MC-17-964 Permit NO. MC-4-17-964
Miami Shores Village Permit Type: Mechanical-Residential
10050 N.E.2nd Avenue NE
Work Classification:Addition/Alteration
Miami Shores,FL 33138-0000 PenPennit Status:APPROVED
Phone: (305)795-2204
FCORtD4`
issue Date:4/1412017 Expiration: 10/11/2017
Project Address Parcel Number Applicant
1201 NE 91 Terrace 1132050010210
Miami Shores, FL Block: Lot: FELIPE VALLS SR
Owner Information Address Phone Cell
FELIPE VALLS SR 3663 SW 8 Street (305)219-0471
MIAMI FL 33135-
3663 SW 8 Street
FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 3,000.00
ULTRA LOW TEMP INC (786)326-2592 Total Sq Feet: p
Tons: Available Inspections:
Additional Info:LEGALIZING EXISTING AHU&CONDENSIN 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 $1.80
Invoice# MC-4-17-63609
DBPR Fee $2.00 04/14/2017 Credit Card $271.80 $ 50.00
DCA Fee $2.00
Education Surcharge $0.60 04/06/2017 Credit Card $ 50.00 $0.00
Permit Fee $105.00
Scanning Fee $3.00
Technology Fee $2.40
Work without Permit Fee $205.00
Total: $321.80
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.
April 14, 2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
April 14, 2017 1
Miami Shores Village R
ARIO J§ 27
,
Building Department .
10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC201 � �
BUILDING Master Permit No'Z� Ic-_7 —:3?_
PERMIT APPLICATION Sub Permit Not�6c_( 4
❑BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION ❑RENEWAL
PLUMBING ® MECHANICAL PUBLIC WORKS [:] CHANGE OF CANCELLATION E:] SHOP
�""�� L�jI st CONTRACTOR DRAWINGS
JOB ADDRESS: mn Na -
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:Ll od • 02,1 n Is the Building Historically Designated:Yes NO
Occupancy Type:WLoad: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):
g- -1'Ci1I 1 c Val' S Phone#:,� � �13��
Address: 3 SUC.� �/�
City: MIIA_J�'a State: Zip:
Tenant/Les ee Name: �(/,..0 L Cao��/� Phone#:
Email: yiS� K-( HcP •C...a t
CONTRACTOR:Company Name: 0 i T v Low Phone#:!4g6- 61q (j q 3
Address: 6 5 0.
City: o.l t� 11 State: Zip: 3 O
Qualifier Name: C CJr p &cwt!J` Phone#:
State Certification or Registration#: C 12�� -1 S 3 O Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: 2 City: State: Zip:
Value of Work for this Permit:$ 3 n�. Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration CC❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: J
Specify color of color thru tile:
Submittal Fee$ t__(.'\ Q Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bon 7 01A
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 absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day by day of
�r /�7�.'C �— 20 17 by
wl o is personally kno to who is personally known to -
me or who has produced as me or who has produced �rt ��"�'e— as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: y
Print: J rYvl Print:
Seal: GEORGETTE BLACKBURN Seal: VVYtin
MY COMMISSION i FF 202094 Notary PublIc State or Fiorkle
s, EXPIRES:June 13,2019 �; Mario Santana
" of Barbed TMu Budget Notary Swim My Commission FF 957a77
APPROVED BYI&N.V\\Aans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
5 OI
lose 11111M Miami Shores Village
rpa Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
BUSINESS NAME: U L 1 V -P�- LZw S AP f QJ(
BUSINESS ADDRESS: 1535 W 40 'a- - CIN STATE ZIP I Z
BUSINESS PHONE: 0 S�O ) J2� - FAX NUMBER(__)
CELLPHONE ( QUALIFIER'S NAME:��C� L�
QUALIFIER'S LIC NUMBER: 0�AL `a��s
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD �.
CMC1249530 p `
The MECHANICAL CONTRACTORlift
Named beldw IS CERTIFIED. >~'"
Under the prpvisions of Chapter 489 FS.
Explrajlon date AUG 31;2018 x., V-
P'bRQR•
. j/ -'11L?RILL TEMP IN
n
4h °"
PLA AS UI t SEQ#'Li608300002E77 `
6 F
Ali`qv 3
)04026
Local Business Tax Receipt
Miami—Dade County, State of Florida
—THIS IS NOT ABILL—DO NOT PAY LBT11)
6089932
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
ULTRA LOW TEMP INC RENEWAL SEPTEMBER 30, 2017
1695 W 39 PL B 6352512 Must be displayed at place of business
HIALEAH FL 33012 Pursuant to County Code
Chapter 8A—Art.9& 10
OWNER SEC.TYPE OF BUSINESS
196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED
ULTRA LOW TEMP INC BY TAX COLLECTOR
CMC1249530
Worker(s) 1 $45.00 09/09/2016
CREDITCARD-16-052272
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's qualifications,to do business. Holder must comply with any governmental
or nongovernmental regulatory laws end requirements which apply to the business.
The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 88-2713.
For more information,visit www.miamidade.gov/taxcollector
Accw"® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMlDD/YYYY) I
04/03/17 I
THIS CERTIFICATE IS ISSUED ASA 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 1
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 CONTACT IRIS ROSARIO
NAME:
J Mendez 8 Associates Inc PHONE
(A1C.No,Ext)._(305)685-5001_)6 _ _ _FAX
No): (305)764-3551
13205 NW 7th Avenue EMAIL mendezandassociates
ADDRESS: 1 @gmail,com
Miami,FL 33168 I INSURE
R�SlAFFORDING COVERAGE NAIC A
Phone (305)685-5001 Fax (305)764-3551_ INSURER A: ASCENDANT INSURANCE COMPANY
FuTRA
URED NORMANDY INSURANCE COMPANY
_INSURER B.LOW TEMP,INC _INSURER C: _
1533 W 40 Street INSURER D.
HIALEAH,FL 33012- (786)326-2592 INSURER E_—
l - _ _ INSURER F: _ 1
COVERAGES _ CERTIFICATE NUMBER: REVISION NUMBER:
I 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 I
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 I ADDLSUBR _
LTR TYPE OF INSURANCE I NSR)WVp POLICY NU (M
MBER POLICY EFF POLICY EXP
GENERAL LIABILITY I i_ - - M/DDIXYYY) (MM/DD/YYYY) _ LIMITS
EACH OCCURRENCE $ 1,000,000.00
F-1-1 COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED
PREMISES1Ea occurrence) $ 100,000.00
A O ❑ CLAIMS-MADE Q OCCUR — I I GL-45553-1 _MED EXP(Any one person) J $ 5,000.00
09/22/2016 09/22/2017 PERSONAL a ADV INJURY $ 1,000,000.00
F] —I GENERAL AGGREGATE s 2,000,000.00_
G❑EN'L AGGREGATE�E LIMIT APPLIES LOC PRODUCTS-COMP/OP AGG $ 1,000,000.00
POLICY PRO- I .__._
—JECT $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I Ea dent) 1,000,000.00
❑ ANY AUTO I BODILY INJURY(Per person) $
ALL OWNED SCHEDULED 03240024-1
C ❑ AUTOS ❑ AUTOS 08/13/2016 08/13/2017 BODILY INJURY(Per accident $
❑ HIRED AUTOS NON-OWNED PROPERTY DAMAGE
❑ AUTOS
_-- (Per accident)__ _
S $
_ _ _ PIP _ $ 10,000.00_
❑ UMBRELLA LIAR ❑OCCUR FJ CH OCCURRENCE $
❑ EXCESS LIAB_❑CLAIMS_MADE I AGGREGATE $
_❑ DED ❑ RETENTION$ _ 1 _ -- $ —
WORKERS COMPENSATION f0T,
C STATU- OTH-
AND EMPLOYERS'LIABILITY Y/N ORY LIMITS_L.ER
ANY PROPRIETOR/PARTNER/EXECUTIVE 800084177 EL.EACH ACCIDENT $ 500,000.00
B (Mandatory
In NH) EXCLUDED? INIA 106/03/2016 06/03/2017
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000.00
Ir yes,describe under
_DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00
ACORD 101,Additional Remarks Schedule,if more space Is required)
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach
A/C SERVICES, INSTALLATION AND REPAIR
CERTIFICATE HOLDER _ CANCELLATION _
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Building Department ACCORDANCE WITH THE POLICY PROVISIONS.
10050 N.E.2nd Avenue AUTHORIZED REPRESENTATIV
Miami Shores,Florida,33138
L__ _I IRIS ROSARIO
ACORD 25(2010105)OF 9 8-2010 ACO D COR RATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD