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MC-17-906
y y s ! , Miami Shores Village ' FEt� 10050 N.E.2nd Avenue NE � � � i.. Irm P lti/ctr{c C/assit�i:avt1� �#diti� iteration Miami Shores,FL 33138-0000 Phone: (305)795-2204 y. Issue :7171216171 Expiration: 01/03/2018 Project Address Parcel Number Applicant 45 NE 98 Street 1132060131130 Miami Shores, FL Block: Lot: JAVIER ZAYAS Owner Information Address Phone Cell JAVIER ZAYAS 45 NE 98 Street (305)318-6738 MIAMI SHORES FL 33138- 45 NE 98 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,400.00 CAMACHO MECHANICAL CONTRACT (305)696-5456 Total Sq Feet: 0 Tons: Available Inspections: Additional Info:A/C REPLACEMENT/REPAIR Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work:A/C REPLACEMENT/REPAIR Underground Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# MC-4-17-63545 DBPR Fee $2'25 07/07/2017 Credit Card $ 110.70 $50.00 DCA Fee $2.25 Education Surcharge $0.40 04/03/2017 Credit Card $50.00 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 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 AFFI AV I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a d zo inF�thermore I authorize the above-named contractor to do the work stated. July 07, 2017 ontractor / Agent Date Buildin Department Copy July 07,201 1 Miami Shores Village s_ Building Department P 3 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 6 BUILDING Master Permit No.-�C n— 9 0 PERMIT APPLICATION Sub Permit No. Imc LT_ q o ❑BUILDING F-1 ELECTRIC ROOFING REVISION EXTENSION RENEWAL ❑PLUMBING 0 MECHANICAL EJPUBLICWORKS F-1 CHANGE OF CANCELLATION E:1 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 45 NE 98 ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Javier Zayas Phone#:3053186738 Address:45 NE 98 ST City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: JAVI@SWARMinc.com CONTRACTOR:Company Name: Camacho Mechanical Contractor, LLC. Phone#: 3059654568 Address: 1030 SW 117 CT UNIT D12 City: Miami State: FL Zip: 33184 Qualifier Name: Luis Camacho Phone#: State Certification or Registration#: CMC1249978 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$1400 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New K Repair/Replace ❑ Demolition Description of Work: A/C Replacement/repair Specify color of color thru tile: Submittal Fee$ 60 jD0 I d Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 1 TOTAL FEE NOW DUE$ O 1 0 ` (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 pproved and a reinspection fee will be charged. a Signature G 12,wli OWNER or AULN I CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this —day of 1�+�'FrOe� 1 20 1 ) by day of ,vtC ' 20 t? by 'jP6MIA.�who is ersonally known to Ll/�l_S (Al�1(� who is p anally kn��olio t1 0 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: Print: Print: (� ; :'ey•.,, REBECCA LOPEZ q Seal: IVY -�i�� y 'fir: Seal:PhG ,�+.a REBECCA LOPEZ r 4. .A Commission#FF 238061 Expires June 8,2019 Commission#FF 238061 Expires June 8,2019 �. n.�- Dpded Thru TtOy Fein 4wranw 80a38S7019 1�„gIffi Doodad TMu Troy Fein inurm=800.385.7019 APPROVED BY V'InsExaminer Zoning Structural Review Clerk (Revised02/24/2014) ,SNOR ES D Miami Shores Village t Building Department Ron ..... 10050 N.E.2nd Avenue „4e Miami Shores, Florida 33138 'rWRID�' 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): 445 AJ t__ "1 D S+% City: Miami Shores Village County: Miami Dade Zip Code: I 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 CjoonMM AHU or PKG. UNIT MODEL# , 200 2 COND. UNIT MODEL#�, ( p 2 f t3769 7 KW HEAT NOM TONS 1*00S oil AHU CU PKG 1)M.C.A ,(p AHU CU PKG AHU C PKG 2)M.O.P '5 IS CU PKG AHU CU PKG 3)VOLTS 130 AH CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT YES YES NO NEW 4"CONCRETE SLAB YES YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity(Wire Size): Y- ff' 2. Maximum Overcurrent Protection (Fuse/Breaker Size): �� 1 3. Voltage of Circui (208 240/480): 4. Size Disconnecting Means: 1 I 2 Contractor's Company Name: V , AMAC�, O Phone: V b I-7 State Certificate or Registrati No. C _l"4� Certificate of Competency No. Signature Date: (Qua fler's signature) C IML 17,L,L II OCX (Rev1sed02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 CAMACHO, LUIS CAMACHO MECHANICAL CONTRACTOR LLC 1030 SW 117TH CT UNIT D#12 MIAMI FL 33184 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and STATE OF FLORIDA Professional Regulation. Our professionals and businesses range -a4 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 CMC1249978 ISSUED: 08/16/2016 to serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more CERTIFIED MECHANICAL CONTRACTOR information about our divisions and the regulations that impact CAMACHO,LUIS you,subscribe to department newsletters and learn more about CAMACHO MECHANICAL CONTRACTOR 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! EWationdate AUG31.2018 OW81600025% DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATIONo CONSTRUCTION INDUSTRY LICENSING BOARD CMC1249978 The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 CAMACHO, LUIS CAMACHO MECHANICAL CONTRACTOR LLC 1030 SW 117TH CT UNIT D#12 MIAMI FL 33184 1 ISSUED: 08/16/2016 DISPLAY AS REQUIRED BY LAW sen# L7608160002596 00307 Local Business Tax Receipt Miami—Dade County,State of Florida THIS IS NOT ABILL-DO NOT PAY L=BT 6739206 BUSINESS NAME/LOCATION RECEEFT NO. EXPIRES CAMACHO MECHANICAL CONTRACTOR LLC RENEWAL SEPTEMBER 30, 2017 1030 SW 117 Cr D12 7012701 Must be displayed at place of business MIAMI FL 33184 Pursuant to County Code Chapter 8A-Art•9&10 OWNER SEC.TYPE OF BUSINESS AVMENT RECEIVED CAMACHO MECHANICAL CONTRACTOR Lift GENERAL MECHANICAL CONTRACTOf�y TAX COLLECTOR CMC1249978 $75.00 08/21/2016 Worker(s) 1 CREDITCARD-16-048379 This permlt4ota certification of the Tax holder"sconfirms q ualitica6o�to dothe businass.Holdermustmast comply with any governmental license, or nongovernmental regulatory laws and requirements which apply to the businsss. The RECEIPT N0.above moor he displayed an sit commercial vehicles-Nfiaml-Dads Code Sec 80-276. For more infommtion,visit wwwmilimidedo.saftER611actor From:Acceptance InsuranctFax:(305)740-0516 To: Fax: (305)756-8972 Page 3 of 3 03/15/2017 11:02 AM CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) 03/15/17 THJS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERVICATE 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 pollcypes)must be endorsed. N 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 certMcate holder in lieu of such endorsement(s). PRODUCER NAME: Mabel Felipe Acceptance Insurance Services PHONE (305)740-0515 Fn/c No; (305)740 0518 6887 S.W.40th St. -M IL mabel@acceptanceinsservices.com Miami,FL 33155 INSURERS AFFORDING COVERAGE NAIC li Phone (305)740-0515 Fax (305)740-0518 INSURERA: Hudson Specialty Insurance Company 37079 INSURED INSURER B: Camacho Mechanical Contractor,LLC INSURER C: 1030 SW 117 Ct INSURER D: Miami,FL 33184- (305)965-4568 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. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYW M/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000.00 A ❑ CLAIMS-MADE ❑ OCCUR N N HBD10010735 MED EXP(Any one person $ 5,000.00 ❑ 07/03/2016 07/03/2017 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 ❑POLICY ❑ PES ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS BODILY INJURY(Per accident) $ ❑ HIRED AUTOS ❑ AUUTOSWNED PP OP Rdent AMAGE $ ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ❑TORY LIMITS ❑ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space Is required) Air conditioning installation,service 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 Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 305-756-8972 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD WE 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: 8/26/2015 EXPIRATION DATE: 8/25/2017 PERSON: CAMACHO LUIS FEIN: 264593668 BUSINESS NAME AND ADDRESS: CAMACHO MECHANICAL CONTRACTOR,LLC 1030 SW 117 CT MIAMI FL 33184 SCOPES OF BUSINESS OR TRADE: CERTIFIED MECHANICAL HEATING,VENTILATION, CONTRACTO 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 benefits 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 shall be subject to revocation if,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)113-1609 Mechanical Contractor, LLC CMC 1249978 1030 SW 117 Ct.unit D-12,Miami,FL 33184 E-mail:Camachomechanical®msn.com Tel. (305)965-4568 Date: 03/22/2017 State of: Florida County of: Miami Dade Before me in this day personally appeared Luis Camacho who,being duly sworn,deposes and says: That he will be the only person working on the project located at 45 NE 98 st Miami Shores,FL 33138 Sworn to (or affirmed) and subscribed before me this -` day of 2017,by Personally know OR Produced Identification Type of Identification Produced Print,Type or Stan T ,�•. REBECCA LOPEZ Commission#FF 2380b Expires June 8,2019 BaWTMuTmyFah boffoceg:. roe owl" Miami shores Y `.`amu►$°ve. Building Department 10050 N.E.2nd Avenue Miami Shores, Fiorida 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 it 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,parttime employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLIDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Si State of Florida County of Miami-Dade The foregoing was acknowledge before me this (3 rqday of -N!Pk+) ,20 11 . By v 7-6A\AQ5 who is personally known to me or has produced D lr'N,e e 1 S as identification. Notary: `• Y:"Ys4�= YANADY PRIE70 MY COMMISSION#FF 214031 SEAL: ;J 'o€ EXPIRES:March 25,2019 �/�.F R per. Bonded Thru Notary Pubkc Underwrbrs