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MC-16-585� c 15-306 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-270198 Permit Number: MC -3-16-585 Scheduled Inspection Date: November 02, 2016 Inspector: Perez, JanPierre Owner: DAIDONE, GLENN Job Address: 339 NE 100 Street Miami Shores, FL Project: <NONE> Contractor: ERV AIR CONDITIONING INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)788-2711 Parcel Number 1132060135360 Phone: (305)975-5943 Building Department Comments CHANGE OUT AC SYSTEM 3.5 TON PLUS 3 SUPPLY 2 RETURN AND 2 EXHAUST FAN 1 VENT DRYER Infractio Passed Comments INSPECTOR COMMENTS False ‘,11-11,4, Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-253984. seal refr lines and missing lock cap November 01, 2016 For Inspections please call: (305)762-4949 Page 37 of 51 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. MC -3-16-585 Permit Type: Mechanical - Residential Work Classification.. A/C Replacement Permit Status: APPROVED Issue Date: 3/1112016 Expiration: 09/07/2016 Parcel Number Applicant 339 NE 100 Street Miami Shores, FL 1132060135360 Block: Lot: GLENN DAIDONE Owner Information Address Phone Cel I GLENN DAIDONE 54 NE 97 Street MIAMI SHORES FL 33138-2331 (305)788-2711 54 NE 97 Street MIAMI SHORES FL 33138-2331 Contractor(s) ERV AIR CONDITIONING INC Phone (305)975-5943 Cell Phone Valuation: Total Sq Feet: $ 5,205.00 0 Tons: 3.5 Additional Info: CHANGE OUT AC SYSTEM 3.5 TON PLUS 3 Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $3.60 $2.74 $2.74 $1.20 $5.00 $182.18 $3.00 $4.80 $205.26 Pay Date Pay Type Invoice # MC -3-16-58898 03/03/2016 Credit Card 03/11/2016 Credit Card Amt Paid Amt Due $ 50.00 $ 155.26 $ 155.26 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 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 m If, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DO • S, OOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information construction and zoning. Futhermore, I authorize the above -nam Authorized Signature: Owner / Applicant / Building Department Copy March 11, 2016 cur c• ntra and that all work will be done in compliance with all applicable laws regulating or to dp-the work stated. / Agent March 11, 2016 Date 1 - BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑PLUMBING MECHANICAL JOB ADDRESS: City: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNE PHONE NUMBER: (305) 762-4949 MAR 0 3 2016 !F?Y: F BC 201`-1 Master Permit No. 12 Sub Permit No. 1' • c-1 L' Sa-s ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS PE- /IV 5, -- Miami Shores County: Miami Dade Zip: .??3/3S/ Folio/Parcel#: I J -92(.h7 Of; 3 t" is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Imo) Flood Zone: OWNER: Name (Fee Simple Titleholder): C & L) /� Ute u+1 )G Address: '729 / /i) 6/ , fj ) c't City: /tit 62t -g --7-4S/`1 Pt5 State: Tenant/Lessee Name: Email: NO BFE: FFE: Phone#: 3/78"6// 1 Ft_ Zip: 33/3f� Phone#: CONTRACTOR: Company Name: -(.71/,-? v /-F rZ '1',)43 ,' T. /L)4..,,' . k Phone#: Address: f6) P-10 60,-) G:- s J) r City: " , .e.? ,P-1--7, • State: 19 Zip: Qualifier Name: LIFT7i--.0,9g. 5=7D %' �: r 2, .-kie 0 /f'A Phone# S) 5 —k-, / ti' -:4 State Certification or Registration #: 6/1-(1_, //S ' c Z Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: City: State: Zip: Address: Value of Work for this Permit: $ as Type of Work: E1 Addition Description of Work: (?-;%1:1.1../-cc ° °r ✓ (i5 r ve4-. ,.ate C):? Square/Linear Footage of Work: ❑ NewIE Repair/Replace ElDemolition 6L/5/5,...-14/ pia c56-uOA/ Z di/9) abid ei4 haots ❑ Alteration Specify color of color thru tile: Submittal Fee $ �y Scanning Fee Technology Fee $' Structural Reviews $ (Revised02J24/2014) Permit Fee $ f 1 CCF $ Radon Fee $ Training/Education Fee $ DBPR $ U� " Double Fee $ CO/CC $ Notary $ .20 Bond $ TOTAL FEE NOW DUE $ + SS • c -a Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage tender'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. 1 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~LEI DER 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 51500, the appllcont 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, o certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days ofter 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 jJ .-;sY�sjr.r OWNER or AGENT The foregoing instrument�jwas acknowledged before me this -2L-- day o{(2CIC 1L_c..- ' , 20 /Z : by who is personally known to C � en44 r)11". me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print: mow"; Futtt,c TB Se o'er "".apanAiv 1. r .u,: nifisi. APPROVED BY IRevtsed02/24/2014) as \i(Nikans Examiner The foregoing instrument was acknowledged before me this P day ,�of �^'/4.7ce 4- , 20 0 , by $'^'ry`� ,j ,who me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: 4 - V : MABELIS E FERNANDEZ 114 * MY COMMISSION #FF127992 N."17 ExPIRMitinco..ana. x6)1970153FlorldallotaryServioe.com 1.1 to as Structural Review Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 5 /-' MO 5r �j f�� City: Miami Shores Village County: Miami Dade Zip Code: 33 f `� V ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: et% %1-//e2 /eA4)/Z? W //'4 ��r3 - Phone: 'rWq s ig Contractor's Company Name: � / State Certificate or gistration No. ('2A -i 2_ /A' /<---'2.2, Certificate of Competency No. Signature i .� � 1�� Date: ��1' /s/2 (Qualifier's•4ignature) 3.r (Revised02/24/2014) UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 'NU +v f✓i5- AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT _ NOM TONS .. AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER ice-? YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES O YES NO NEW 4"CONCRETE SLAB YES ' • YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: et% %1-//e2 /eA4)/Z? W //'4 ��r3 - Phone: 'rWq s ig Contractor's Company Name: � / State Certificate or gistration No. ('2A -i 2_ /A' /<---'2.2, Certificate of Competency No. Signature i .� � 1�� Date: ��1' /s/2 (Qualifier's•4ignature) 3.r (Revised02/24/2014) RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CAC1815622 The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date' AUG 31, 2016 RUIZ DE VILLA, ERNESTO _ ERV AIR CONDITIONING 10840 SW 69 DR MIAMI FL 33173-2008 ISSUED: 08/21/2014 ■ 001855 DISPLAY AS REQUIRED BY LAW Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY 6124929 BUSINESS NAME/LOCATION RECEIPT NO. ERV AIR CONDITIONING INC RENEWAL 10840 SW 69 DR 6387799 MIAMI FL 33173 OWNER ERV AIR CONDITIONING INC Worker(s) LBT EXPIRES SEPTEMBER 30, 2016 Must be displayed at place of business Pursuant to County Code Chapter BA - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPEC MECHANICAL CONTRACTOR CAC1815622 PAYMENT RECEIVED SY TAX COLLECTOR $75.00 08/20/2015 CREDITCARD-15-041701 This Local Business Tax Receipt only confirms paymest of the focal Business Tax. The Receipt is note license, permit, or a certification of the holders qualifications, to do business. Fielder must comply with any governmental or noagovenuneotal regulatory laws and requitemeos which apply to the hesiness. The RECEIPT N0. above must be displayed on all coaueercial vehicles- Miami -Dade Cade Bac 8a-276. For more information, visit w ehbagom'dade gov/mxsellecmr SEQ # L1408210001201 ACC,R1: CERTIFICATE OF LIABILITY INSURANCE DATE (MINDONYYYI 11117/15 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 CER71FICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate hoW t Is an ADDITIONAL INSURED, the policyries) must be endorsed. A SUBROGATION i9 WAIVED, subject to the terms and conditions of the policy, certain policies may requite an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER West Coast Insurance Consultants In P.O Box 520574 Miami, FL 33152 Phone (305) 883.1880 INSURED ^—_. ERV AIR CONDITIONING INC. 10840 S.W. 69 (hive Miami, FL 33173-2008 Fax (305) 858-1685 305 CONTACT HAktE' �((P�NC ■m. (305)688-1880 1 FAX - AIL P q 3: _seg e199Qlnsn.com INSURER5BI AFFORDING COVERAGE INSURER A: GRANADA INSURANCE COMPANY (305)688.1B85 NAIC A INSURER 8: INSURER C: INSURER O INSURER 0: NSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TI -10 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 CERTIFICATEMAY 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. UM(TE SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LT TYPE OF INSURANCE IINSIR _ POLICY NUMeeR LIMITS 0150 POLICY EFF POLICY EXP (MN _COOIYYYYIINMTO/YYYY) __EACH OCCURRENCE h AMAOE 1r108,01005 PREMISESJFE_ Madan! MED EXP (Any one person A I ❑ GENERAL LIABILITY C�O��MMERCIAL CENFITALLIABILITY ❑ru CLAIMS•MADE 0 OCCUR 0 GENT. AGGREGATE LRJIT APPIJES PER: C� POLICY [1 PRO- ❑ I.Oc Y I0185FL00031147 11/07/2015 11/07/2018 AUTOMOBILE LIABILIr/ ❑ ANY AUTO ❑ ALL OWNED �--I AUTOR 0 WREU AUTOS iJ AUTOS ❑NONOWNED AUTOS 11 fJ UMDREU.A LIAE r' occuo • EXCESS LIAO I CLAIMS -MADE DEO ❑ 0: - •N WORKERS COMPENSATION AND EMPLOYERS' LIABRJTY Y I N ANY PROPRIETOR/PAWNER/EXECUTIVE OFFICRRi 4EMRFR EXCLUDED'? ( - NIA (Mandatary 1n NH( 1 eve.. dirmnrtre Uncal D01:SLRIPTION OF OPERA IONS Wavy s 2.000,000.00 $ 100,000.00 s 5.000.00 PERSONAL d ADV INJURY GENERAL AGGREGATE s 1,000,000.00 $ 2,000,000.00 'RODUCrs- cOMpAp Act s 2,000,000.00 aMAI T SINGLE. LIMIT a. DOD .Y INJURY (Pcr person) 6 BODILY INJURY (PLY accident, 5 PROPERTY DAMAGE--- 5 (Per accidend_ EACH OCCURRENCE AGGREGATE 5 S WC ❑ 505704.S. II --TT OTH. 18YJ.1MIT5.,..- �E.L. EACH 50C0ENT S EL (YWA.RE- EA EMPLOYE S F.L. 0150850 - POLICY LIMIT S DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES iAdacu AC000101, AddEtio,nd Remits Scneedle, Y more spate Is required) license no CAC1815622 Change out a/c system , plus 3 supply,2 return and 2 exhaust fan, 1 vent dryer. _ CERTIFICATE HOLDER Miami Shore Village Building Department 10050 N.E.2nd Ave Miami Shore, FL 33138 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL Be DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010,05) OF (01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 JEFF ATWATER CHEF 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 hu elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 3/13/2016 EXPIRATION DATE: 3/13/2018 PERSON: RUIZDEVILLA FEIN: 280493838 BUSINESS NAME AND ADDRESS: ERV AIR CONDITIONING, INC. ERNESTO 10840 SW 69 DR. MIAMI FL 33173 SCOPES OF BUSINESS OR TRADE: HEATING, VENTILATION, AIR-COND Reward to Chapter 440.03(14),F.S. an dem *,o sleds exemption from this chimer by M a awtilcr• l Wdkn under Cite ssdbn may not nmrrbaa/M wcomperes/co under MI duper. Pureuent b Mahler 4400502),F.&, CrNkdM ofSmbn to b. tempi.. sooty coIy *498, Oa mete d Oe grkrs or we* sow on the nob of simian b be e•rpLWelt to Pulpier 440144(13), F.S., Nodose of obWon b be Ixsmpl,ad 009 therelleates ofsisdkn to be exempt shag be abject by t•wrabi 1, et any time 8rOa line of M notice or Oa Mumma d the connote, the pawn nrca0 r M notice or metals no IaiOer Insets eve npuir8W d the rctial for Mauna of■ emb . The dspaYnsnt sbsti make • DFS-F2-DWG252 CERTIFICATE OF ELECTION TO EE EXEMPT REVISED 0813 QUESTIONS? (/50)413-1609 Miami Shores Village Building Department 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. Owner ,, Contractor C.T )4''.'E ucwo gj o 1 Z Ie lJt / S Print Name: //��, NPrint Name: 2,_ Signature: State of Florida ) County of Miami -Dade Sworn t day of State of Florida ) County of Miami -Dade ) Sworn t' _ bscribed before me day of i 1�' <`-: ,, Type of Identification produced w un (S ) (407) 398-0153 FloridallotaryService.com ,_ > Type of Identification produced '•=r-,:-.7-1°,--- Writafte ai,....„-de6),..i:‘,....L.1-,....-‘ 4 ' President •-‘4.-.):::::-.-.D.-.- --.-4":44 tl ..." Date:03/01 /2016 State of Florida County of Miami -Dade Before me this day personally appeared Emesto Ruiz de Villa who being duty swom depose and say: That he or she will be the only person working on the locate /3f 9/\m/Y7 Swom to (or affirmed) and subscribed before me this d MABELIS E FERNANDEZ MY COMMISSION #FF127992 641 EXPIRES June 1, 2018 (407) 308-0153 FloridallotaryService.com day of d 5 .20/k., by Personally know ProducORed Identification Typed of tification Produ Pnnt Type or Stamp N of Notary WROZZIS