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MC-15-2510Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. MC -1 0-15-2510 Permit Type: Mechanical - Residential Work Classification: Addition/Alteration Permit Status:: APPROVED Issue Date: 412912016 Expiration: 10/26/2016 Parcel Number Applicant Owner Information PORTO CABRAL LLC Address 500 NE 92 Street MIAMI SHORES FL 33138-3157 Phone 500 NE 92 Street MIAMI SHORES FL 33138-3157 Contractor(s) VITAL AIR SOLUTIONS INC Phone (954)821-8640 CeII Phone CeII Valuation: Total Sq Feet: $ 1,500.00 0 Tons: Additional Info: DUCT WORK Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved:: In Review Type of Work: Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Amount $1.20 $2.25 $2.25 $0.40 $5.00 $150.00 $3.00 $1.60 Total: $165.70 Pay Date Pay Type Invoice # MC -10-15-57283 10/01/2015 Credit Card 04/29/2016 Credit Card Amt Paid Amt Due $ 50.00 $ 115.70 $ 115.70 $ 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 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. OWNER .FFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constr tion an.- ..' more 1 authorize.� the above-named contractor to do the work stated. ms's-�!A_ '_ April 29, 2016 Authorized Signature: •wilei icant / Contractor / Agent Building Department Copy Date April 29, 2016 1 BUILDING PERMIT APPLICATION 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 1015 FBC 20 tC r\ Master Permit No. �- S C31- 03 Sub Permit No. I .4 e,� 7 — 2 510 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ® MECHANICAL El PUBLIC WORKS JOB ADDRESS: k-) e- ( (;)-- City: � City: Miami Shores ❑ CHANGE OF NTRACTOR County: Miami Dade ❑ CANCELLATION Zip: ❑ SHOP DRAWINGS Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: NO Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ''I�\ l Phone#:��� (0LI BIP° Address: (300 ( 1� �D�—� City: N-/l,� ' �1g State: Zip: Tenant/Lessee Name: Phone#: Email: 740,423-6 PoU0 0) Y ( (- CONTRACTOR: Company Name: Vi ) A L A) 1` 5 O ii -1 i 04f/ ALA'hone#: "PS t A9 / SS 61 Address: 110 34) n! ' lilt) A V � City: FO Ampwwo 8.. 0—c/tr State: L W Zip: 3 3 O O zi Qualifier Name: A'/L. 16 y V) 14 L Phone#: State Certification or Registration #: C./ -}"'G / Si 103 7- Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ t coo .0 Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: D v C vo 0 Specify color of color thru tile: Submittal Fee $ CR) Permit Fee $ 1 1 v v CCF $ CO/CC $ Radon Fee $ S DBPR $ ' S Notary $ S Scanning Fee $ 3 - Technology Fee $ Training/Education Fee $ O ' t%Q Double Fee $ Structural Reviews $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 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. SignatureY 17.f. J \ 6 The foregoing instrument was acknowledged before me this OWNER or AGENT 0 day of C1c , 20 1 , by WCC F"`vGP4Pspersonally known to d- me or who has produce.IXC v (.-XCJEKM as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: # APPROVED BY (Revised02/24/2014) Y� i s�+ Notary Public State of Florida • Sindia Alvarez • My Commission FF 156750 Expires 09103112018 ,,; Signature' V. V \, ('• CONTRACTOR • The foregoing instrument was acknowledged before me this GI day of ! GO/TO _ `' ., 20 l by t� .L. kj--\1vl� , CI i3 personally known to me or who has produced •R tXJ,'t7 lAC>120'asw identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: t/Plans Examiner .°A., Notary Public State of Florida °ASindia Alvarez v My Commission FF 156750 oFc�oaP Expires 09/03/2018 # #.# ****** Zoning Structural Review Clerk BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016 DBA: VITAL AIR SOLUTIONS INC Business Name: Owner Name: WARLEY BELTRAME VITAL Business Location: 801 NW 44 ST BAY 4805 OAKLAND PARK Business Phone: 954-821-8640 Receipt #:HEATING/AIRCONDITION CONTRA' R Business Type: (CLASS 8 A/C CONTRACTOR) Business Opened:01 /28/2015 State/County/CertlReg:CAC 1.818037 Exemption Code: Rooms Seats Employees Machines Professionals 1 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost 27.00 0.00 0.00 2.70 0.00 0.00 Total Paid 29.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: WARLEY BELTRAME VITAL 611 CYPRESS LAKE BLVD STE L POMPANO BEACH, FL 33064 This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Receipt #WWW -15-00000599 Paid 10/07/2015 29.70 2015 - 2016 From:HG Holdam Insurance & Tax Acct 561 434 3505 03/29/2016 12:06 4720 P.001/001 'AC.: `..F.K1.' CERTIFICATE OF LIABILITY INSURANCE '. DATE(MM/DD/YYYY) 03/29/2016 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 pollcy(ies) 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 cerci lcate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER H.g. Holdam Insurance 3830 Jog Road Lake Worth, FL 33467 Phone (561) 434-4451 Fax (561) 434-3505 CONTACT NAME: (NC No, Est): (561) 434-4451 �A/Ac, No): (561) 434-3505 ADDRIESS: craig@hgholdam.com INSURER(S) AFFORDING COVERAGE NAIC Y INSURER A : Federated National M COMMERCIAL GENERAL LIABILITY INSURED Vital NC Solutions Inc 4030 NW 4th Ave Pompano Beach FL 33064 INSURER B : Progressive Express GL -0000032593-00 INSURER C : 01/12/2017 INSURER D : $ 1,000,000.00 INSURER E : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER F : ■ • THIS INDICATED. CERTIFICATE EXCLUSIONS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR W VD POLICY NUMBER POLICY EFF tMMIDDJYYYII POLICY EXP (MM/DD/YYY1) LIMITS A M COMMERCIAL GENERAL LIABILITY N N GL -0000032593-00 01/122016 01/12/2017 EACH OCCURRENCE $ 1,000,000.00 ■ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 ■ MED EXP (Any one person) $ 5,000.00 II PERSONAL &ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 0 POLICY • JECOT • LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 ■ OTHER $ B AUTOMOBILE LIABILITY N N 02868007-0 02/10/2016 02/10/2017 COMBINED SINGLE LIMIT (Ea accident) $ ■ ANY AUTO BODILY INJURY (Per person) $ 25,000.00 ALL OWNED SCHEDULED • AUTOS 0 AUTOS BODILY INJURY (Per accident) $ 50,000.00 NON -OWNED ■ HIRED AUTOS ■ AUTOS PROPERTY DAMAGE (Per accident) $ 25,000.00 ■ . $ ■ UMBRELLA LIAB • OCCUR EACH OCCURRENCE ■ EXCESS LIAB ■ CLAIMS -MADE AGGREGATE $ $ ■ DED ■ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A $ PER OTH- ■ STATUTE ■ ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) AC Installation Service & Repair. License # CAC1818037 CERTIFICATE lane nFR _--.--.. --.__. Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138-2382 Fax 305-756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) QF © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD VITAL A/C SOLUTION INC DATE: 1 /20 ?67 STATE OF r(Q/UccOk) COUNTY OF bei BEFORE ME THIS DAY PERSONALLY APPEARED IV SAY: viifft WHO BEING DULY SWORN , DEPOSES AND THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROSPECT LOCATED AT: Ivy. ( a -n1 3 rZ - 3"3 aDo 2 5inveril, SWORN TO/(OR AFFIRMED) AND SUBSCRIBED BEFORE ME THIS °A.6-1) PERSONALLY KNOW OR PRODUCED IDENTIFICATION 2016 , BY TYPE OF IDENTIFICATION PRODUCED ► JY / I G • PRINT, TYPE OR STAMP NAME OF NOTARY URIDA MIRABAL MY COMMISSION # FF 159697 EXPIRES: January 12,2019 oe�O' Bonded Thr, Budget Notary Servic Miami 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 Depai talent 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. Signature: State of Florida County of Miami -Dade The foregoing was ackn edge before me this r day of `--_- , 20 Lal. Notary: SEAL: MC -a— who is personally known to me or has produced Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 QC n Inspection Number: INSP-266335 Permit Number: MC -10-15-2510 Scheduled Inspection Date: August 31, 2016 Inspector: Perez, JanPierre Owner: Job Address: 500 NE 92 Street Miami Shores, FL Project: <NONE> Contractor: VITAL AIR SOLUTIONS INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060141200 Phone: (954)821-8640 Building Department Comments DUCTWORK Infractio Passed Comments INSPECTOR COMMENTS False °\/\ L\y Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-244732. August 30, 2016 For Inspections please call: (305)762-4949 Page 31 of 38