JUL 16 2014
To: Dade Super Coot Air Conditioning By' t: 62
13605 SW 149 Ave Palmiss no Residence
Suite 13 1035 N 96 Streeet
Miami FL 33196 Miami hares FL 33138
You are hereby diraded to perform the followtrtg work per Plans Attached []
the plans and sped fic icn9 prod..
R+�ntlon Rate:5.00% Specificati oris Attar ed ❑
Deaoripgpn of Work Cost Coude Description Amount
MVAC:work. : 18500.000 WAC 22,2W.o0
Notes
Su......r or,Dade Super Cant Air Conditioning,as an independent ent contractor and shoi r mvide and furnish all labor,
materlais,tools,supplies,equipment serves,facilities.supervision,and administration; ssary for the proper and complete
performance and acceptance of the following.portions of the work,hereinafter"the Subco. Work",for the Prate,together
with such.other portions of the dramas.speciflcoWos ane:Addendum(as related thereto.
Scope of Work,Cor tl6m,and fist of Attac homts:
Attachments:
1. Contract Drawings as per Attachment"aa
2 Some of Wo*as per Attachment st3°
.3. Schedule afalis:and Payment Application Form(AIA G-702;t703)as per:Atta ettt'C°.
4. Insurance requirements ask"7
S. SubcontractorNendor FEIN Form {First Job}
8. . 'Release.Auttaization Form(First Job)
EXCLUSIONS-NIA
Amount of S ibcontract 2UN t00
Contractor _ ' . Date 611-
'Sutoontraotor ,.�.,_ �,� Date ,
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