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MC-17-693 1 -6el 7, Miami Shores Village Aerr type!:� lerll ( R )ds I v: 10050 N.E.2nd Avenue NE �. ... ,.... Wprtf tss cetrcrtt A1C ReplAc6rn erlr '' Miami Shores,FL 33138-0000 t arm t.� s:APPROttEt'� Phone: (305)795-2204 .. Isau ate. i2ti2017, Expiration: 09/16/2017 Project Address Parcel Number Applicant 92 NE 95 Street 1132060130450 Miami Shores, FL Block: Lot: HAYDEE&DOUGLAS ROMANIK ', Owner Information Address Phone Cell HAYDEE&DOUGLAS ROMANIK 92 NE 95 Street MIAMI SHORES FL 33138-2707 92 NE 95 Street MIAMI SHORES FL 33138-2707 Contractor(s) Phone Cell Phone Valuation: $ 3,950.00 SANTY'S AIR CONDITIONING&REFR 305-884-5333 ,..,µ. _.._ _. _. .. ..H ..s _....... _ ......__ . _ ..... _.._. _.._.. . Total Sq Feet: 0 Tons: Available Inspections: Additional Info:A/C CHANGE OUT Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work:A/C CHANGE OUT Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# MC-3-17-63314 $2'07 03/15/2017 Check#:13251 $50.00 $101.79 DCA Fee $2.07 Education Surcharge $0.80 03/20/2017 Check#: 13256 $ 101.79 $0.00 Permit Fee $138.25 Scanning Fee $3.00 Technology Fee $3.20 Total: $151.79 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 zoninc Fu uthorize the above-named contractor to do the work stated. March 20, 2017 n d ature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 20,2017 1 P Miami Shores Village r� MAR,1,5 2017 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 FRC 20 l 4 �� BUILDING Master Permit No.Kc -•b93 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION F-]RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP j ( CONTRACTOR DRAWINGS JOB ADDRESS: �JV �� s City: Miami Shores County: Miami Dade zip: -33, 136 Folio/Parcel#: .Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 1✓u 14k:5 RZ5 cel Com' Phone#: ' (00 468NO Address: q, l r-4 City: iLl,e State: i- I en' - Zip: 3 3% ✓8 Tenant/Lessee Name: Phone#: Email: [ /� r CONTRACTOR:Company Name: � me: � e. �� s lTPhone#: -�` q_533 Address: _ �3 ii /�'1, W. � � ��- City: � c°"^ ' \ /� State: F f Zip: 33/ � fes' Qualifier Name: Pn 61v 1.c int rv" v,-9 Phone#: State Certification-or Registration#: C 11" S �1 30 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City:_ State Zip: Value of Work for this Permit:$ Square/Linear Footagc-,if Work: Type of Work: ❑ Addition ❑ Alteration ❑ N^ew� ❑ Repair/Replace ❑ Demolition Description of Work: C ✓ 'rte ® r "` " Specify color of color thru tile: Submittal Fee$ 56ya 1 dV Permit Fee$ I CCF$ CO/CC$ 5carning 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 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 1'5T-l+ day of AJAW 44 20 It- by day of L-0(52(4— 20 t' ) by U"Iof, 9�c)rrr W A— ,who is personally known to �z�h Do Arrnm If ,who 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: NOTARY PUBLIC: r Si n: o E Sign: Print: `�;Nota�Fy' abl'�-Mate of Florida prim. I F op°•'• Commission#►DD 862331 11" Seal: a• ;iPa'Pie' SANDRA UGALDE Seal: 1111111\\ P: i e : Notary Public-State of FloIfida ='' My Comm.Expires Feb 18,;��oF�;o? Commission#DD 8623 >k�lalalak>xallx�lall��l�l>F*�1�1>Ylx>Balalsr>x>tl>ale�alexekl�ala>xl�al �la�a�l�lxlxl� >II�I�Iak�l�l>k>all�s>�>Al��x xlallrlx�l*al>yek/m APPROVED BY �' Plan Examiner Zoning Structural Review Clerk (Revised02/24/2014) �yeoRFs y� Miami Shores Village Building Department a... 10050 N.E.2nd Avenue �. Miami Shores, Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address(where the work is being done): City: Miami Shores Village County: Miami Dade Zip Code: 33138 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO❑ ARHI Sheet Attached:YES ❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 14 Cie.✓1 AHU or PKG.UNIT MODEL# P el 8.71� COND.UNIT MODEL# ild O e/ 6 KW HEAT NOM TONS 'ID V-1 AHU CU PKG 1)M.C.A AHU CU PKG AHU CU PKG 2)M.O.P AHU CU PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES /^ NO YES NO NEW 4"CONCRETE SLAB YES�' NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO A 1. Minimum Circuit Ampacity(Wire Size): d f d 2. Maximum Overcurrent Protection(Fuse/Breaker Size): "tj Z cy 3. Voltage of Circuit(208/240/480): �� 4. Size Disconnecting Means: 0 Contractor's Company Name: Sa Phone: State Certificateor eg' ratio N ertificate of Competency No Signature Date: (Qual er's signature) (Revised02/24/2014) SANTY-1 OP ID:GM CERTIFICATE OF LIABILITY INSURANCE FD 03/201201 YY) 03/20!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(s). PRODUCER CONTACT Ch stat Martinez BenTrustInsurance Group PHONEFAX 701 Waterford Way,Suite 300 305-722-7058 A/c No):305-714-4401 Miami,FL 33126 ARE Michael Alvarez :cmartinp;@bbmia.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Arch Specialty Insurance Co 21199 INSURED Santys Air Conditioning$ INSURER S MOSSO Insurance Co. 25011 Refrigeration,Inc. 7531 N.W.70th Street INSURERC: Miami,FL 33166 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. ILTR TYPE OF INSURANCE ADDL S POLICY NUMBER UBR POLICY EFF POLICY EXP LIMBS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,00 CLAIMS-MADE OCCUR AGL0033459-01 01/25/2017 01/2512018 REM PISES Ea occurrence $ 200,00 MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 3,000,00 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 X POLICY❑JECOT- 7 LOC PRODUCTS-COMP/OP AGG $ 3,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 300,00 Ea accident B ANY AUTO WPP1457393 00 04105/2016 04/05/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Pe..dent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER TH- AB AND EMPLOYERS'LIIUTY YIN STATUTE ER ANY PROPRIETORIPARTNER/EXECUTNEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F-1 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addllional Remaft Schedule,may be attached if more space Is required) License#CAC057305 CERTIFICATE HOLDER CANCELLATION CIMS331 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Ave AUTHORIZEDREPRESENTATIVE Miami Shores,FL 33138 Brown and Brown of Florida,Inc. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACCOR"® CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) 3/20/2017 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 have ADDITIONAL INSURED provisions or 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). CONTPRODUCER SUNZ Insurance Solutions LLC ID: (Essential) NAME* T Jennifer Hau er c/o Essential HR, Inc.dba first Star HR PHONE 972-4040295 FAX Ne: 4455 LBJ Freeway, Suite 1080 E4ML Dallas,TX 75244 ADDRESS: iennifer.haU er firststarhr.com INSURERS AFFORDING COVERAGE NAIC# INSURERA: SUNZ Insurance Company 34762 INSURED INSURER 8: Essential HR Inc dba FirstStar HR INSURER C: 4455 LBJ Freeway INSURER 0: Suite 1080 Dallas TX 75244 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 34710866 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 DL SUER POLICY EFF POLICY EXP LTR POLICYNUMBER M/DDATM (MM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR D GE TOR NTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PROJECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UM13RELLALIAB H OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WCPE0000018404 10/1/2016 10/1/2017STATUTE ER AND EMPLOYERS'LIABILITY Y/N WCPE00000184 03 10/1/2015 10/1/2016 ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED? ❑ NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Coverage provided for all leased employees but not subcontractors of.,SANTY'S AIR CONDITIONING$REFRIGERATION,INC.7531 NW 70 STREET Effective date:10/1/2013 CERTIFICATE HOLDER CANCELLATION 63200001 Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Shores ent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE pa Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 �'+' f�/f AUTHORIZED REPRESENTATIVE Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 34710866 1 1 Master Essential HR dba First Star HR I NagaliAohpadmin.com 1 3/20/2017 8:47:15 AM (PDT) I Page 1 of 1 RICK SC ;GO STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC057305 The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 DE ARMAS, PABLO • SANTY'S AIC&REFRIGERIATION INC 7531 N W 70TH STREET MIAMI FL 331 r a • ISSUED: 09/22/2016 DISPLAYAS REQUIRED BY LAW SECT# L160922OW2207 001013 Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOT A BILL-DO NOT PAY 1975813 [L.BT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES SANTYS AIR CONDMONING&REMGERAnON INCRENEINAL SEPTEMBER 30, 2017 7531 NIN 70 ST 1851147 Must be displayed at Place Of business MIAMI R 33166 Pursuant to County Code Chapter SA-Art 9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED SANTYS A/C&REFRIGERATION INC 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR �C057305 $75.00 08/09/2016 Worker(s) 10 CHECK21-16-110243 This LOW Basiam Tax Remdo aaiy canihms palImeat of the Lax)Basing Tax.The Reoelpt is not a Room, or a or a cmentaateg of the holder's final to a ��� Iy With any govammsetel or aoaHoveramsatai regalatory Islas and The RSI Ma above amt be displayed an aR coan¢arcisl VOW--Inial#-Dade ire Seo tla-276. Formas hdormatiaa.v�it