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MC-15-2650Miami Shores Village 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING MECHANICAL El PUBLIC WORKS JOB ADDRESS: Master Permit No. 04. 4q p� �kF) 4-11 FBC 20N : Sub Permit No. M G IS--2OSO 0 REVISION ❑ EXTENSION ❑ RENEWAL CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: // 2 /5 / 6,-G. o c7 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): -/ / �f� i y �c�G 1i 77 — 't.. Phone#: ? 6'S 3 3 / o 3 L Address: 2 0? pi// ?s -- City: 5 City: /7/9/1/ State: /- Zip: / Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: / v 0 if 'P® I/6 rz Corerprri odu N 6rf(/' Phone#: 796— Address: 43 3/r v\-) 2. /tr City: tA' A State: C L Qualifier Name: 1 � �'- "A 0 V 12 i2 State Certification or Registration #: AC / g II 5 3 31 Phone#: l,L Zip: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: Value of Work for this Permit: $ CA 0 0 L Square/Linear Footage of Work: Type of Work: 0 Addition ❑ Alteration 2 New 0 Repair/Replace 0 Demolition Description of Work: A% e•--- v/ 2 4 / C ..Z'X! S -7-4\ LL A1 -r d U o-1 0 State: Zip: Specify color of colo hru tile: Submittal Fee $ —• Permit Fee $ -45 Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/74/70141 4 CF$ CO/CC$ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ ' 0 0 "(--))4 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 The foregoing instrument was acknowledged before me this 021 day of 2 2'cv44.e---11L ,20 / / ,by /J4//a4/5.1 , who is personally known to me or who has produced F/ ANL_ as identification and who did take an oath. NOTARY PUBLIC: (� Print: cJi n/ /2//%I'4,-,/,/ Sign: Seal: tlte'�' JIM D PAMPUN °'�Notary Public - State of Florida Commission # GG 041934 My Comm Expires Jan 13, 2021 *gal" % ° ***************** APPROVED BY uc I * CONTRACTOR The foregoing instrument was acknowledged before me this 5 t day of net atz � �Ct-( , 20 t7 , by '&t m�- rZ(*vho is personally known to me or who has produced' identification and who did take an 4,00 Marchs ic' .c<` NOTARY PUBLIC: Sign: Print: Seal: ® 1112 s�'�6r, dlhm r'A���JIIIID111111N���\\\ as *********************************************************** lans Examiner Structural Review Zoning Clerk CK Property Solutions LLC 209 NE 95 St Suite 7- Miami Shores- FL 33138 September 14,2016 Havana Air Conditioning Inc 887 West 34 Street Hialeah FL 33012 Re: 186 NE 106 St. Miami shores, FL 33138 Mr. Osvaldo Borrell, This is to notify you that effective immediately we are removing you as the mechanical contactor for projects at location 186 NE 106 St. Miami shores, FL 33138 because of the unwilling on your part to complete the work. Vi ' oottungal Managing Member CK Property solutions LLC. 10/21/2016 USPS.com® - USPS Tracking® Englilh Customer Service USPS Mobile Register I Sign In 0 -US SCOM USPS Tracking® Tracking Number: 70160910000145379489 Still Have Questions? Browse our FAQs Get Easy Tracking Updates > � Sign up for My USPS. Product & Tracking Information Available Actions Postal Product: Features: First -Class Mail® Certified Mail'" GATE ;;, 1 n44 October 18, 2016 , 4:02 pm Delivered, Left with Individual 7 Ir..;i', October 15, 2016 , 2:46 pm Notice Left (No Authorized Recipient Available) October 12, 2016 ,12:46 am Departed USPS Facility October 9, 2016 ,10:06 pm Processing Exception, Regional Weather Delay October 5, 2016 ,12:14 pm Arrived at USPS Facility October 4, 2016 , 6:04 pm Departed Post Office October4, 2016 , 3:36 pm Acceptance MIAMI, FL 33161 MIAMI, FL 33161 MIAMI, FL 33152 MIAMI, FL 33152 MIAMI, FL 33152 MIAMI, FL 33153 MIAMI, FL 33153 Text Updates Email Updates Track Another Package Manage Incoming Packages Tracking (or receipt) number Track allour y packages from a dashboard. No tracking numbers necessary. Track It Sign up for My USPS https://tools.usps.com/go/TrackConfirmAction?qtc tLabels1=70160910 145379489 1/2 Esta ffi_ ;Till Domestic Ma,11Ont For deliveryJrnfor,matlonq.0 sit ou �?uebsite�at www.u'sps com�:a ervice IUTAIL?:RECEII?T rin0)Fp141( Certified Mall Fee , I 111 u $3.30 - Iii $ r i` Extra ,= ces & Fees (check box, add tee ` ': • •'• ,:,,, [- ES ❑ Return Receipt (hardcopy) $',. ,i�, ❑RetumRecelpt( ) �' Here 0 Certified Mail Restricted Delivery $ fitf -z' "�/M� y� ❑AduR Signature Required $ - _ , -,- 1A1 — 4 B1S�� �Adutt 3lgnahue Restricted Oel,ery $ Postage 0,7 it/i E %ms's#. Total Postage and Fees $ $3e77�RES,F�- Sent To ------- - ----- Sheer andApi N"o., or IPJ §ox" o. City, State, Z1P+46 P-Forrn,.3800; Aprilv20'15 PSN7 30 02 UOU 90n7 R i so, otlost ictw, ns JEFF ATWATER CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FRSM 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: 3/21/2017 PERSON: AGUIRRE FEIN: 208059187 BUSINESS NAME AND ADDRESS: NORTH POLE AIR CONDITIONING INC 8395 WEST 26 AVE. HIALEAH FL SCOPE OF BUSINESS OR TRADE: Heating, Ventilation, Air - Conditioning and Refrigeration Systems Installation, Service and Repair, Shop, Yard & Drivers 33016 EXPIRATION DATE: 3/21/2019 JAIME IMPORTANT: 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. CFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 M iami Shores Village Building Department 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. State of Florida County of Miami -Dade The foregoing was acknowledge before me this C727 day of —114-‘14---4--' , 20 r7 . By who is personally known to me or has produced as identification. Notary: SEAL: ssoS.1 si4,, JIM D PAMPLIN �� Notary Public -State of Flor E commission er GG 041934 s��S My Comm. Expires Jan 13, 2021 Bonded through National Notary Assn. NORTH POLE A IR CONDITIONING I NC 8395 WEST 26 AVE HIALEAH FL 33016 MIAMI DADE(786)295-2424 BROWARD (954)354-9493 DECEMBER 21, 2016 State of Florida County of Dade Before me this day personally appeared Jaime Aguirre Who being sworn deposes and says. That he or she will be the only person working on the project located at: 121 N.E. 96 Street Miami shores, Fl. 33138 Jaime Aguirre North Pole Air Conditioning Inc. 8395 West 26 Ave Hialeah, FL. 33016 Sworn (or affirmed) and subscribed before me this..-. day JArw� /46virre Personalknoll ....................... Or Produced Identification............ Type of identification.................. ype or Stamp Name of Notary Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. Owner's Name (Fee Simple Title Holder): L Xi P/°/ 417 .4'o�e.sio44.-5 Phone #: S" 3 3 / e24. 3 2. Owner's Address: '2 c-7 9 moi/ 95 5 r 7-.f- 7 City: 7'//42,4/7 S/;-ores" State : Zip Code: / 3 Job Address (Of where work is being done): �6 ,r /c2i City: Miami Shores State: Florida Zip Code: 3 Contractor's Company Name://4,,40.4 At.), e...A..-7,99/ru% Phone tics- - 5Y.t- 9/3 b Address: 217 al 3 y P L ✓ City: 2,4.a/,r & State: sC/: Zip Code: 33 0 /2 Qualifier's Name : d�/vie/I© Lic. Number: z*.e/ Ze 5 6. / 3 J/ Architect/ Engineer of Record Name: Phone #: Address: City: State: Zip Code: Describe Work: hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. Signature er or Agent The foregoing instrument was aknowledged before me Signature Contractor or Architect The foregoing instrument was aknowledged before me this day of liVtrr.rc_ k ,2017,by I/ i �{ Kom-fronor,1 this day of o is ersonally known to me'•r who has produced , 20 by who is personally known to me or who has produced as indentification. as indentification. Nota Sign: Seal: Public ELIZABETH ELORRIAOA •rt MY COMMISSION # FF953536 •.,,a .;,• EXPIRES January 25.2020 OW) 35#8-0'53 HonclaNatryServic.e ear Notary Public Sign: Seal: Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 186 NE 106 Street Miami Shores, FL 33138- Owne ee.c:.nation CK PROPERTY SOLUTIONS, LLC Andress NO, MC -10-15-2650 Yt31mir / ype: Mechanical - ,Residentir' work C' assification: Addition/AlteratiO Permit Status: APPROVE,. Issue Date:12/11/201 Expiration: 06/08/2016 Parcel Number 1121360050010 Block: Lot: 209 NE 95 Street MIAMI SHORES FL 33138- 209 NE 95 Street MIAMI SHORES FL 33130. Contractors) Phone Cell Phone HAVANA AIR CONDITIONING, INC (3051558-913f 1 Applicant CK PROPERTY SOLUTIONS, LLI Phone (305)758-3133 Tons: Additional Info: Classification: Residential Approved: in Review Comments • Date Scanning: 3 Date Approved: • In Reoiran Tyr -' cr `-Nark Fear TIje CCF DBr✓R Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $5.40 $4.73 $4.73 $1.80 $315.00 $9.00 $7.20 $347.86 Valuation: Total :q Feet: CPII 8,000.00 no ff Available Inspections: F I sner:+inn TvnP- Pay Date Invoice 12/11/20 10/19/2C 5 Pay Tyr,,, iC .10-15-5 /467 :;re,Jit ;1 ar _i Cres::: Amt Paid Amt Due 17. 6 $50.00 $ $ 0.00 In considerat;on of the issuance to me of this perrr pertaining thereto and in strict conformity with the plat accepting this permit I assume responsibility for all requir' " c,,, r' Pr—roICAL PL' IMBING. MFCHANICA OWNL!.E .'.7FIDAVIT: I certify that all the foregoinc construction and a9Ring. Futhermore, I authorize the t, I agree to perform the nork covered hereunder in comp! s, drawings, statements or specifications submitted to the prof 'ort. e'en_ , WINDC'"F, Drinoc Pnnr! ...,d 9WII .^!1\!r, P00I. ',for informat,cr: is acc:;rate; i d that all work wil; be done in corn 'Dove -named contractor to 'lo the work stated. / r gen Author'. ed Sig ture: Owner / Applica rt BuRlIng Department Cop 1r / Cc,,tractor Final Rough Duct Reviex, \1 3nhani:a! Underground ince with ell ordinances and regulations authorities of Miami Shores Village. In understand that separate permits are r. fiance w tr, nil app'icab!e !aws regulating Decer Date Decerr"^^r 11, 2015 1 a Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING MECHANICAL El PUBLIC WORKS JOB ADDRESS: / 7J Com' /7777- City: Miami Shores County: - IN OCT 192015 BY: FBC 20)/1 Master Permit No.0/, - Sub Permit No./ e%L - 273,f?) ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade Zip: Folio/Parcel#: // 2 / 3 G v S fc, 7 c2 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: � Flood Zone: OWNER: Name (Fee Simple Titleholder): Cif /2C/I 'i Ty Ciy; 0.-4- Address: .4Address: Z v 9 ✓i 4 5'S % 7 City: s Yi /9if //2 �/u 4 State:/1-76- Tenant/LesseeesNamed Phone#: Email: // 2fc.- 01-2 BFE: FFE: Phone#: CONTRACTOR: Company Name: ,1, �p- SIL e, p , /r o.x%/1 Address.:) p �l ? ti),. -53 ----✓7 r City: l-�/A°-e/y4 State: FL Zip: )'G/ Qualifier Name: .1/04)" /gD i- -ct/ Phone#: �v- Zip: 3 3 / Phone#: 07)Sr1` 7/33 State Certification or Registration #: 24-'- D S"6 47 3 e Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ fa' C2 C7 ° Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work:fL,-647%4/C UAV/ 7:5 Specify color of color thru tile: ,g� Submittal Fee $ L O ,A0 Permit Fee $ 1\,5 'V CCF $ 5. q 0 CO/CC $ Scanning Fee $ 1,66 Radon Fee $ L < 4 3 DBPR $ " ° 3 Notary $ Technology Fee $ 7 In Training/Education Fee $ o f0 Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ GI v V (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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 17/1" NER or AGENT The foregoing instrument was acknowledged before me this ��e) day of ��� �/ , 20 /. , by i'//t aee t/iti % , who is personally known to me or who has produced FL— 7) as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY (Revised02/24/2014) JIM D. PAMPLIN Notary Public - State of Florida ; eal: ,. My Comm. Expires Jan 13, 2017 4FOF FI ri,�;:�' Commission # EE 86489221\a Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of / , 20 if r by S (re-/ , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: rint: . Plans Examiner •.$ cv' •FDENISE VARGAS MY COMMISSION # EE 164827 .. K= EXPIRES: March 27, 2016 H -4'8Aqe Bonded Thru Notary Public Underwriters as ** Zoning Structural Review Clerk