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MC-14-2562 Inspection WorksheetC- t 4—1 e CA Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-266981 PermitNumber: MC-11-14-2562 Scheduled Inspection Date: September 12,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: , Work Classification: A/C Replacement Job Address:2 NW 108 Street Miami Shores, FL 33168- Phone Number (305)773-3101 Parcel Number 1121360110090 Project: <NONE> Contractor: HVAC ENERGY SOLUTIONS Phone: (954)391-7029 Building Department Comments A/C CHANGE OUT. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-223749. missing lock cap Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 09,2016 For Inspections please call: (305)762-4949 Page 23 of 40 Miami Shores Village Building Department NOV 2014 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 201® BUILDING Master Permit Noj+lgoii PERMIT APPLICATION Sub Permit No. MQ-- ( q - 62- r-]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP An `� CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Ziwii /449 Folio/Parcel#: Is the Building Historically Designated!Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: WNER�_ ome(Fee Simple Titleholder): lot Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:. 44�/ G — C Q /,� Phone#: Address: f z� � City: State: Zip:A4019 00 Qualifier Name: '' Phone#:,fAz ay7.�tr State Certification or Regis ration#:q�{��y�� � �? Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$6 4500 Square/Linear Footage of Work: Type of Work: ❑ Addition 10 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Descriptiop i� n,,,�� � u a � ii—;•` - as °t � :� Submittal Fee$L '�/ Permit Fee$ , / CCF COyCC$ y Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ IZ3 • Q-z (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 excridipy$2500; the applicant must promise in good faith that a copy of the notice of commencement and construction lien•law liraVe delivered,to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of comm be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In such posted notice, the inspection will not be approved and a reinspection fee will be charged. s. Signature' OWNER or AGENT RA OF� The foregoinginstrdmqrrq was ackno ledg d before me this The foregoing instrument wa acknowledged before me this day of 20 ' by 1�cy1 day of• $� by �- wh is personally known)o d ho is personally k wn to me or who has produ ed P as me or who has produced as identification and who did take oath. identificatio and who did take an oath. NO NOTARY P L Sign Sign: ��•• PV7�i Print prin ; ° o �y Pu Florida .`.►" `'e''� .•? yComm'.Expires Jul 16,2018 Seal: =��• •`�i Notary Public-State of Florida Seal: "'+, °'•' Commission#FF 138285 a• •� My Comm.Expires Jul 16,2018 BMW Througfr National Notary Assn. ' ,,,`��P;�' Commission 0 FF 138285 Bonded Through National Notary Assn. � APPROVED BY � Ilar%i Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD " CMC1249713 The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 a� a PASCUAL, ENRIQUE HVAC ENERGY SOLUTIONS 6575 W 4TH AVE 406 HIALEAH FL 33012-6637 0 . ~ ISSUED: 08/12/2014 DISPLAY AS REQUIRED BY LAW SEC1# 1_1408120002253 107415 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAY 6004212 __11 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES HVAC ENERGY SOLUTIONS RENEWAL SEPTEMBER 30, 2015 6575 W 4 AVE 406 6264709 Must be displayed at place of business HIAL —11.33012 Pursuant to County Code Chapter BA—Art.9&10 OWNER SEC.TYPE OF BUSINESS QUALITY FLOW COMFORT INC 196 GENERAL MECHANICAL CONTRACTOCAYMENT RECEIVED CMC1249713 Y TAX COLLECTOR Worker(s) 1 $45.00 07/27/2014 CREDITCARD-14-030125 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovormuentel regulatory laws and requirements which apply to the business. The RECEIPT N0.above must he displayed on all commercial vehicles—Miami—Dade Code Sec Ila-276. For more information,visit www.miamidsde.gevftaxcollector A�=%'�"® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD""'"- _ _ _ 11/20/14 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 poNcy(ies)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 - _ - NAME: Marcos A.Alvarez Excellence Insurance Agency PHONE - -- --.- FAX _._. ILO�Xtl_ (305)226 3900 =AIC (305)226-3997 38p1 SW 107 Avenue E-MAIL - - -- -- ----� -ADDRESS _____aalvarez@excellenceinsurance.net --- -- -- -- - --._. Jami,FL 33165 - INSURER(S)AFFORDING COVERAGE _ __ NAIC# Phone (305)226-3900 Fax (305)226`3997 INSURERA: Granada Insurance Company 1687.0 _ --- --— _ INSURED -- ------ --- INSURER B Quality Flow Comfort, INC DBA Hvac Energy Solutions INSURER C., 6575 W 4 Ave Unit#406 INSURER D__ Miami,FL 33012- 305-219-0650 INSURER E: ---- ---- — - r - INSURER F: COVERAGES_ CER_T-1 CATE NUMBER: — _ REVISION NUMBER:_ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PQLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADD UBR -- LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF BODY EXP YY LIMITS GENERAL LIABILITY ----- -- i- �I --- __----_-�_- -_—_- COMMERCIAL GENERAL LIABILITY I I OAAMAGE TO RENTED CH OCCURRENCE - -$ 1,000,000.00 PREMISESaE-a occurrence-__$_ 100,000.00 ❑ El CLAIMS-MADE Q OCCUR - - A --- �0185FI-00050285 MED EXP(Any one person) $ 5,000.00 —I I 06/11/2014 tPERSONAL&ADV INJURY $ 1,000,000.00 06/11/2015 i GE_NERALAGGREGATE_ $ 2,000,000.00 -- �-$. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 1 � - f 0 POLICY ❑ PRO- ❑ LOC _ COMBINED SINGLE LIMB AUTOMOBILE❑ ANY AUTO(ABILITY - _-._. _ (Ea acaden�_ --- -- --- -- BODILY INJURY(Per person) $ ALL OWNED SCHEDULED I I O ❑ AUTOS ❑ gUTOg BODILY INJURY(Per accident $ -� C— -- - ---- - _ ❑ HIRED AUTOS ❑ A�PIOSWNED MMP. ROPERTY DAMAGE $ ❑ Per accident $ ❑ UMBRELLA LIAR ❑OCCUR -- � L-- _--- --- —�_--! — ---------- EACHOCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE __ $ _-_ L2,DED- El RETENTION$ III WORKERS COMPENSATIONAND EMPLOYERS'LIABILITYY I N R_Y_I ❑WC STATU 0TH- L._IIvS ❑ER- ANY PROPRIETOR/PARTNERlEXECLITNE ---'� OFFICER/MEMBER EXCLUDED? i N IA E.L.EACH ACCIDENT $ - - ---- (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ Masdescribe under I __---... --- y - —E DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is rt—equird) -- -- - -- Contractor License Number MC 1249713 I !� CERTIFICATE HOLDER ------------ _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH T E P Y PROVISIONS. 10050 NE 2nd.Avenue TI ;1E Shores, Florida 33138 ------------ ---_ .— AUTHOR EP E NT Fax 305-756-8972 © -2 10 ACORD CORPORATION. All rights reserved.) ACORD 25(2010!05)QF a ACORD name and logo are registered marks of ACORD a4 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION ** CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 5/26/2013 EXPIRATION DATE: 5/26/2015 PERSON: PASCUAL ENRIQUE FEIN: 201726189 BUSINESS NAME AND ADDRESS: QUALITY FLOW COMFORT INC HVAC ENERGY SOLUTIONS 6575 W 4TH AVE APT 496 HIALEAH FL 33012 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-COND Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 • ,5�et�cR I"NINE NMI" Miami Shores Village Building Department I�lpR�p► 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.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore, , o�v be personally liable for the worker compensation injuries of any person allowed to work under this permit. 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 S NOTICE AND UNDERSTAND ITS CONTENTS. Print Name: Print Name: �'�l Q�1rS o Signature: J Signature: State of Florida) State of Florida) County of Miami-Dade) 1'/ County of Miami-Dade) f Sworn to subs crib d o e me this Sworn to subscri re me this day of ttQ 20 day of ,20 ` . B HECTOR J.HALL Y f `5' •"c y Comm.Expires Jul 16,2018 """ HECTOR J.HALL �(� ) \• 4-'� + #FF 138285 (SEAL) '��'+µr U.`'- Notary Public State of Florida • � Type of e ' caei& h National Notary Assn. Type of Id E - �i$m. xpues u •�• pCr�rp,n Through National Notary Assn.