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MC-17-118 Permit NO. MC-1-17-118 `yNORE,t V, Miami Shores Village Permit Type: Mechanical-Residential r � 10050 N.E.2nd Avenue NE ' Work Classification:Addition/Alteration Miami Shores,FL 3313&0000 Pen Permit Status:APPROVED Phone: (305)795-2204 �LORIDP Issue Date: 1/23/2017 Expiration: 07/22/2017 Project Address Parcel Number Applicant 68 NE 91 Street 1131010200020 ROBERT IRWIN FLOYD GONZAI Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ROBERT IRWIN FLOYD GONZALES 68 NE 91 Street (305)492-9763 MIAMI SHORES FL 33138-2808 68 NE 91 Street MIAMI SHORES FL 33138-2808 Contractor(s) Phone Cell Phone Valuation: $ 300.00 02 AIR CONDITIONING SERVICES, LL (305)607-8051 Total Sq Feet: 0 Tons: Available Inspections: Additional Info:2 EXHAUST FANS INTALL Inspection Type: Classification:Residential Final Approved: In Review Rough Duct Comments: Date Approved::In Review Review Mechanical ��]� Date Denied: Type of Work:2 EXHAUST FANS INTALL Underground Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# MC-1-17-62630 DBPR Fee $2.25 01/17/2017 Check#:404 $50.00 $ 120.10 DCA Fee $2.25 Education Surcharge $0.20 01/23/2017 Check#:401 $ 120.10 $0.00 Notary Fee $5.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $170.10 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 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. Futhermore, I authorize the above-named contractor to do the work stated. January 23, 2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy January 23, 2017 1 Miami Shores Village [BY , r�► Building Department JAN 17 2017 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 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit NO._,` l C ❑BUILDINGYMECHANICAL CTRIC ❑ ROOFING REVISION [:] EXTENSION ❑RENEWAL ❑PLUMBING ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP /- i CONTRACTOR DRAWINGS 10B ADDRESS: Ip NE 9`�� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: �FFFFE: OWNER: Name(Fee Simple Titleholder): lay G�d�� ICS Phone#: ` 1 l�-ci-76 6 3 Address: /" S City: tu vl-,i G/"f�S State: Zip: �.3 t Tenant/Lessee Name: / Phone#: �US' l�T 0 Email: t/1-ZCt CONTRACTOR:Company Name: Z t d< ��t t O+J i I-J Phone#: Address: 28�t S 3 2 '� PIL-- �7c City: lM �'��t State: fi L Zip: �� !7/ . Qualifier Name: .SC-Ad?- (-A•wt ;L,1 Phone#: 305' �0 / '30S) State Certification or Registration#: C �� 1 ( 3 Certificate of Competency#: DESIGNER:Architect/Engineer: ,�.. �„ .�•_«....�_e�..• Phone#: Adc}il ..�r�...e► a�.. M: •tea .t - �.. City: '' State: Zip: Value of Work for.:bis permit:$ _ �� nr : : ,• Square/Lipear F.ou age o Work: }�,Type of Work: ❑ Additioi ` Alteration ❑ New ', ie a jirj�eplace ❑ Demolition t•4!�>... r_ a�w/g�ww+F 1;�� v �n of Work: (7�_1 e�Vl G�-uS"I �i✓LS 1�5'�t Specify color of color.�hk'a' tile: Submittal Fee.$ `- . : Permit Fee$ { -9 CCF$ r`�`� CO/CC$ Scanning Fee$ Radon Fee$ Z • Z DBPR$ Notary$ _ 5i Technology Fee$ f� Training/Education Fee$ �� Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ t 2 Q _I O (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 the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or A6 CONTRACTOR The foregoing instrument was acknowledged beforemethis The foregoing instrument was acknowledged before me this day of 1 V b V 20 �/ ,by day of Jm KA 20 by fioN d bcmQ1e------)who is personally known to OS(GI(� COI b who is personally known to me or who has produced - xwa •.•� as MOLINA as oduced identification and who did take an oath. ? __ notary Pubiidd&Wiabll! da who did tak •MICIHF�' My Comm.Expires Se 19,2017: I No3in NOTARY PUBLIC: �.s+r r'` %�9„t• Comtnissi0WQTP IJX#tWLI i .4"•r� . , o17. R ) h a�• � .. 115J7� y Sign: Sign: Print: P'1ZCf��-�' Print: fv"� Seal: "' MgI{p,Rg1 K GONZALEZ t' MICR L MOL A Seal: Pubk��6� .1 ¢iR• �: MY COMMISSION#GG 0442002 1 1tPtF19f lorida EXPIRES:November 2, i:~ PublkUnderrniters Ff53��P 0' BondedTFwNot�Il h1i5c;en # c: APPROVED BY �lans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 ,W_ 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 CAMELO,OSCAR ALBERTO 02 AIR CONDITIONING SERVICES, LLC 15024 SW 104TH STREET,APT 2211 MIAMI FL 33196 Congratulns! With this license you become one of the nearly one mllllon Fatioloridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range44STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. ' PROFESSIONAL REGULATION Every day we work to improve the way we do business in order CAC1817913 + ISSUED:' 07/20/2016 to serve you better. For information about our services,please F - to onto www.myfloridalicense.com. There you can find more CERTIFIED AIR COND CONTR'A;-�; ^ " information about our divisions and the regulations that impact CAMELO,OSCAR ALBERTO.x,,' you,subscribe to department newsletters and learn more about 02 AIR CONDITIONING SERVICES,LLC the 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, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Exomion dale.AUc 3I,2019 LIso7200000728 DETACH HERE RICK SCOTT,GOVERNOR v�� KEN LAWSON,SECRETARY STATE OF FLORIDA µ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ext s CONSTRUCTION INDUSTRY LICENSING BOARD CAC1817913 The CLASS BAIR CONDITIONING CONTRACTOR, Named below IS CERTIFIED - x`- - Under the provisions of Chapter 489 FS. """- "-_'% - . \ I f.. Expiration date: AUG 31,2018 �./' ..�..�- -„,... ...^—”' ��iw,. - i'.A »• "`�. \ � 'tea *,. ..F4 y1 S '1� �.�, x,. i`� .' CAMELO,OSCAR ALBERTO l 02 AIR CONDITIONING SERVICES ILC .;'--15024 SW 104TH STREET APT 2211 w"" � =," `a�'"+.,�` :; MIAMI -FL 3'3196 R ./..�„�-�.•" �' .moi .•..:.L.:�f.:nY..-r- ,,+7.�. ��» �`'� �'t `'*•y 3A\'� `. ISSUED: 07/20/2016 DISPLAYAS REQUIRED BY LAW SEAN L1607200000728 012330 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT ABILL-DO NOT PAY 7177963 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES 02 AIR CONDITIONING SERVICES LLC RENEWAL SEPTEMBER 30, 2017 15024 SW 104 ST APT 2211 7458049 Must be displayed at place of business MIAMI FL 33196 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS 02 AIR CONDITIONING SERVICES LLC 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR ,r,C/O OSCAR CAMELO, MANAGER CAC1817913 Worker(s) 1 a75.00 07/19/2016 CREDITCARD-16-042145 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'squalifications,to do business. Holder must comply with any gavernaieaW or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles-Miami-Oak Core Sec Ba-M For more information,visit yvww.ariamWade.92YAMcoUec�or .4CORv" CERTIFICATE OF LIABILITY INSURANCE F1/6/2017 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(a). PRODUCER CONTACT NAME: PTL INSURANCE ASSOC. , INC. PHC N 7201 CORAL WAY o XI: 305-262-7094 ac No:305-262-4907 MIAMI, FL. 33155 ADDRESS: MISURERIS) AFFORDING COVERAGE NAICY INSURER A:ASCENDANT CONKI&RCIAL INS. INSURED OZ AIR CONDITIONING SERVICES LLC INSURER B: INSURER C:, 15.024 SW 104TH ST APT 2211 INSURER D: MIAMI, FL 33196 INSURER E: 305-607-8051 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. ILTR TYPE OF INSURANCE IN3R WV0 POLICY NUMBER MMIDD MMID LIMITS GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 R COMMERCIAL GENERAL LIABILITY PREMISES Ee occurrence s 100,000 CLAIMS-MADE D OCCUR MED EXP(Any one person) $ 50,000 A GL-45491-0 09/10/16 09/10/17 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE s 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/0P AGG $ 1,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY '31NULE LIMIT Ea eeddent $ ANYAUTO BODILY INJURY(Per person) s ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per acoldeM) $ HIRED AUTOS AUNON-OWNED $ Per accident s UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $' DED I I RETENTION$ $ WORKERS COMPENSATIONCOTFr AND EMPLOYERS'LIABILITY YIN T R 1 I ANY PROPRIETORIPARTNERIEXECUTNE OFFICERAIENSER EXCLUDED? a NIA E.L.EACH ACCIDENT $ (Ma ftwy in NH) E.L.DISEASE-EA EMPLOYE $ If yyes describe cinder DENIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) AIR CONDITIONING INSALLATION, SERVICE AND REPAIR. q CERTIFICATE HOLDER CANCELLATION MIAMI"SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2 AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHO EP SENTATIVE 111988-2010 ACO C RPORATION. All rights reserved. ACORD25(2010/05) The ACORD name and logo are registere marks of ACORD 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: 10/14/2016 EXPIRATION DATE: 10/14/2018 PERSON: CAMELO OSCAR A FEIN: 270612648 BUSINESS NAME AND ADDRESS: 02 AIR CONDITIONING SERVICES LLC 2840 SW 132 PL MIAMI FL 33175 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 beneffta 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 listed 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 shaft be subject to revocation It.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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 02 Air Conditioning CAC# 1817913 July 11, 2016 State of Florida County of Miami-Dade Before me this day personally appeared Oscar Camelo who,being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 68 NE 91 Street,Miami Shores, FL 33138. Sworn to (or affirmed)and subscribed before me this 11 cn day of January, 2017,by Oscar Camelo. Personally known OR Produced Identification ( Type of Identification Produced D•l� Print, Type, or Stamp Name of Notary �i" MICHELLE MOLINA ,u[ary Public-State of Florida My Comm..Expires Sep 19,2017 %:;;•oF��qP`' Commission#FF 055738 2810 SW 1.32 Place.Miami.FL 33175 305-607-8051 t f� I RES n ,... ,.,.. Miami V 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 YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature:_'Y&k Own r State of Florida County of Miami-Dade I The foregoing was acknowledge before me this day of V a� • ,20_n. By '`P\ uN/\�� - who is personally known to me or has produced as identification. Notary: SEAL: ,aa\\ .Av Pye, MICHELLE MOLINA ;4otary Public-State of Florida +'-MY COMM rxpirpq Se17 Commission#FF 05573E IIIIII\a\\a as