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MC-14-999 Inspection Worksheet r Miami Shores e Villa9 10050 N.E. 2nd Avenue Miami Shores, FIL 1 Phone: (305)795-2204 Fax: (305)756-8972 V Inspection Number: INSP-212518 Permit Number: MC-5-14-999 Scheduled Inspection Date: August 25, 2014 Permit Type: Mechanical - Commercial Inspector: Perez,JanPierre Inspection Type: Final Owner: PROPERTIES LLC, SHORE SQUARE Work Classification: Addition/Alteration Job Address:9099 BISCAYNE Boulevard BURGER vein Miami Shores, FL 33138- Phone Number (305)779-8040 Parcel Number 1132060110040 Project: <NONE> Contractor: RESULTS AIR CONDITIONING CO Phone: 305-886-2534 Building Department Comments REPLACE EXISTING DIFFUSERS WITH NEW 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. August 22, 2014 For Inspections please call: (305)762-4949 Page 10 of 31 RECEIVED MAY 16'2014 Miami Shores VillageBy . Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 [0 ( , n BUILDING Permit No.ay I 'l r-Ci PERMIT APPLICATION Master Permit No.-c- tf Permit Type: MECHANICAL JOB ADDRESS: 1 0 GI-1 p7w 0 ' City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I Ioil — 0040 Is the Building Historically Designated:Yes NO Flood Zone: �j l'LCI OWNER:Name(Fee Simple Titleholder): C-7kYLe std fie• 7 e'� �' Phone#:0'20z�7�"b� " ��C✓h Address: & I Of- I 2 City: t/.aCt-4 1 State: Zip: (� Tenant/Lessee Name: Phone#: Email: !/ CONTRACTOR:Company Name: � =--SO I TJ A-i c `' -Ad Qr�1 Address:_7L1 N w City: ILI l N"t' State: VL Zip: Qualifier Name: J-0-se = (20 rbe7-&__ Phone#: '305 :7 F5. 3 Cl F3 State Certification or Registration 4:01 (2 0 4_7(053 Certificate of Competency#: Contact Phone#(305J7 F,5 0'7-�9'3 Email Address: DESIGNER: Architect/Engincer: Phone#: goo Value of Work for this Permit:$1 2 Square/Linear Footage of Work: Type of Work: ❑Address *Iteration ❑New ❑Repair/Replace ❑Demolition Description of Work: Submittal Fee Permit Fee$ D t O z) CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 7,. SCM �Vd 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 commence 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 jurisdictioT I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES BOILERS,HEATERS,TANKS and 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 a applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE Ol COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS T( YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUI LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE Ol COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise i good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whit occurs seven (7) days after the building it is issued. In the absence of'such posted notice, the inspection will not be approved and reinspection fee will be char ed. Signature Signature EX AVor Agent Contractor The foregoing instrument was acknowledged before a tl' 1 The foregoing instrument was acknowledged before me this day of� l',20 by &41 , day of 7??�'i ,20�,by JedC AX who is perspally known to me or who has produced who is per orally known to me or who has produced As identification and who did take an,oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ,;k�%Er• ELIZABETH RODRIGUEZ =• MY COMMISSION#EE205307 EXPIRES July 08,2018 Sign: Sign: '4`ot Print: / Print: 'li� ��. G yye�i My Commission Expires: - V` if?'ri'••., KATYA GONZALEZ My Commission Expires: '__ Commission#FF 032722 ' Expires July 2,2017 .. Bonded Thu Troy Fm Inarenca 800385 7019 APPROVED BY v �1 Examiner Zoning Structural Review Clerk Revised 3/12/2012)(Revised 07/10/07)(Rcvised 06/10/2009)(Revised 3/15/09) OP ID:MIAC CERTIFICATE OF LIABILITY INSURANCE DATE(M3/20 05/13/20 4 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 policy(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). CONTACT PRODUCER Phone:305-262-5244 NAME: Jorge Pena Allsafe Insurance Group dbaONE FAX Fax:786-388-7244 PH ASI Florida A/c No Ext:305-262-5244 /C ANo):786-388-7244 7171 Coral Way#209 EMAIL certificates@asiflorida.net Miami,FL 33155 ADDRESS: PRODUCER RESUL-1 Jorge Pena,PIAM CPIA CUSTOMER ID 7t: INSURER(S)AFFORDING COVERAGE NAIC S INSURED RESULTS AIR CONDITIONING INSURER A:Western World Insurance COmpan 13196 COMPANY INSURER B:Bridgefield Employers Ins. 10701 7451 NW 72 AVE MIAMI,FL 33166 INSURER C: INSURER D: INSURER E: 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. INSR DL SUBR TYPE OF INSURANCE POLICY NUMBER MIDDY EFF MPO/LDO EXP LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RE A X COMMERCIAL GENERAL LIABILITY N998030190 10/29/2013 10/29/2014 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,00 X BI/PDED DED$500 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY PRO Loc J CT PROF LIAB $ INCLUDE10 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA UAB X OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ TATUTH- WORKERS COMPENSATION WC SLIMIT X 0ER AND EMPLOYERS'LIABILITY T RY LIMIT ER Y / B ANY PROPRIETOR/PARTNER/EXECUTIVE❑N N/A 830-35672 01126/2014 01/26/2015 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) AIR CONDITIONING INSTALLATION & REPAIR Qualifier: Jose A. Corbera License #CAC057653 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Ave Miami Shores,FI 33138 AUTHORDMD REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION F CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET •� � TALLAHASSEE FL 32399-0783 CORBERA, JOSE ALEX RESULTS AIR CONDITIONING COMPANY 7451 NW 72ND AVENUE MIAMI FL 33166 I STATE OF FLORIDA AG# 6 7 4 6 L Congratulations! With this license you become one of the nearly one million j DEPARTMENT-QF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. Is PROFESSIONA14p REGULATION Our professionals and businesses range from architects to yacht brokers,from boxers to barbeque restaurants,and they keep Florida's economy strong. j w CAC05765316y.,12 110434078 Every day we work to improve the way we do business in order to serve you betters For information about our services,please log onto ww.myfloridalicense.com. i CERTIFIED A�RCQND iCONTR vv There you can find more information about our divisions and the regulations that I , CORBERA, O'S$ 411.1; .x impact you,subscribe to department newsletters and learn more about the RESULTS AIRCONDi'TIONING COMPANY Department's initiatives. Our mission at the Department is:License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida,and congratulations on your new license! =s `csRT=Fxsn un- 31.1.h2 provisions 10 :cn.142 Fs ;axpiratioa date :AUG' 31�� 2014 L1208'1601424 __ ----DETACH.HERE DOCUMENTTHIS AC# 6 2 7 4 6.111, STATE-OF FLORIDA" DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION 'INDUSTRY LICENSING BOARD SEWL12081601424 LICENSE NBR 08/16/20" 12 1.30434.078 1 CAC057653�, 'rXY ''r The- CLASS B AIR CONDI'T'IONING CONTRACTOR Named below IS CERTIFIED: � •-; ti -• Under the rovisions ofr Cha ter . 89F P P ; iv Expiration date: AUG .31, , 2014yv�d" YA +S: CORBERA; JOSE .ALEX �,�,#�` RESULTS AIR CONDITIONING COMPANY 11240 SW 29 STREETd3 MIAMI FL-33165 r : TRICK SCOTT, KEN LAWSON GOVERNOR SECRETARY __�___ DISPLAY-AS-REQUIRED-BY LAW — _— 000875 Local Busir�ess��'axyRece��'�� x 3- Miami-Dade C(j'pty,,Stats of Florida F y: =THIS IS NOTA BILL-:DONOTPAX , 323923. E f o BUS INESS%NAME/LOCATION RECEIPTNO s 1Y RESULTS AIR CONDITIONING-CO RHIIEWAL EXPES �r T �• MEDLEYEL331662461 323923 lNust tie displayed atsptaca oflil* In ss PUr3n3gL:2'O:Gr.OUAty Co'drs r'•.-t "Art 9 . OWNER SEC.TYPE OFSBUSINESS RESULTS AIR CONDITIONING`CO 196 SPEC MECHANICAL CONTR'A`CTOR PAYM BY F �. WOrkei(s) 10 z Thi;:LocalBusinessiaxReceiptonlyconfirmspaymerrtoflheLocalBusiness Tax.The "13t.. ro se _ pertni4or a certification of the holder s qualrfrcatiorrs3to ddbusmess Holdenrtrost y any .rti! I or nongovernmental regulatorylawsand iegmrtsremewhich apply'to the busme TheRECEIPT NO.abovemustbedisplayedonall commercialvehrcCes Formorerirformatiod,visit-www.miam�� } ''