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MC-14-1832 (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-235285 Permit Number: MC-8-14-1832 Scheduled Inspection Date: May 27, 2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: MICHELLE, DANILO DI Work Classification: Addition/Alteration Job Address:9145 NE 4 Avenue Miami Shores, FL 33138 Phone Number Parcel Number 1132060140080 Project: <NONE> Contractor: ARCHON AIR MANAGEMENT CORP Phone: (305)592-8552 Building Department Comments INTERIOR REMODEL KITCHEN AND 3 BATHROOMS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-233985. CREATED AS REINSPECTION FOR INSP-218299. A/C CLOSET NOT DONE CANCELLED BY EDWIN Failed Correction ❑ Needed Re-Inspection a Fee No Additional Inspections can be scheduled until re-inspection fee is paid. May 26,2015 For Inspections please call: (305)762-4949 Page 20 of 26 - 'I 21�""__ Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235285 Permit Number: MC-8-14-1832 Scheduled Inspection Date: May 27, 2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: MICHELLE, DANILO DI Work Classification: Addition/Alteration Job Address:9145 NE 4 Avenue Miami Shores, FL 33138 Phone Number Parcel Number 1132060140080 Project: <NONE> Contractor: ARCHON AIR MANAGEMENT CORP Phone: (305)592-8552 Building Department Comments INTERIOR REMODEL KITCHEN AND 3 BATHROOMS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-233985. CREATED AS [PEI REINSPECTION FOR INSP-218299. AIC CLOSET NOT DONE CANCELLED BY EDWIN Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. May 26,2015 For Inspections please call: (305)762-4949 Page 20 of 26 1` Miami Shores Village Building Department FEB 2 7 015 10050 N.E.2nd Av�Uej-Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(365-)-756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 � BUILDING Master Permit No. Pr—j%-i PERMIT APPLICATION sub Permit No. h-vc-1 LOS 32, ❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL []PLUMBING MECHANICAL ❑PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOWINGS )CONTRACTOR JOB ADDRESS: / Cly//! City: Miami Shores Coun : Miami Dade Zi : Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ��G"� r(�' f�, G Phone#: WL 32-2w`f& jh Address: `� State: �� Zip: � City: yL��C�t�i�G��9 /irT Phone#: Tenant/Lessee Name: Email: A. 0• Phone#:� CONTRACTOR:Company Name: p2i �a Address: � � �'�'� Zip: City: State: _ L �'•.J I� Phone#: 2s— sl Qualifier Name: _Certificate of Competency#: State Certification or Registration#: �/'� �c>� � Phone#: DESIGNER:Architect/Engineer: City: State- ZIP Address: Value of Work for this Permit:$ C D .� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: r a l (h ` Specify color f color thru tile: Pe mit Fee$� CCF$ CO/CC$ Submittal Fee$ Notary$ Scanning Fee$ Ra Fee$ DB $ Double Fee$ Technology Fee$ Training ta-F Bond$ Structural Reviews$--� � � �i TOTAL FEE NOW DUE$ ' (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 certiTted 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 re'nspection fee will be charged. e"�'Signature S)gnatur 15 WNER rA ENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before/me this _day of_4 020 4& ,by day of /'vim`✓ 20 /� ,by (sem�-/� (J� �- ,who is personally known to n rw �) °/ `o `a: ,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: � P Sign: Sign: NANIT2A AGUILAR Print Print: / � '' a My Comm.Expires May 14 2018 Seal: Seal: "'� ;A�' Com! fission#FF 088866 nw. ******************* ************************************************************************************* APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) s�ORFs Miami Shores Village "" Building Department glee 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. Owner's Name (Fee Simple Title Holder): �C�/i rr l�� OCl2 Phone#: ?X,,'=3'V�-.mac If-t0. Owner's Address: q/`-J" City: e e�i� /.L� g State : TL Zip Code: 3 3z 3;S Job Address (Of where work is being done): q S C-- `4 , City: Miami Shores State:—Florida Zip Code: Contractor's Company Name:�i2 C0jz.vs .rh-c Phone#: 7g& Z36 3 UY/ Address: !7 yo(C W 3o La ,z e City: l.-4a le e S State: �/. Zip Code: 315 did Qualifier's Name : lase e-/�y e-v o Lic. Number: Architect/ Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: /�si�a�a �/u.-,i�� keeoo 4*-1 &11/ I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Mi i Shores harmless of all legal involve ent. Signature Signature O er or Age t Contractor or.AcGZeet- The foregoing instr ment was akn wledged before me The fo egoing instrument was aknowledged before me this 2-3 day of !"ey 201J,by,Dmile 0l Alla.L� this day of 20A�-b-y c: L•Qv,r°.�a Who is uced who is personal) ed YOMI%Y8 MANGO YO111�BY�►N O a indentification. entification. 'i MY Mi98lON M E81 OM ' Nota 8 App 23.2018 Notary my C§1�*�� Sign: AM Sign: � Seal: Seal: U A) Z6Q C17 tD 00 'W(0 S31 WO rP Fh Wr A F- 14 0 N N C) N O F+ Cf'I F- N RICK SCOTT,GOVERNOR KEN LAWSON.SECRETARY o 'd STATE OF FLORIDA 3 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ��' ,. CONSTRUCTION INDUSTRY LICENSING BOARD y CAC057574 ' /~ The CLASS B AIR CONDITIONING CONTRACTOR. f. O Named below IS CERTIFIED � " � Q Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 co UGARDE, LUIS ALBERTO . ARCHON AIR MANAGEMENTCORP v 14 2501 NW 74 AVENUE MIAMI FL 33122 ` 3 in J s.R4 .. I7l Q+ ISSUED: 09/02/2014 DISPLAY AS REQUIRED BYLAW SEQ# L1409020001306 ba F+- 0 U!v z� rn(D 0) •rn w VI w Wr 0 N N m N 0 w N anauss .. —moo Local Business Tax Receipt 3 Miami-Dade County, State of Florida -THIS IS NOTA BELL - DONOTPAY 3871283 ��rr (��++ BUSINESS NAME&OCATION RECEIPT NO. E/\P�e1G5 O ARCHON AIR MANAGEMENT CORP RENEWAL EXPIRES 30, 201s 2501 NW 74 AVE Cl 4041588 Must be dispiayere at Mus ace of bines MIAMI FL 33122 Pursuant to County Carle Ol Chapter SA-Art.0&c tG OD (0 N OWNER SEC.TYPE OF BUSINESS PAYMENT RECIRVEO ARCHON AIR MANAGEMENT CORP 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR ►� Worker(s) cac05757$ $75,00 07/24/2014 O FPPUO5-14-014153 3 This Local Business Tait Receipt only cognufairms paymarn of the Local Business Tax.The Receipt is not a license. must nr nongovernmental regulatory lays and requirements which apply to thelder buslonss caNptp with any governments! a The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec Ba-ZM. � W For more Idermation,vim www.miamwade.qovjtaxwqjWy CD K K W o age: 4 of 11 02/26/2015 12 :50 PM TO: 13057568972 FROM: Edwin Berrios 3NEr #7865347344 . lCC3RC7DATE{MIA WYYYYI CERTIFICATE OF LIABILITY INSURANCE 2/23/2015 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 pot cy(iss)must be endorsed. H 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). PRODUCERCONTACT Jamie Greer _ Bowen,Miclette&Britt of Florida,LLC NAME: �t?7-647-1696_ j�_ 1020 N.Orlando Avenue Suite 200 r—,.4.._._.___.._ _ Maitland FL 32751 E certificates@bmbinc.com _ _ 01SURER(SI APFORDING COVERAGE ... NAIC _ IN.WMRA.National Trust Insurance Company INSURED ARCHONAIRM rNsuRER a. Archon Air Management CorporationsuRER 2501 NW 74th Avenue -._ _.__. ......_...... ._..._ Miami FL 33122 — INs1JffER E INSURER F: COVERAGES E F A E E :1552046255 RKIMN NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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. ---- TYPE OF INSURANCE POLICY NUMBER POLICY F�1�-'—POLICY W LIMITS A ; X COMMERCIAL GENERAL LIABILITY Y j Y .GL00129303 2/3MO15 ?J32018 EACH OCCURRENCE $1,0001000 A CLAIM$A DE X OCCUR — S lEa vt awrtttitBt S 100,000 rM D EXP(Any nna yearsvn) $5,000 . PERSONAL&ADV INJURY $300.000 GENPL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1'D00'0()0 F--I ' Y__l'PRO- _... PoL4CY l " 3EOTx j Loc PRODUCTS-COMNOPAGG i 51.000.DW OTHER: g A AUTOMOBILE LABILITY Y Y CA00201783 3; 2015tEa araldant L 500,OOU_ 21312018 S _ _.. X 'ANY AUTO SOOiLY INJURY(ppr Ipaiwrl) :$ Aly,gWhtED $CI LED ANiUl7 BED aMLY INJURY(PW acadent):$ X HIREOAUTO$ X AUrOS I PereeciaWnt `$ $ UMBRELLA LEA" OCCUR EACH OCCURRENCE $ EXCESS LlAa E -..._.____.;..$ ......._..... ._....,_.__._......... AGGREGATE S •._..'1 F)Etl RETEHTroN I �3 j WORKERS COMPENSATIONPER OTH- j AND EMPLOYERS'LABILITY Y 1 N !O➢'FICERJhlEiYiTBER&ARTNEFVCUTriErrE_L.EACH ACCIDENT �§ ,••••••_.....,.......—.,.._ E.L.DISEASE-EA EMPLOYE-$$ Yyeeaa __...................._.......... DEiC Ri OF OPERATiON3 babes I E.L.DWEAU-POLICY LIMTT:S OESCRIP'nON OF OPERATIONS!LOCA17ONS I VEHICLES(ACORD 101,Additbnw Remwtta saRedute,may pe athwwd N more apace is n""twed) The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of Insurance. The terms contained in the policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions ndior endorsements listed below are available by emailing: certificates@bmbinc.com When required by written contract,those parties listed in said contract,including the certificate holder,are added as an additional insured with respect to the general liability,auto liability as afforded by the policy and/or endorsements.When required by written contract,waiver of See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 10050 Northeast 2nd Miami Shoresvillage2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTA 0 1988.2014 ACORD CORPORATION. Ail rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD age: 5 of 11 02/26/2015 12 : 50 PM TO: 13057568972 FROM: Edwin Berrios ONE #7865.347344 AGENCY CUSTOMER ID:ARCHONAIRM _ LOC#: ADDITIONAL REMARKS SCHEDULE Pagel of AGENCY NAMEDWSUREO Bowen,Miclette 8 Britt of Florida,LLC Archon Air Management Corporation 2501 NW 74th Avenue POLICY NUMBER Miami FL 33122 CARRIER NASC COOS EfFECTNE GATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 15- FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE subrogation,with respect to the general liability,auto liability,is granted to those parties listed in said contract,including the certificate holder.The general liability,certified herein are primary and non-contributory to other insurance available,but only to the extent required by written Contract. RE:License#CAC057574. ACORD 101 i2008/01j 0 2048 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD age: 3 of 11 02/26/2015 12 :50 PM TO: 13057568972 FROM: Edwin Berrios ONE 4, 7865347344 a° CERTIFICATE OF LIABILITY INSURANCE (" 'D°'"""r' rza/zols 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:N the asrt{ticats holder Is an ADDtTKfNAL INSURED,the policy Iles)must be endorsed,N$U$ROtiAnoN 18 WAIVED,subject to the terme and cwWitlons 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: PHONE tAJC,No Em); 141-277-1820 x4M FAX ASC Nah 727 797-0704 FrankCrum Insurance Agency,Inc. E-MAIL ADDRESS: 100 South Missouri Avenue INsu-ER s AFfOROByr;COVERA6B NAIL r Clearwater FL 33756 INSURED INSURER A: IF Winston CrumInsurance Co. 1180o INSURER B: PN RER C: FRANKCRUM L/C/F ARCHON AIR MANAGEMENT,CORP. RdSURER D: 100 SOUTH MISSOURI AVENUE IDESURER E: CLEARWATER FL 33756 URER F: COVERAGES CERTIFICATE NUMI®ER. 289289 REVISION NUMBER: 2 THIS 18 TO CERTIFY THAT THE POUCIEsS OF BNSUIWME LOT QtB BELOW HAVE OWN;FL=TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. SFOTVYrrHSTANOlNt3 ANY REQUIREMENT,TERMOR CONWTiON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VMCN THIS CERTIVICATE MAY BE OWED OR MAY PERTAIN,THE OWRANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU9UE+CT TO ALL THE TERMS,EXCLUSIONS AND CONOMMS OF SUCH POLICIES,UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rm OF PSItRANM ADOL SLWR LTR pNggp WVO POLICY Rttfr £R POLICY w1 �y LIMITS RAI.t.lAS4.iTY EACH OCCt)RRENG E $ Cfkd)dEtiCIAL LIABILITYEACH • CLANS-MADE ®OCCUR S , S OED EXP iA�y ar A®+ ) S PER90NAL A ADV WAAY $ 0ENt AfiGREGATE LBAPt APPLIES PER GENERALAC4ftGATE S PRICY PROJECT LDC PRDDUCT"OMPW AOG g AYTVNIO"A LUtalm S ANV AUTO CndNBNittO SINGLE L047 S ALL OlbxE6 aCHEDLts.fiD BODILY tNAMY fA'�'BOmi S AUTOS Aijt'O$ HIRED AUTOS NON-ON SOMY NU46TY(Per aem*,t) S AUYD3 PROPERTY DAMAGE S UMBRlEL4A I" O(X;Uq $ L CW64S-1,tAbE E�GCURREN'^E S DEO RETEK; ACKIREOATE y 4A7E1OyEFWLAQuTy KERS COMPENSATION AND $ , wC205040Qtt 01F0112015 01I01/201s x `C STATVTCW OTH- ROPRIETORPARTNERMaCUTNE LWIM ER CEPMEMSER EXCLUDED? N/A ;"K) EL EACH ACCO=_lit t M Inn.Ca—b.-d. DESCRIPTION OF OPERATIONS aen w L.D .EA EMPLOY t D�BCA T s DESCRIPTION OF OPERATiONg/L�ATIONS 1 V$Ft�LE3(Attach ACORD 1M,AdrXeaneF Remarks,sctRlutuis,Nr iM1Oro*pace EFFECTIVE Q51p5/ZOOg,COVERAGE ISFOR 100a/a OF THE EMPLOYEES OF FRANKCRUM LEASED TO ARCHON AIR MANAGEMENT,CORP.(CLIENT) FOR WHOM THE CLIENT 15 REPORTING HOURS TO FRANKCRUM.COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. (CLIENT REFERENCE:LICENSE NUMBER:#CAC057574) CERTIFICATE HOLDER CA1dC TION SHOULD ANY EXPIRATIONOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE THEREOF,NOTICE WILL SE DELIVERED IN ACCORDANCE Wrrfi THE POLICY PROVISIONS. MIAMI0 SHORES VILLAGE AUTHORGEOREP sENTA 100 10050 NORTHEAST 2ND AVE. MIAMI SHORES,FL 33138 ACORD 25(201 C/od) The ACORO name and kMo areregistered marks of ACO ®188&2010 ACORD CORPORATION.All tights reserved. RD / <FF�¢