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MC-16-1531 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-260196 Permit Number: MC-6-16-1531 Scheduled Inspection Date: October 17,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: TADDEO, FRANK Work Classification: Addition/Alteration Job Address:341 NE 92 Street Miami Shores, FL 33138- Phone Number (305)758-7493 Parcel Number 1132060136380 Project: <NONE> Contractor: COOL WIND CORP Phone: (305)879-6580 Building Department Comments INSTALL DUCT FOR MICROWAVE EXHAUST Infractio Passed Comments INSPECTOR COMMENTS False L L Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid October 14,2016 For Inspections please call: (305)762-4949 Page 10 of 43 r 3 [ s y, Miami Shores Village 10050 N.E.2nd Avenue NE A 1 Miami Shores,FL 33138-0000 Phone: (305)795-2204 11 E 01,11 Expiration: 1 06/201 Project Address Parcel Number Applicant 341 NE 92 Street 1132060136380 FRANK TADDEO Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell FRANK TADDEO 341 NE 92 Street (305)758-7493 MIAMI SHORES FL 33138-3133 Contractor(s) Phone Cell Phone Valuation: $ 750.00 COOL WIND CORP (305)879-6580 ...... ......... Total Sq Feet: 0 Tons: Available Inspections: Additional Info:INSTALL DUCT FOR MICROWAVE EXHAUST Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work: Review Mechanical Scanning:3 Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# MC-6-16-60021 DBPR Fee $2.25 06/09/2016 Check*10350 $ 115.10 $50.00 DCA Fee $2.25 Education Surcharge $0.20 06/02/2016 Check*10337 $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 AFFIDAVIT: I certify that all the foregoing informatio is ccurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above- c tr t the work stated. % June 09,2016 Authorized Signature:Owner / Applicant / n a / Age t Date Building Department Copy June 09,2016 1 t Miami Shores Village Building Department JUN o2 Z016 ,i 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 �Y: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201y� BUILDING Master Permit No. RGI (o PERMIT APPLICATION Sub Permit No. G1'1. (, tS- ❑BUILDING [:] ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING IMMECHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP l ` C� CONTRACTOR DRAWINGS JOB ADDRESS: \ I�J L'�" City: Miami Shores County: Miami Dade ZiD: Folio/Parcel#: �,\- `'®''`P'' 00 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: `��`Flood Zone: BFE: FFrEE: �1 OWNER:Name(Fee Simple Titleholder)': V 61A ' ° Phone#: ��`� S�^� � � l 3-7 Address: City: VV�� c c tate: Zip: 3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Com Name: Ph Company Yone#: Address: City: State: _VL. Zip: \ �� Qualifier Name: ��/� l c� c)-N Phone#: State Certification or Registration M �./`��- \�J�� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alter tin ❑ New ❑ Repair/Replace ❑ Dem olition Description of Work: s Specify color of color thru tile: Submittal Fee$ r3 ' CZ Permit Fee$ CCF$ ®� CO/CC$ Scanning Fee$ Radon Fee$ _' DBPR$ c2 : Notary$ Technology Fee$ Training/Education Fee$ ® Double Fee$ Structural Reviews$ Bond$ s TOTAL FEE NOW DUE$ (Reyis�lP2/24/2014) 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 low 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 re' ction fee will be charged. Signat a Signature /// ER or ENT CONTRACTOR The foregoing instrume t was ac owledged before me this The foregoing instrume t was acl owledged before me this day of �i� l ,20 1 (o .by 6 Y o 20� ,by � �i � d hos p iersonally know ' o 50 "o is personally known to me or who has produced as 2 who has produced mc ((rr ORESTES LUIS identification and who did take an oath. identification and wh did tak tl�:= , FF196062 NOTARY PUBLI NOTARY PUBLI EXPIRES February 04 2019 040139",53 o„ Si n: Sign' Print: Print: ;„ Wo STES LUIS 531ON#FF i*'inr.2 t a MA MISSION#FF 020150 Seal ,,. EXPIRES Februa Seal: ES:May 21,2017 loos,3�y p, rY 04 2u*a Rt h• Bou Co"': Pobfc Undetere **************************** ***** ***** ****************************************************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 5�oRES Gr Miami shores Village E'er Building Department j142ires Oma' 10050 N.E.2nd Avenue lOR1Up' 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 covers _ m the contractor's company for day labor,part-time employees or subcontractors. BYSIGNING BE OW YOU OW EDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: ner State of Florida County of Miami-Dade The foregoing was acknowledge before me this 7 day of M v '2016 By �1 C .dT ® Cwhopersonally knownt moe.or has produced as identification. No MY COt�NISSION=7 EMBES,Ma#FF 020150 J!P tt• Bonded Ttw No Puy bBc Undewdtere SEAL: COOL WIND CORP. 16612 SW 114 CT Miami, FL 33157 coolwindac@aol.com 305-879-6580 State of: f�7�YJA County of: J:�� Before me this day personally appeared who,being duly sworn,deposes and says: That He or She will be the only person working on the project located at: 1ti! Pml5�wm , V--- 3313 worn (o affirmed)a d s bscribed before me this 114 day of !� .20k6 , by Personally know. !! Or Produced Identification: Type of IdentificationPro d. ORESTES LUIS MY COMMISSION#FF 196062 ' W1, EXPIRES February 04 2019 tA07��8-053 Fkwdx *W =n /Print,Type or Stamp Name of Notary R4CK.SCOIT_GOVE-11NOR r: - - =.-_._ __ KEN_LAWSON.SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION " CONSTRUCTION INDUSTRY LICENSING BOARD ` GAC1817188 The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions.of Chapter 489 FS. Expiration date: AUG 31,2016 n ARENCIBIA,YOEL COOL WND CORP , 4381 SW 154TH PL r ' MIAMI- 1=L33 t85 ,; ISSUED: 05/15/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405150001093 Miami-Dade County, Stag of hoild -THIS IS NOTA BILL DO NOT PAY 6395677 +r BUSINESS NAAWLOCATION RECKWIrmo. EXPIRES COOL WIND CORP RENJEWAL SEPTEMBER 30, 2014i OPERATING IN DADE COUNTY 6""70 Must be displayed at place of business I pursuant to County Code Chapter$A-Art.8&10 OWNER SEC.TYPE OF BUSINESS PAYMENT FIECEIVEb ' COOL WIND CORP 196 SPEC MECHANICAL CONTRACTOR 13YTAx COLLECTOR C/O YOEL ARENCIBIA QUALIFIER CAC1817188 Worker(s) 1 $75.00 08/09/2015 CREDITCARD-15-W228 This Local R usinassTax Receipt only confirms payment of the ion Business Tax.The Receiptis nota license, permif,or s cereificadon of the holder squalificadons:to do business.Holdernomil raniply with any 9ovenunemal or noal;mramaatal regulatory laws and regairemeuts which apply to the beWipa The RECOPT N0.ebove must he displayed on all commarcial vehidesr fiiiaml-Bade Cale Sec Sa-m. For nmre information,visit wmt miamidada.gevltaxcollector .��WS JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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: 8/6/2014 EXPIRATION DATE: 8/5/2016 PERSON: ARENCIBIA YOEL FEIN: 455603430 BUSINESS NAME AND ADDRESS: COOL WIND CORP 4351 SW 154TH PL MIAMI FL 33185 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 Used 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 certificata,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shag 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)413-1608 CERTIFICATE OF LIABILITY INSURANCE DA05/301sm AC®RO® 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 pollcy(les) 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 antza Moms The Insurance Guy,Inc. pffi& 305 668-7100 888 236-8036 4928 S.Le Jeune Road : Yaritza@ThelnsuranceGuyinc.com INSURER(S)AFFORDING COVERAGE NAIL# Coral Gables FL 33146 INSURER A: GRANADA INSURANCE COMPANY 16870 INSURED INSURER B: Cool Wind Corp. INSURERC: 16612 SW 114 CT INSURER D: Miami FL 33157 INSURER Et INSURER F: COVERAGES CERTIFICATE NUMBER- REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPEOFINSURANCE NSR SUBR WVD POLICYNUMMBER POLICY EFF POLICY EXP tMWDDIYYyYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS-MADE I X I OCCUR MED EXP(Any one person) $ 5,000 A 0185FL00038175 08/06/2015 08/06/2016 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY Ea accident LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL SCHEDULED BODILY INJURY(Per accident) $ OWNED AUTOS NONDOWNEDPRO E $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONW STATYL'MU- OTH- AND EMPLOYERS'LU►BIUTY Y/N I ER ANY PROPRIETORIPARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICERIMEMSER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N mors space to required) CAC 1817188 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD