MC-15-2163 Al
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Miami Shores Village N,:,t
10050 N.E.2nd Avenue NE
H , ter
Miami Shores,FL 33138 0000X,
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Phone: (305)795-2204
;1t} 12t� Expiration: 06/2016
Project Address Parcel Number Applicant
358 NE 101 Street 1132060135280
Miami Shores, FL 33138- Block: Lot: PATRICE AND SCOTT SMITH
Owner Information Address Phone Cell
PATRICE AND SCOTT SMITH 358 101 Street
MIAMI SHORES FL 33138-
358 101 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 300.00
HAVANA AIR CONDITIONING, INC (305)558-9136
_.. Total Sq Feet: 0
Tons: Available Inspections:
Additional Info:HOOK UP MECHANICAL Inspection Type:
Classification:Residential Final
Approved:In Review Review Mechanical
Comments: Date Approved::In Review
Date Denied: Type of Work:
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee $2.00 Invoke# MC-8-15-56837
DCA Fee $2.00 08/24/2015 Credit Card $50.00 $64.60
Education Surcharge $0.20 10/09/2015 Check#:13082 $64.60 $0.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $114.60
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 FIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio nd zoniZthermore,I authorize the above-named contractor to do the work stated.
October 09, 2015
Authorized Signature:Owner / Ap nt / Contractor / Agent Date
Building Department Copy
October 09,2015 1
Miami Shores Village
BuildingDepartment
AUG � t015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 _;•�,
INSPECTION LINE PHONE NUMBER:(305)762-0949 — --- "
FBC 20W SN
BUILDING Master Permit No. es-pr I�` 2t I
PERMIT APPLICATION Sub Permit No. LSC- LS- '213
BUILDING ❑ EL RIC ❑ ROOFING F-1 REVISION ❑ EXTENSION ®RENEWAL
❑PLUMBING MECHANICAL ❑PUBLIC WORKS n CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
10B ADDRESS: 3506 n5t
City: Miami Shores County: Miami Dade Zi
Folio/Parcel#: 1 1 " Jho• 013 • S2%0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): SPY11_VV% Phone#:
Address: JSt> "IE lot i5f "
City: 1.i1; 5Vx-. 'e5 State: FL zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 4L Phone#� �>���
Address: ���I,�es% 3 ST
City: 1/lAj ew& State: Zip:
Qualifier Name: Phone#:
State Certification or Registration* c�s�lv�� Certificate of Competency#:
DESIGNER:Architect/Engineer: lA Ierr�nrldE2 ?F_ —1 Ko%3 Phone#:
Address: 13144 1 Std aot -r-on/ City: 1.4AYY11 State: FL_ Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: � �� m
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ yy++
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable) �k
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) A
Mortgage Lender's Address fIJ
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 notbe roved and a reinspection fee will be charged.
0 Signature Signature L;Zl�
OWNER or AG CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing intrument was acknowledged before me this
day of by ® day of 1 20 _ S by
�j c �, is ersonally known ®S�9G��� 6-112 1,wh s personally kno 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:
Sign: Sign: —4/�
Print: M G V LOQ ✓fi n C,2 Print: cz..-`� ���✓ ^ �'�Z
Seal: Seal:
tPP:P••i
MARCos a MARnNEZ
,.r4 ••Y�r�, MARCOS A.MARTIN IZ =*: +_= MY COMMISSION#FF 8989
MY COMMISSION#FF 008989EXPIR
= 'a•' EXPIRES:Ma ••••04 ES:May 15,2017
y 15,2017
sam�xe< a� * *e�r��x • �°�1S1#lTiWs�Po �x�s *airs* ws*a**e * „o„F.o sonde ' ' WtiPo+l�
APPROVED BY PI s Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
CL
Leal Business Tax-Receipt B-'w
Miami—Dade County,State of Florida
=1IF19 IS NOTA PALL-00 NOT PAY N�_L
28T8123
B AINESS 19AAn13140eA ON IRCCEI"NO.
EXPRES
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OWNER IM0.'rYP9 OFRIMINE69 PA1ttVt8[Fi RIr661tre0
HAVANA AIR COPiDITIONING INC190 SPEC MECHANICAL BY TAX COLLECT=
CONTRACTOR 49,50 100912015
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CERTIFICATE OF LIABILITY INSURANCEDATE(MM7DDIY"
r 1010712015
THIS CERTIFICATE 15 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, THAs CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIRcATE HOLDER.
IMPORTANT:Ifthe certificate hIs an ADDI
the terms and CTIpNAL INSURED,the poticy(les)must t)e endomed. UBROGATION IS WAIVED,subject to
policy,certain Policies may require an endorsement A statement on this certificate does not confer rights to the
certlfleate holder In lieu of such eridorsement(s),
PRODUCE
Emmanuel insurance Associates,Inc. NAME:PRbNF-S3rai Mediae
2370 E 8TH AVE Ell: (305)693-WM Ne: (305)6914391
AD sarai(�emmanuelinsurance.com
HIALEAH FL 33013-4236 INS S AFFORDMG COVERAGE NAIL F
U�W (NSURERA: Pretend Contractors Insurance Co. 12497
HAVANA AIR CONDITIONING INC INSURER a! RetailFirts Insurance Co. 10700
OSVALDO BORRELL INSURER C:
887 W 34TH ST MSIR D
HIALEAH INSURER E
FL 33092-5159 ,
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,
LTR TYPE bP INSURANCE gR POLICY NUMBER
GENERAL LIABILITY MM/D LAS
COMMERCIAL GEN2RALLIA&LI Y EACHOCCURReNCE S 1,000,000.00
CLAIMS-MADE ®OCCUR PREMf ES Ea oma encs S 30,000.000
A PC4406017 02 MED E%P Wiy au Peen 5 5,000.00
0W23/2015 09/23/2016 PERSONAL&ADV INJURY E 1,000,000.00
GENLAGGREGATE LIMIT APPLIES PER: OENERALAGOREGATE g 2.000,MAA0
POUOY PRO. LOC PRODUCTS-coawroP AGG S 2,000,0Do. 00
AUTOMOBILE LIARKM 8
ANY AUTO ecd0ent
At 70�D SCHEDULED BODILY INJURY(Perpereon) E
AUTOS
MREO AUTOS � VOSO BODILY INJURY(Per eeddoo $
eCCidera $
OS
UMBRELLA LIAR 8
OCCUR
EXCESS LI" CLAIMS MADE OCCURMNCE g
DED REPENTIONI pGATE S
WORNERMS COInPENSATION $
AND EMPLoyew LIABILITY YIN bT 0TH_
B ANY PROPRIETOR/PARTN�CUnyE I tr R
I01AaROFRCROMMInNN) GLIDED? El N/A 0520-4 1-0 09/10/2015 OZ/=oi6 E.LEACHACCIDENT S 1,000,000.00
Kdat
I oPERATICNB below. E.L.DISEASE-EA FM PJ OYE S 1.000.000.00
E,LbISEASE_POLICYLIMIT s 1,000,000.00
DESCRIPTION OF OPERATIONb/LOCAnoN3/VERICLES(AM GB ACQRO 101,Admslvnm Rcmanla Senedu)e,n more
Mechanical Contractor. uPmm 1e ro9uimi)
Any Changes or alterations Done to this d0c==atter being issued shall constltute it null and void.
CERTIFICATE HOLDER
CANCELLATION
MIAMI SHORES VILLAGE
10050 NE 2 AVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE
MIAMI SHORES,FL 33136. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERr,D IN
ACCORDANCE WITy THE POLICY PROVISIONS.
AU1TrOR�p AT1YE
ACORD 26(2010/06) The ACORD name ahtl I o are registered marks
ACORD CORPORATION_All rights reserved.
09 arks of ACORD