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MC-14-1461 (2) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-215499 Permit Number: MC-7-14-1461 Inspection Date: July 01, 2015 Permit Type: Mechanical - Commercial Inspector: Perez,JanPierre Inspection Type: Final Owner: MILITANA,JOHN AND ADRIENNE Work Classification: Kitchen Hood Job Address:8900 BISCAYNE Boulevard Miami Shores, FL Phone Number Parcel Number 1132060110160 Project: <NONE> Contractor: UNIVERSAL HOOD TECH INC Phone: (305)687-7099 Building Department Comments INSTALL COMMERCIAL HOOD FOR PIZZA HUT Infractio Passed Comments INSPECTOR COMMENTS True Inspector Comments Passed Failed El Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 July 01, 2015 Page 1 of 1 t Miami Shores Village rvzr��,r�� wl-A Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �`'�� Tel: (305)795-2204 Fax:(305)756-8972 BY' )A INSPECTION LINE PHONE NUMBER:(305)762-4949 � 7 FBC 20 BUILDING Master Permit No. Lc.Cn- I q 139 PERMIT APPLICATION Sub Permit Nott �L ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING )�MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �cQ U 1/�1 I �uA Cid: Miami Shores County: Miami Dade Zip: Folio/Parcel#:1�` �d �' (DW Q Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: U OWNER: Name(Fee Simple Titleholder): � a-'7, Phone#: Address: Ci'b0 k U 13 City: Icl�l U( `Q State: Zip: �J`, J Tenant/Lessee Name: V e G1 L ,L L Phone#: ?05-q Jo"/0)00 u ! { 1 Email: v r CONTRACTOR:Company Name: IU Q-�60 1 �0�'(-K ... CIC Phone#:'36b -CAI Address: 131)U )JU) Q UP, ()0�A (0 7 City: ('�))G k Uc«G State: Zip: � 6 Qualifier Name: �)ccje 230[1'1C, Phone#: - 6 `7 State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: J , Phone#:`��"L'�� V� � 'r .t� l\I Address: � n 1L V ( -City: VIQ State: Zip: 3 ►3�d Value of Work for this Permit:$ 7, 00b Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: y-)�IjG I Crum m w l a 1 Specify color of color thru tile: Submittal Fee$ Permit Fee$ V 1 CCF$ L- CO/CC$ . Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 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 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 obisence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. C� Signature Signatu C, OWNER or AGENT CONTRACTOR The foregoing instrum.e.nj was acknowledged before a this The foregoing instrument was acknowledged before me this T� day of 201 by day of (_)n e. 120 by who is personally known �(75e (�IL)I I, o 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: NOTAR UBLIC: Sign: V ' Sign: Print: Z� u4) Print: �° IA Seal: Seal: * onw: MY COMMISSION A FF 108425 4u ; of Florida EXPIRES:Apol3.2018 1.1444. BP*Tku 8WO Notery Swkes 17s�y p'n APPROVED BY Pla s Examiner Zoning Structural Review Clerk (Revised02/24/2014) r r RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CS II10278 The SHEET METAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 , A& ■ ■ BALUJA, JOSE ANTONIO -,,14-- UNIVERSAL UNIVERSAL HOOD T * 12843- W OTH T F MIAMI L � 7 ISSUED: 05/29/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405290002689 1 .............. ._. _....._._. Og2157t AMlbil� K� n �.Y H,F , � � � „�� `.�..� NYt Y •x4Tt �xn�}1 � f d �' ✓J ��Sar may,, $� -•4� '•$' �t'a *s rr `" lz 77 •a 1 r�i xV02 t { , � � r`x f �d , SEC.TVPE OFItt1E88 PAYM�ftr6CEIW °w" 196 1 ro DING � I OR BY TA? �LECT f3 HOCfDTECHI CSC11fi71 $7S O F 7/10/ 3 u#ftr# i{s} i TXHS1- I Q2�� I BusinI4,j!Re 0 'qa{Business Tax The 401 ry t is not a�icense t�a cert of the quehfl fNess.Hald�a ��en`19�mmenuii or lfKnmentaF tola aquusmas wh�c fo fhe bualu� ' s 71ie RECEIrrw6l above R dI la aii card tti Kiat vehi s Cods Sec sP Yom.. t9li'" 'if�Mormat,al�, 14 03l CERTIFICATE OF LIABILITYI0ATE L_: INSURANCE o( ��1�DPYY� PRODUCER Morgan Insurance Group Tt(iS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION 1 13155 SW 42nd St##107 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE IC THIS CERTIFICATE TIFATE DOES NOT AMEND,EX"T"END OR II i Miami,FL 33175ALTER THE C - 9E-AFF RDED BY THE POLICIES SELPiLV ^, Phone(305)222-9001 Fax(305)222-9006M^ INSURERS AFFORDING COVERAGE MAIC { INSURERA: NAUTILUS INSURANCE COMPANY 1 INSURED Universal Hood Tech,Inc ------ --- _._ __....._. _.__ .._.___ 12843 SW 45 Ter Miami,FL 33175- INsuRERcm ......._......_......'..... " "___._q_...—.._.......................... L{305}667-7099 INSURER E. _COVERAGES THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWrrHSTANDtNG ANY REQUIREMENT,TERMOR 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.AGGREGATE LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. v—ry .. — INSR AdD*L TYPE OF INSURANCE LTR INSRO POLICY NUMBER �Y EPDLY aXPiRaTtdN ATE•,(MfNllidtYYYY}OkTE(lAiAIddIYYYY!( LIMITS _ GENERAL LIABILITY EACH OCCURRENCE � [/)COMMERCIAL GENERAL LIABILITY ,IVXCBU 0012312013 0912312014 [PREME3 occurrence) rrence 1001000.00 ❑❑ CLAIMS!BADE OCCUR MED EXP(Any one person) 5.000.00 _ m_ A ❑ r7 _ PERSONAL ADINJURY_._ .. 1000,000 GENERAL AGGREGATE 2,000,000 GEWL AGGREGATE LIMIT APPLIES PERS =PRODUCTS-COMPIOP AGG M 1,000,666 ❑ POLICY ❑PROJECT ❑ LOC – AUTOMOBILE LIABILITY a....._............. COMBINE=D SINGLE LIMIT j f–; ANYAUTO Eaaccident ❑ ALL OWNED AUTOS BODILY INJURY 1 (� ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS BODlILYINJURY _.... PROPERTY DAMAGE _❑_e, �_ ___._____ __ __._ Seer accident} GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ j❑❑ ANY AUTO OTHER THAN i AUTO ONLY ........_,.7A—P�,. . EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE- ❑ ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND w.--- ___. ..._ _.___ EMPLOYERS'LIABILITY YIN; _ ?Lt�Tldl ......... ...._ ANY PROPRIETOR I PARTNER I EXECUTIVE E.L EACH ACCIDENT OFFICER I MEMBER EXCLUDED? i { (Mandatory in NH) 1 E.L.DISEASE-EA EMPLOYEE ttye s,�describe under SPECIAL..PROVISIONS below E.L.DISEASE-POLICY LIMIT ,____. ..__ OTHER F6E - _� – ._6. --'---CRiPTION OF OPERATIONS I LOCATIONS 1 VEHICLES/EXCLUSIONS ADDECf BY ENaORSEMENT/SPECIAL PROVISION'S Sheet Metal Fabricator. License#CSC1110278 CERTIFICATE HOLDER CANCELLATION ..............__ _..__.. _... ._. .... _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WLR.ENDEAVOR TO MNL MIAMI SHORES VILLAGE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10060 NE 2 AVE THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OSUGATION OR LIABILITY MIAMI SHORES, FL 33138 OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRES TATIVES AUTHORIZED REPRESENTATIVE ACORD 26(2009101)OF @ 1988-2009 ACOR5 CORPO O .All rightsP reserved. The ACORD name and logo are registered marks of ACORD ACC>ROO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYYYY) 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(ies)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 Praxiom Risk Manaement, LLCS;ONTAC'q_ 123 West Bloomin dale Ave, #300 --_ Brandon; FL 3351` pH9Y@_ ,B Xt..................... .. .._ ....... E-MA1L AOQRE"... P..-...,___._..__.._._�,....._._..._... _..._...__. _ INSURE R(}.AFFQRQINI3 CpVEFtAOE NAtC# WwW,praxtom rm.com tNsuREsahnol4gy thsursltL1p3�y_ 9? ZO . INSURED INSURER B Quadrant PHR, LLC 8640 S. Peoria Avenue Tulsa CK 74132 1N§LIRERD INSURER E tN8 RE F: I COVERAGES CERTIFICATE NUMBER: 19003264 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. ..._,.... ....... P P UCY EXpT _. .. _ _.. LTR TYPEOFINSURANCE POLICY NUMBER ONYYY , MMIDONYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ pp,aq qq COMMERCIAL GENERAL LI�rDUTY PR Mt Ea a rence $ CLAIMS MADE i OCCUR ! MEQ EXP(Any ona _. ._.._ ..... -...._..._.._.__-_..__ ' I PERSONAL&ADV INJURY 5 GENERALAGGRE $ ................... i 1 GATE_..,.. GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS GQMPlOP AGG $ F-111 POLICY JFCT PRO- LOC $ ?rAUTfiM1DB[E AB1LTY � a aBINDN i LIM; $ ANY A1.iT0 I E BODILY INJURY SPer parson) $ ALL OWNED SCHEDULED. .... AUTOS AUTOS BODILY INJURY,Peraccident,;$ HIRED AUTOS AUTOS NON-O'✓vNED " ��— -- PRRi7P�R�Y DAMA� µ �__ � (Pa, acc denl) $ a $ UMBRELLA LIAR OCCUR ' EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE .- _._. QE $ D L RETENTIONS A WORKERS COMPENSATION °T+WC3301408 1/1(2014 1/1/2Q16 WCSTATU O�i2H AND EMPLOYERS`LIABILITY Y t N i ✓�:rc�RY IMlTS I ANY PROPMETORIPART'NEWEXECUTIVE _E L.,,EACH tcCG1.1 NT ._.. $ 1 000 000 { OFFICER/MEMBER EXCLUDED*) N t A _ ,„,,.,.....,_._.. (MandatoryIn NH) E.L.DISEASE-EA EMPLOYEE $ 11yea,tlesoriba unr�r ,..... ... -4- DES ._..-_,... ._�>D� ,a�,Q, CRlPTIpMOFOPERATIONSnalovEL DISEASE-POLICY LIMIT ;$ 1,000;000 E DESCRIPTION OFOPERATIONS(LOCATIONS I VEHICLES.(Attach ACORD 101,Additional Remarks Schedule,It more space Is raeuiradl Descriotion of Operations:Sheet Metal Fabricators-Liscense#CSC 110278 PEO Client Name:Universal Hood Tech,INC Location:13700 NW 19th Avenue#8-7,Opa Locka,Fl.33054 Workers'Compensation coverage is provided for only those employees leased to,but not subcontractors of Universal Hood Tech,Inc CERTIFICA O_L99R C NCETION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village BLDG DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE NTH THE POLICY PROVISIONS. Miami Shores, FI 33138 AUTHORIZED REPRESENTATIVE David E.Carothers 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010106) The ACORD name and logo are registered marks of ACORD C'R� NO '19901;64 CLIFN'" CbF;; PEC) Leve do 1 21'2r14 {1 45:,53 AN Page 1 f 3. "S'.LN rerta Moate cancels and 1:nez„e s �Af._ Previously �ssuec1 text.i