MC-16-3253Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number
201
v»- Addit..
11it Status: APPROVE
Expiration: 06/28/2017
Applicant
1226 NE 100 Street
Miami Shores, FL 33138-2604
1132050090060
Block: Lot:
VALDIVIA HOLDINGS LLC c/o M
Owner Information
Address
Phone
Cell
VALDIVIA HOLDINGS LLC c/o MELLAW 2601 S BAYHORE Drive
--- - -- -- - COCONUT GROVE FL 33133-
2601 S BAYHORE Drive
COCONUT GROVE FL 33133-
Contractor(s)
ERV AIR CONDITIONING INC
Phone
(305)975-5943
Cell Phone
Valuation:
Total Sq Feet:
$ 8,000.00
1000
Tons:
Additional Info: REPLACE ONE UNIT WITH A 3.5 TON GOO
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 3
Date Approved: : In Review
Type of Work:
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$4.80
$4.20
$4.20
$1.60
$5.00
$280.00
$9.00
$6.40
$315.20
Pay Date Pay Type
Invoice # MC -11-16-62216
11/30/2016 Check #: 998
12/30/2016 Check #: 6703
Amt Paid Amt Due
$ 50.00 $ 265.20
$ 265.20 $ 0.00
Available Inspections:
Inspection Type:
Final
Rough Duct
Review Mechanical
Underground
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, his permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required fo ELECTRICAL, PLUMBING, IMECHANI WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS
constructio
FI
an
AVIT: I certify that
ning. Futhermor
uthorized S
all
regoing..nformation is accurate and that all work will be done in compliance with all applicable laws regulating
'ze the =hove -named contractor to do the work stated.
gnature: owner' / Applicant /
Building Department Copy
Contractor
December 30, 2016
Date
December 30, 2016 1
Miami 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 is MECHANICAL PUBLIC WORKS
JOB ADDRESS: / 2 2 co/U& /t ® �T
Questions/Comments/Concerns
Monique ith, 786-253-2869
)
NOV 3n2018
FBC��20N
Master Permit No. /pp2 is- - pry
fy
Sub Permit No.
c ao
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County:
Folio/Parcel#:
Occupancy Type: Load:
Miami Dade Zip: /5R
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Va /a1 /h id /765. a�
Address: IZZ ( /DO ST
Phone#: 784, _25-5 240 7
City: H. (� t S70 12--8 S State: Zip: 33 /2 0
Tenant/Lessee Name: Phone#: 206' 2E3 2s g
,t4 o AJ/vC@UN1G -i--1,0 MES., x'z
Email:
CONTRACTOR: Cdompany Name: 6/eV 4//Z CD,t1Dl�'11�i1,1®/l%, T�lC • Phone#: Cid) 9 55%3
Address:
�/" �� cid 64 Dr. �j
City: /�/ jG /77 / State: ' 1 Fe- Zip: 5 ` / <3 L`
Qualifier Name: ,neS7 / %Z de_ L e // r Phone#: d��g7J`�'—V7-3
State Certification or Registration #: eA c /815-Z.- Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: g 0 C s,_ City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work: / 000 S E
Type of Work: ElI�Addition i II Alteration„,...-0New Repair/Replace n Demolition
C >4- C&T ®NL7 AO T Poi 771- 4- 3,s m Ai /
®®D 114/J II k CE-? -I- !AgT 4-(.L 2 -.i H IVE-i / T l L 4-7701
Description of Work:
F
Specify coir of color th"rutile
Submittal Fee $`✓ Permit Fee $- -- 2tS V CCF $ CO/CC $
� . ._,s i
Scanning Fee $ - ' ,
` ifadon Fee '-$ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
5
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 II be approved and a rein ection f ill be charged.
Si natur It Signature .440e4f;i
DR or ACONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
30 day of 11.1 °.'i , 20 t _ by I 1 day of (J0-rfk%az4 , 20 ((.. , by
Pk..ONl Q(k._- Sml,6who is i:s_cAialldato 5rry .,kD R.A.);2 Vii\ot , who is personally known to
me or who has produced as
identification and who did take an oath.00IIIIIUitt,���
NOTARY PUBLIC: �aay0 *"MVCril��o
Sign:
Print:
Seal:
WI :off? o
'salj41642600 Di 111 �0```\`
********************** **** ********* ******
APPROVED BY v
(Revised02/24/2014)
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
e
4,*• ANGEL PAEZ
Notary Public • State of Florida
Commission * FF 977888
1i<* *f *ss Apn 8.02028*
,g-
*** **********s*x�ir+a�
PI ns Examiner
************
Zoning
Structural Review Clerk
WritesI& Mph. prudget-
> =' ':,
Date:03/01/2016
State of Florida
County of Miami -Dade
Before me this day personally appeared Emesto Ruiz de Villa who being duty sworn depose and
say:
That he or she will be the only person working on the locate / 2( / /00 S
Swom to (or affirmed) and subscribed before me this f day of / 0 .204L, by
Personally know
ProducORed Identification
or SillallBsW641, • ry
My Comm. Expires Apr 3. 2020
11/15/2016 14:23 3058881885
ACI`) `I " CERTIFICATE OF LIABILITY INSURANCE _ R. _
THIS.CERTIfICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO S U
RIGHTPON THE CERTIFICATE HOLDETHIS
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
I REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT:.11 the teitlflca a 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). — _...
_.. ...... ._. .. ___..•._.. ._. ''CONTACT
PRODUCER I
I West Coast Insurance Consultants In PHONE n.(305)888-1880 _1laNN4l (305)888-1885
P.O Bax 5217574 f pR g; wise 199 --.... .. __._. • �..
I Miami, FL 33152 _.__.. __.. INSURER(3J AFFORDING 9OVERAOE __ . _•—_ ,
Phone 1305) 888-1880 Fax (305) 888_1885 'Ij INSURERA: : GRANADA INSURANCE COMPANY
_.—... —_._ .._.__. .. _..-- '--•' —.. I
PAGE 01
DATE (mWDWYYYY)
11/14/16 —
NATO
INSURED
ERV AIR CONDITIONING INC.
10840 S.W. 69 Drive
Miami, FL 33173-2008
COVERAGES CERTIFICATE NUMBER:_ _ REVISION NUMBER:
THIS IS•TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW_ HAVE SEEN 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.
INSURER D : •
305 INSURER E: — ,... ...--..
Iryan IAPPl,autuc POLICY EFF POLICY EXP
LTR •, TYPE OF INSURANCE _ —____11148. WW2_ —_ POLICY NUMBER (MMIDDIYYYY) •(MM/DCIYYYXI
A
GENERAL LIABILITY
41 COMMERCIAL GENERAL LIABILITY
L .1 [..J CLAIMS -MADE I I OCCUR
11
GEN'L AGGREGATE LIMIT APPLIES PER:
1...l POLICY '.... J PRO• 1.
.JEGT .: LOC
AUTOMOBILE LIABILITY
11 ANY AUTO
fo. AUTO8 NEO
1.1 HIRED AUTOS
L.�
I. AUTOS
SCIaEOULE0
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NON-OWNEDS
I ,. 1 UMBRELLA LIAR I.: I OCCUR
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•
I . 1 DEO _i. i RETENTIQN$
WORKERa COMPENSATION
AND EMPLOYERS' LIABILITY Y 1N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER ExCLUDED?
(Mandatory In NH) l.
If yes, describe under
DeScRIPTION OF OPERATIONS below
Y
0185FL00031147
NIA
11/07/2016
11/07/2017
LIMITS
EACH OCCURRENCE $ _2.000.000_00
LIGE TOE $
RENTED 2 100,000.00
PREMISES a occurrence
MED EXP (Any one person
PERSONALS ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
s 5,000.00
s 1,000,000.00
$ 2,000,000.00
$ 2,000,000.00
MBINED SINGLE LIMB
Ea acci n))
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
it c e DAMAGE
er acci en
S
EACH OCCURRENCE
AOOREGATE
WC STATU• OTH-
;•.
EACH ACCIDENT
E.L. DISEASE -EA EMPLOYE, $
E.L. 0i$gA$E - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD tot, AdrIltlonar Remarks Schedule. If more space Is required)
license no CAC1815622
CERTIFICATE HOLDER
MIAMI SHORES VILLAGE BUILDING DEPT
10050 NE 2 AVE
MIAMI SHORES FL 33138
ACORD 26 (2010/05) QF
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ITHE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
i*—AUTHORIZED REPRESENTATIVE
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