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MC-14-1533 Inspection Worksheet Miami Shores Village i 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-216046 Permit Number: MC-7-14-1533 Scheduled Inspection Date: December 02,2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: FABLE, ELISE Work Classification: Addition/Alteration Job Address:941 NE 91 Terrace Miami Shores, FL 33138-3219 Phone Number Parcel Number 1132060030050 Project: <NONE> Contractor: GABLES AIR CONDITIONING CORP Phone: (305)924-2545 Building Department Comments CHANGE AC 2 1/2 TONS 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 December 01,2015 For Inspections please call: (305)762-4949 Page 1 of 40 4 •f' � Z 1 � ,4 _ ' mss ° z, Miami Shores VillageTv 10050 N.E.2nd Avenue NE t@C°atifiirl Miami Shores,FL 33138-0000 Phone: (305)795-2204 , x toat � � Expiration: 01103/2016 E Project Address Parcel Number Applicant 941 NE 91 Terrace 1132060030050 MONTANA 13 HOLDINGS III LLC Miami Shores, FL 33138-3219 Block: Lot: Owner Information Address Phone Cell MONTANA 13 HOLDINGS III LLC 970 SOUTH SHORE Drive MIAMI BEACH FL 33141- , 970 SOUTH SHORE Drive MIAMI BEACH FL 33141- Contractor(s) Phone Cell Phone :Valuation: =3,000.00 GABLES AIR CONDITIONING CORP (305)924 2545 (786)326 2814 Tons:2 1/2 Available Inspections: Additional Info:CHANGE AC 2 1/2 TONS Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved:: In Review Review Mechanical Date Denied: Type of Work:CHANGE AC 2 1/2 TONS Underground Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# MC-7-14-52302 DBPR Fee $2.00 DCA Fee $2.00 07/07/2015 Check#: 1051 $227.80 $0.00 Education Surcharge $0.60 Permit Fee $105.00 Scanning Fee $9.00 Technology Fee $2.40 Work without Permit Fee $105.00 Total: $227.80 In consideration of the issuance to me of this permit, I agree toerf a work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawin s a ments or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work do by it er my elf, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WIN OWS D ORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing info o s accur and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the abov con for o the work stated. July 07, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 07,2015 1 * Miami Shores Village .. JUS �® 014 Building Department BY. 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 Permit No.� — r ( �- PERMIT APPLICATION sub Permit NoW -- ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [)fl MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / t, c J e/,/ City: Miami Shores County: Miami Dade Zip: 1 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): r I L5 e1 Phone#: Address: ofL/1 926- 111 '�-e—J-LTIU City: '7P'V"j ► S"Or-a�- State: Zip: Tenant/Lessee Name: Phone#: Email: ,(®_9 �d r CONTRACTOR:Company Name: 64 ) a� C �s� Phone#:��� ��7 �"S�U Address: 2,2-XV T City: G nA State C Zip: 3.1 Quplifier Name: ey o f�L Phone#: State Certification or Registration#: OR' f q l W 3 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ jy® e 1'9 Square/Linear Foota of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace Demolition Description of Work: 17,2 � Specify color of color ibru tile: Submittal Fee$_ Permit Fee$ j( j9 �-v06`CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ ` U S •Go Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (90 (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 certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven ays after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and spectio fee will be charged. Signat Signature OWNER or AGENT TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 ,by day of 20 ,by c Who is ersonally kno n)o who is personally known to me or who has produced //as me or who has pro dced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PyJBLaG:. Sign: Sign: In v _— Print: Print: Seal: ;,LOA.;; 40 YANELL Afl.ON50 Seal: �a`�r``����. YANE LE ALONSO • )•` MY cOMMISSION#FF083778 17 pQi MY cOMMISSION#FF0887?8 EXPIRES O0t0b®r 18.?Q x°�� Pa. o.F;,.. ,,�p�R,o,.• EXPIRES October 18.2017 Iqp� -0153 Florldallotwy"Mce.00m 153 FW1daN0taryServlce.com APPROVED BY JPlis E miner Zoning Structural Review Clerk (Revised02/24/2014) .... ON Miami shores Village Building Department �OR> 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT —Z-1- C ' l iA Il` T1StTRA1 �] D. COPY OF WORKERS COMPENSATION INSURANCE* IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. C. COPY OF LIABILITY INSURACE* D. COPY OF WORKERS COMPENSATION INSURANCE* *Y Tw . S1E CART Ir :ATS t` ORES VILLAGE BLDG D 10050 NE 2ND AVE MIAMI SHORES,FL 33138,.-;_; e ratmus Sarclth e�crp i nse num. BUSINESSNAME: 6441a�% 641 R- tom BUSINESS ADDRESS: 22- 5 0 10 'Z ��' CITY A STATE P L- ZIP CODE 3 I Z5. BUSINESS PHONE: FAX NUMBER(__) CELL PHONE ( ) 3 Z r�� QUALIFIER'S NAME: 1A Q d�I� D V ZW,.2,2, QUALIFIER'S LIC NUMBER: 83 ABR-06-2011 17:23 From: To:305756e972 Pa9e:1/4 C RICK SCOTT.GOVERNOR KEN LAWSON:SECiRF—'T.:�,. SUM.OF FL's DEP'ARTINO OF Oft RMN J'�SSA - F Cok � "r C 4MM R_lQq _ The CLASS B AIR C stem ExpirationAUG.f: UG 31 p 33 1$.. 0�i�' << MIAMI -" _ :w ,' ` '�•• ' . V. 1SSfJE{3 {}7/1012014 ��"tl.``'•. . pISPLAY AS REQUIRED BY LAW S O# L1407100000857 zest 'F:•: .+ -.ti.'•I :i'wC,�4'�'••y.w.. �M♦ :5'.:.�•LI.t-�{... ,. p!.•»^' Fry 0.T •�. .h, :m PL` pT< •ll — • ygf�?.�p� �,,v.`]syr•m,,a.�..`.{�,f.>-�'„Nl�-:�-.>� �_••4y •Y��F��A �d Ar GOM •E''T�S9[1.�i. � � ..re'-w•.�.x„•::'+,.e-iw� r"�pi•'�`�. '�. r ei, _�...f » - - :�'�a�a'�"yi.•�`e«:,-.°wrf°'.a)a$•�"`..ed'^�'L.••9. �iy�..-,pF—'�p' S•.x;;�t� :, ' 2 .. x. •�.:1 ti.C�yyt,• .;A?,: '�i�:•�f'3`•. %�:-:•. MAM.. _ �: -idtlYn•�':_1%C� Lp�r '�:a•S`•:.T1'�:°yyy .t !•n• •/�.o�iv:•i��.: .. x.ZM-.Mff 20 .N i Ste('. o - , owDMGN i95 $ :SLtSdtsFiBA�g ' '°< �Y PA R£CE r go GABLES t 3 #±ACi81 y p•,.y;..�;! 8Y TAX�--,0/15/2("4 C 2(y -130 ' RR+t aaAisS�plft�•tas .„�;� . •�Y9 - ion '•w•' - :,ty,::-; :..,.. s5se��8. `E§m' CERTIFICATE OF LIABILITY INSURANCE TM CERTIF6CATE R ISEUM ASA MATTE aF 1�QRMATION ON[Y AND CONFERS NO iZIc3HTJ3 Ili _ oyAiJf5 CERTIFICATE CEEB NOT AF6.7Rf1EAYNELY t NMTIVEI.Y Zoe EXTEND OR ALTER YtJO COVERAG CORDED BY TM POLICIES 6 EWE— ER,THIS LP NTATWE A7 E OF Itit3UfsANHCL DOES NOT COt08T UM A CONTRACT 8E7iMf N TH9ISSUiNf3ll1l8UREl t(S},AUTHORMM AND TME CERTOrtCATE ROLDUL I llo tar WFANT;6 theIfIlwa Cele fD cIB a1,effn WSUgFsD,tips lesj must he er�araed.6 BlFC6AYG6N to WAtYFD,sJ�ject W th0t6rD:8andoondFaft suchendar c tengP*bMrl�y/MquveeneudorSeM=L A3ffieetet40�6+69cardit t8da"rotcoefer eemecabr twtalay to IBCIt of such etldaremnengIt s} �h1g to the cm-- West Cew lMrarM Ca—Awr4b In MAW, 46866 M7 9"a"heat a X88$-7885 HWeah.FL 3=0 bAgal9 rlstlaoom Phone mawl Pax " Macs INSUNrD 18� MWAtEaa: ORANACAD>SL R*=C0 Gil Air c*ndk1qr&Q fil cIxEAa: nor i 7250 NW 2 Street n: MMA .FL 33125. 7 2814 Ec COYERA©E$ CERT#FICATRNUIStg�j; H�lIRF1re: THIS Is TO CERTIFY THAM TI1E SES qp pt REVISION hWMBER: BmIL`ATt#).NOrARTHSTANDM ANY 4 TBD BFJ OW HAVp PjEEJ�19StttD TO TiiO OPSUFIr D NpI D ABOVE FOR THE PO1tLY PERIoo C2RTWICATEMAYBE ISSUMORWAYPr:RTAI Tf{�� OFANYOONTRACTOR01tiERDO WMWVMWREgPWrTAVWMHTHIS L70CdUSICIM AM165' OF �Fb�D BY TIE POLR'��S nth=3LO HPJiEN IS SUBJECT TO ALL THE TEMM. IN Sum{p0E KxE's. 1S SHOWN MAY HAVE�REOUCED BY PA®CLAM. '+I'P>:�uSURAttcE : U POl3GY POLICr GENERAL UAIII - U iT8 ® .t .lb4®.uY 6 O :EN[� S 1.000000,00 S ❑ -A%- �nnm, S 100,IIam A ❑ o110F100098784 OT/01r015 07MI*Mo ms5MMOD p L&ADVUuY g 1.000.0 UQD D Powy D M ❑ PROW=- Acta JUr901JaBY.E trABILIt'N S 1Ip AWAM ai n L.d AUrOS ❑ BghBT06JUf:Y(�tyms�N S Q D AUM BaW4YipJrlAtYg+� 8 ANL g ❑ .LAUAB ❑ s © A00te"TE 's wo ANDEIuaegn ANY YrN y A s �OFM IN >rSfLLUDID7 NIA @l EACH ACGWEWT 8 t�S SClid+fi N�bPi�altot�ts � BL• •EAaipLflyE g 6obw ELS-PO4GT LtxR S s 1i6N�oPEFkIrWIsILOGA7t8tLSlV6hc1E�fAV=hAC0PM101.A tK m ksaeholWle,U�,espmmnks4�I�+4 I license number:+cao1817783 CERTIF10ATE NOIJ3ER CAAWEtL ATION AAFAIUH8Ho1rESVILLACsF �iA.DANYGFMB TABOVEDl BE aEbPOLMMCAMC&LMBEFOM RATION DATE TtMMP.UoTtOE WILL EMp ZUVCb DIN BUILDING OSPT ACCORDANDE Wm1 THE POLtCY MWIlSlOHs. Ff0M NE x AVE AUr if0l SEN*arivJ: M ABM FL 33138 AC01W 26(20'1918 a 7908-'018 ACURO CORPORATION.All rlgets reserved. The ACCRD nww and mgo ars reg6s8ered n oft of ACORD TAT:a6pd 2L-GegS)-S0::ol :LUO.ad 60:0T TT02-2T-aeu 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 R CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 4/15/2014 EXPIRATION DATE: 4/14/2016 PERSON: GONZALEZ ALEXANDER FEIN: 465262769 BUSINESS NAME AND ADDRESS: GABLES AIR CONDITIONING CORP 2250 NW 2 ST MIAMI FL 33125 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 hated 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 t Miami shores Village Building Department LORiAA 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,you may 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 THIS NOTICE AND UNDERSTAND ITS CONTENTS. Print Name: `t;l 1 S'� l`Q Print Name: f�1 60W Signature: Signature: State of Florida) State of Florida) County of Miami-Dade) b' County of Miami-Dade) - Sworn to subscribed before me s Sworn to d ubscribed before m s day of ,20 day of ,20 . By ` By �'""�•r`!4 9AwSoYANELL4 A, N ' YAN ELLE ALONO e)KI _(SEAL Type o i Type of IdMISSION#FF08-97198 (407)3819 FIor1d. oery3vrym (48bMote ee.com i RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION rA-4c CONSTRUCTION INDUSTRY LICENSING BOARD `" CAC 1817783 The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 o� f a GONZALEZ GONZALEZ,ALEXANDER a GABLES AIR CONDITIONING, CORP 2250 NW 2ND STREET MIAMI FL 33125 ❑. _ : ■ ISSUED: 07/10/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407100000857 002760 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - ODNOT PAY LBT 7169289 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES GABLES AIR CONDITIONING CORP RENEWAL SEPTEMBER 30, 2016 2250 NW 2 ST 7447996 Must be displayed at place of business MIAMI FL 33125 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS GABLES AIR CONDITIONING CORP 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED CAC1817783 BY TAX COLLECTOR Worker(s) 1 $45.00 08/18/2015 FPPU03-15-019894 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 mast comply with any governmental or mmegovemmental regulatory laws eon requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec Be-276. For more information,visitwww.mismidade.novhaxwllector r 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: 4/15/2014 EXPIRATION DATE: 4114/2016 PERSON: GONZALEZ ALEXANDER FEIN: 465262769 BUSINESS NAME AND ADDRESS: GABLES AIR CONDITIONING CORP 2250 NW 2 ST MIAMI FL 33125 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 tea chapter by a t:macane of erection under this section ma not recover tis or compensation under this chapter.Pursuant to Chapter 440 05(12),F.S.,C diff ates of election to be exempt...apply only within the scope of the election tbu o e be exempts mor trade listed on the notice of bion to be exempt.Pursuant to Char 440.05(1 3),F.S.,Notices of election to be exempt and certificates of certificate t nob subject to revocation t,at any time after the riling of the notice or the issuance of the certificate,the person named on the Mice or roger mem 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