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MC-16-2255 Permit No. MC-8-16-2255 s�jQ1!ES o��C Miami Shores Village Permit Type:Mechanical-'Residential 10050 N.E.2nd Avenue NWt r WorfcCiassification:AdditionlAlteration Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 •N{�.N �toRtot* Expiration: 02/11/2017 Issue Date:8/1502016 Project Address Parcel Number Applicant 11004 NW 2 Avenue 1121360020240 LSP HOMES LLC Miami Shores, FL 33168- Block: Lot: Owner Information Address Phone Cell LSP HOMES LLC 455 NE 210 Circle Terrace (305)527-3643 MIAMI FL 33179- 455 NE 210 Circle Terrace MIAMI FL 33179- Contractor(s) Phone Cell Phone Valuation: $ 9,500.00 ADVANCE AIR TECH CORP (305)795-3414 �. Total Sq Feet: 0 Tons:4 Available Inspections: Additional Info:NEW DUCTS FLEXIBLES,REFRIGERATION Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved: : In Review Review Mechanical Date Denied: Type of Work: Underground Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $6.00 Invoice# MC-8-16-60946 DBPR Fee $4.99 08/15/2016 Credit Card $311.48 $50.00 DCA Fee $4.99 Education Surcharge $2.00 08/10/2016 Credit Card $50.00 $0.00 Permit Fee $332.50 Scanning Fee $3.00 Technology Fee $8.00 Total: $361.48 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 AFFIDIT/1 ertify th all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and o Futhermo , I authGrize the above-named contractor to do the work stated. August 15, 2016 Auth ized Si ture:Owner / Applicant / Contractor / Agent Date Building Department Copy August 15, 2016 1 VD Miami Shores Village Building Department Aug 10 2016 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 20 Iy � BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. �11 I - aaSS ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING F� MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ,�pp CONTRACTOR DRAWINGS JOB ADDRESS: 7t O O N UI `-Mr Qy City: Miami Shores County Miami Dade Zip: Q)`AR Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): t*SP ".OItiQ`� LLP— Phone#: IPJ-5 Z-1- " 3 43 Address: iQ)0 i W V J �, h VJ City: Y�I,ZMi S�01-Q State: L Zip: k(o'b Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:—�sa,nLc 9 �{ l eC (��Y Irl Phone#: Address: C;O l c) s J City:_ Y,\ari State: -r-L Zip: 33k55 Qualifier Name: �� �nas� La\c:�s22 Phone#: �0E- 494 �3y� State Certification or Registration#: LAC'_ to jan-?1 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 47,'goo -uIcz, Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Rept ce ❑ Demolition p �j �'1 escri tion of_Work:.� 91 all Now l l 4 i�C 4 �C71�1'S Specify color of color thru tile: Submittal Fee$'2-50 Permit Fee$ 6' w CO/CC$ Scanning Fee$ : ,3 Radon Fee$ DBPR$ �' Notary$ ' Technology Fee$ y ' w Training/Education Fee$ '2- Double Fee$ ' Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ � l `� (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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which curs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be pro d and a ins ection fee will be charged. Si natur g Signature OW ER rAGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this S"1�C" day 2f 20 (=.by a n0day of v5 20-9'C>/(o, by A ho is personally known to -F.7, who is personally known to me or who hN�yllabl�r(�N� �„u„ as me or who has produced r$ L./43—( t�—�/��� identificatior§WldVH6r*d$$$W)Eb oai = identification and who did take an oath. Old�NOISSIVVVdO� °� *= NOTARY PUq elpaqS %,''� � r�ab; NOTARY PUBLIC: Sign: Sigrr. -. � •,. Print: E{ Vh Print: Seal: ;�"�4P Sharita Afterbury Seal: •� F<<o32 z�' =,c = COMMISSION#FF140831 %* e 4 o EXPIRES: Aug. 2, 2018 '�',��pT• �","• cP`� r, **OF low 41t' �'# APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) PLEASE CUTOUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — — {— IMPORTANT STATE OF FLORIDA ` Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation DEPARTMENT OF FINANCIAL SERVICES 1 who elects exemption from this chapter by filing a certificate of DIVISION OF WORKERS'COMPENSATION F election rower this section may no recover benefits or +� compensation under this chapter. 1 CONSTRUCTION INDUSTRY EXEMPTION 10 t CERTIFICATE OF ELECnON TO BE EXEMPT FROM FLORIDA1 L Pursuant to Chapter 440.05(12),F.S.,Certificates of election to ENSAf WORKERS!COMPENSATION LAW D be exempt..apply only within the scope of the business or trade ' EFFECTIVE DAIS- 2MM15 EXPIRATION DATE: 2x4=17 � listed on the notice of election to be exempt. J PERSM LABRADA IZMERT 1H Pursuant to Chapter 440.05(13),F.S.,Notices of election to be # FM: 472518/62 JE exempt and certificates of election to be exempt shalt be f BUSINESS NAME AND ADDRESS: t R subject to revocation if,at any time after the filing of the notice t ADVANCE AIR TECH CORP }E or the issuance of the certificate,the person named on the } notice or certificata no longer meets the requirements of this t section for issuance of a certificate.The department shay revoke 6010 SW 19TH STREET a certificate at any time for fatlure of the person named on the } MIAMI FL 33155 } certificate to meet the requirements of this section. i 1 ! 4 1 SCOPES OF BUSINESS OR TRA s SHEET METAL WORK- HEATING,VENTILATION, } LINSTALLATIO — — AIR-COND DFS-172-13WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 t STATE OF FLORIDA ° s DEPARTMENT;-OF BUSINESS AND `� PROF�ESSION_ALAEGULATION 1 CAC1818026 ! s ISS` UED:ur01/28/2015, CERTIFIED AIR COND CONTR—f' LABRADA,IZMERT. i ADVANCE AIR-TECH;'CORP y I �rf�ERT(F.IED under.th'e provisions*of'Ctr 89„FS. F.x`pinKion deteeAUG 31,2016 -oL1501280001688 - - 002951 Locall Business Tax Receipt ;Miami-Dade County, State of Florida —THIS IS NOTA BILL — DO'NOTPAY LB . 7181778 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ADVANCE AIR TECH CORP RENEWAL SEPTEMBER 3.0, 2016 16010 SW.19 ST 7462266 Must be displayed at place!of business E MIAMI FL 33155; Pursuant to County Code I Chapter 8A—Art.9&10 { OWNER �' SEC.TYPE OF BUSINESS I , .ADVANCE AIR TECH CORP 196 SPED MECHANICAL CONTRACTOR PAYMENT RECEIVED ' I �BYITAX COLLECTOR i 1 "CAC1818026 p ..lorker(s)' 1 I $75.00 08/18/2015 CREDITCARD-15-04-1413 Thistocal 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 must-comply with any governmental r -or nongovernmental regulatory laws and.requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami Dade_6ode""_Sec Ba-276. _ For moreinformation,visit viww.miamidade.aov/taxcatfactor A CERTIFICATE OF LIABILITY INSURANCE DAT08/0/9/22016016 Y) 08/0 TMS 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). PRODUCER COMA MARTA ALONSO NAME: Florida Bankers Insurance P N : (305)266-6493 N : (305)262-0679 EiA 7278 SW 8 Street ADMDRILES& mike®floddabankersinsurance.com Miami,FL 33144 INSURERS AFFORDING COVERAGE NAIL r Phone (305)266-6493 Fax (305)262-0679 INSURER A: ASCENDANT COMMERCIAL INSURANCE CO. INSURED INSURER B: ADVANCE AIR TECH,CORP. INSURER C: 6010 SW 19th Street INSURER D: INSURER E: MIAMI FL 33155 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 TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LTR INSR I WVD POLICY NUMBER MM/DD MM/D LIMITS © COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 ❑ CLAIMS MADE © OCCUR PREMISES Ea occurGE TO rence) $ 100,000.00 ❑ MED EXP(Any one person) s 5,000.00 A ❑ N N GL-46351-0 11/27/2015 11/27/2016 PERSONAL BADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 POLICY ❑ JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 1,000,000.00 ❑ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ❑ ANY AUTO BODILY INJURY(Per person) $ E:] ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ❑ AUTOS ❑ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ ❑ AUTOS Per accident ❑ ❑ $ ❑ UMBRELLA UAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION OPER [I STATUTE EOR AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTNE❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) LIC#CACI 818026 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01)OF The ACORD name and logo are registered marks of ACORD ADVANCE AIR TECH CORP. 6010 SW 19 ST Miami FL 33155 lic# CAC 1818026 Date: 8 l 101 20 mp State of F 1 o ri ca a County of Before me this day personally appeared labra-(4 who ,being duly sworn ,deposes and say: That he or she will be the only person working on the projet located at: I I Op 4 tj W Z Aae I'-�l�caM� Sorts tT:L- Sworn t ffirmed) and subcribed before me this I o day of . 20jt , by Personally know OR Produced identification Type of identification Produced �Qriall2�Q 7-e.�'�2* Print , Type or Stamp Name of Notary MAMAKU TWMA -` +Q4ANotary '9hlta d f10fIN Note Pdk • J• - COMMIdSNO I R 9"M My COMM.Exon AN 19,MO �a�wM MOI Mlq►p Atitlt. SgoREs pt ,.�. a�.. Miami Shores Village Building Department ��ORiDP' 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 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 coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW Y- U ACKNO GE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of ,201. By�A_ ��Y IS who is personal y known to me or has produced to NLVentification. -• ���.4 - JENNIFER CLAPES N o c Notary Public-State of Florids ;� My Comm.Expires Jun 26,2015 SE q:,4or11001P Commission#r FF 136648 nna•