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MC-17-1822Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. MC -7-17-1822 Permit Type: Mechanical- Residential Work Classification: A/C Replacement Permit Status: APPROVED Issue Date: 7125/2017 Expiration: 01/21/2018 Parcel Number Applicant 1201 NE 98 Street Miami Shores, FL 33138-2562 1132050090220 Block: Lot: INES HEGEDUS Owner Information Address Phone Cell INES HEGEDUS 1201 NE 98 Street MIAMI SHORES FL 33138-2562 Contractor(s) AMERICAN A/C CORP Phone (305)512-4729 CeII Phone Valuation: Total Sq Feet: $ 3,500.00 0 Tons: Additional Info: REPLACEMENT 5TONS A/C SYSTEM Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved:: In Review Type of Work: REPLACEMENT 5TONS A/C SYSTEM Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $2.00 $2.00 $0.80 $122.50 $3.00 $3.20 $135.90 Pay Date Pay Type Invoice # MC -7-17-64597 07/17/2017 Credit Card 07/25/2017 Credit Card Amt Paid Amt Due $ 50.00 $ 85.90 $ 85.90 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 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 prof er 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 AFFIDAVIT: I all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z. �'_� ��� ore, authorize tltb above-named contractor to do the work stated. July 25, 2017 Authorized Signature: Owner / Applic-nt / Contractor / Agent Building Department Copy Date July 25, 2017 1 Miami Shores Village Building Department RECEIVED JUL 2 5 ?01 "0050 N.E.2nd Avenue, Miami Shores, Florida 33138 INSPECTION'S PHONE NUMBER: Tel: (305) 795.2204 Fax: (305) 756.8972 �/ / r „ (305) 762.4949 5-4.i 00 Y FBC 201LI Permit No. N C FR Master Permit No. BUILDING PERMIT APPLICATION Permit Type: MECHANICAL JOB ADDRESS: /2- 0 / N 9,e City: Miami Shores County: Miami Dade Zip: ,3/3S Folio/Parcel#: //"3Z0.SS•009 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 111(JS 11 e. P UC—(CiA dila► Address: l W k j ST City: WPWV ► SVVOrf__s Tenant/Lessee Name: N/A Email: 1 Yk°— @ 11A1 1441 StM • GO OA Phone#: 24/ • 9 C41" State: FL. Zip: 33� �j Phone#: CONTRACTOR: Company Name: Ameewin A/0 (moo€,4 Address: /"/ 42 /V a&d ct- Phone#: 005 524'fZ61 City: ikki /42��,ttI State: Qualifier Name: g...65//i9//p.0 Phil-- State %dl.State Certification or Registration #: v�� /8 /4)34 Certificate off Competency #: A � Contact Phone#: C J I24TZg Email Address: pia' CVbA DESIGNER: Architect/Engineer: Phone#: zip: 33015 Phone#: 305 /L1 Value of Work fol. this Permit: $ Square/Linear Foo ge of Work: Type of Work: Address Description of Work: ❑ ❑New a Alteration / p)'it I e� A e- �'% /f' 041/ e/ di tOn1 vl9 ❑Demolition Submittal Fee ;$ Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO/CC $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 ELECTRICAL WORK, PLUMBING. SIGNE WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 )wner or *gont Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of c/ ..; , 20 /7, by = ,S /��'c�s- ,> �< day of L./:„././20 / by �s;.�,i10 �; Z, who is personally known to me or who has produced i'—.0 who is personally known to me or who has produced mi=l Jiris- S -Zen As identification and who did take an oath. C, as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: My Commission Expires: Julian Cruz Notary Public - State of Florida Commission #GG 28168 Expires 9/8/2020 2.7 Sign: ^� Print: j: /t c \ er„ Z My Commission Expires Julian Cruz notary ruouc - zate oh-lorida Commission #GG 28168 S'/8�`'Z'S Expires 9/8/2020 APPROVED BY Plans Examiner Zoning Structural Review Clerk Date: 07/18/2017 State of Florida County of Miami -Dade American A/C Corp. 19742 NW 60th Court Hialeah, FL 33015 305-512-4729 Before me this day personally appeared Casimiro Diaz who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 1201 NE 98 St Miami FI 33138 Contractor Signature f Sworn to (or affirmed) and subscribed before me this /sday of by �1f--/ill® '/�I-, Z . .20 7 Personally know OR Produced Identification Type of Identification Produced . ,,. ..se Julian Cruz l -. _ No Notary Public - State of Florida I.diiiiiiii ,i. FvFcc Commission #GG 28168 Expires 9/8/2020 Print, Type 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 Notice to Owner — Workers' Compensation Insurance Exemption 7.77.4,11 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. Signature' _—COA•A-1 O fer State of Florida County of Miami -Dade Cit The foregoing was acknowledge before me this / day of , 20 /7 By��cs ,— -2 WS - /;7---,--7,,ze-,?-5‘ who is personally known to me or has produced /< J/�• �'�`/js �_ as identification. Notary. SEAL: Julian Cruz Notary Public - State of Florida Commission #GG 28168 Expires 9/8/2020 Property Search Application - Miami -Dade County Summary Report Property Information Folio: 11-3205-009-0220 Property Address: 1201 NE 98 ST Miami Shores, FL 33138-2562 Owner ENRIQUE J GARCIA &W INES HEGEDUS Mailing Address 1201 NE 98 ST MIAMI SHORES, FL 33138-2562 PA Primary Zone 1400 SGL FAMILY - 3001-3250 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 3/2 / 0 Floors 1 Living Units 1 Actual Area Sq.Ft Living Area Sq.Ft Adjusted Area 2,914 Sq.Ft Lot Size 12,594.12 Sq.Ft Year Built 1955 Assessment Information Year 2017 2016 2015 Land Value $453,249 $422,346 $384,232 Building Value $202,814 $202,814 $202,814 XF Value $49,918 $50,490 $33,690 Market Value $705,981 $675,650 $620,736 Assessed Value $334,563 $327,682 $325,405 Benefits Information Benefit Type 2017 2016 2015 Save Our Homes Cap Assessment Reduction $371,418 $347,968 $295,331 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description EARLETON SHORES PB 43-80 LOT 10 LESS E2OFT BLK 2 LOT SIZE IRREGULAR OR 18021-3924 1197 1 Page 1 of 1 PI'AISER Generated On : 7/17/2017 Taxable Value Information Previous PriceSale 20171 2016 2015 County $210,000 18021 -Sales Exemption Value $50,000 $50,000 $50,000 Taxable Value $207,000 $284,563 $277,682 $275,405 School Board 3371 Exemption Value $195,000 $25,000 $25,000 $25,000 Taxable Value 0213 $309,563 $302,682 $300,405 City Sales which are disqualified as a result Exemption Value I $50,000 $50,000 $50,000 Taxable Value $284,563 $277,682 $275,405 Regional Exemption Value 1 $50,000 $50,000 $50,000 Taxable Value $284,563 $277,682 $275,405 Sales Information Previous PriceSale OR Book- Page Qualification Description 11/01/1997 $210,000 18021 -Sales which are qualified 3924 05/01/1996 $207,000 17232 -Sales which are qualified 3371 09/01/1994 $195,000 16523- Sales which are qualified 0213 07/01/1994 $0 00000- Sales which are disqualified as a result 00000 of examination of the deed The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer. asp Version: http://www.miamidade.gov/propertysearch/ 7/17/2017 r STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 DIAZ, CASIMIRO AMERICAN A/C CORP 19742 NW 60TH CT HIALEAH FL 33015 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Departments 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, and congratulations on your new license! RICK SCOTT, GOVERNOR ,CAC 1816346 ;., STATE OF FLORIDA DEPARTMENT -OF BUSINESS AND ,, PROFESSIONAL REGULATION I. ,. CAC1816346 . ISSUED:'.06/19/2016 r t, - CERTIFIED AIR COND'CONTR ; DIAZ, CASIMIRO: _ i AMERICAN A/C:CORP..,, _. - ,. . , IS'CERTIFIED under the -provisions of Ch:489-FS. Expiration date . AUG 31, 2018 L1606190000672 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The CLASS B AIR CONDITIONING CONTRACTOR Namedbelow=IS CERTIFIED. "Underthe:provisions of:Chapter 489 FS. Expi_r`atiin date: -AUG -31;-,2018 _ `"_ — blAZ'CASIMIRO"'" - - ti ti's« •. AMERICANA/C.CORP =--00,-----,. _ W , ;' -.- --19742'N W 60TH 'CT-- - • ,+- - "' •- - .• e, ,`i '`,.\ '" HIALEAH. � fL.33015 _ , _ `; �` ► r, :t �ti DISPLAY AS REQUIRED BY LAW i• .r' •. • y� SEQ # L1606190000672 ISSUED: 06/19/2016 '.1 '! i 010954 Local Business Tax Receipt Miami—Dade County, State of Florida -TH:S IS NOT A BILL -00 NOT PAY 6495998 BUSINESS NAME/LOCATION AMERICAN AC CORP 19742 NW 60 CT MIAMI FL 33015 OWNER AMERICAN AC CORP Worker(s) RECEIPT NO. RENEWAL 6765979 LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPEC MECHANICAL CONTRACTOR CAC1816346 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 07/12/2016 CHECK21-16-083731 This Local Business Tex Receipt only confirms payment of the local Business Tan_ The Receipt is nota license. permit, or a certification of the holder's qualifications. to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec $o-276. For more information, visit www.miamidade.eoyhaxcoilector -CERTIFICATE OF LIABILITY INSURANCE - DATE (MM/DD/YYYY) — - 09/18/22016 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 certificate does not confer rights to the Certificate holder In lieu of such endorsement(s). PRODUCER & G Insurance Solutions, Inc 1870 W. 60 Street Suite A Hialeah, FL 33012 Phone (305)556-0066 Fax (305)556-9715 C MARIA BACALLAO NAMEA )_ (305)556-0066 FAX Ne}; (305)556-9715 POLICY NUMBER ADDRESS: mbacaliao®comcast.net INSURER(8) AFFORDING COVERAGE NAIC # INSURER A: GRANADA INSURANCE COMPANY INSURED American A/C Corporation 19742 NW 60 Ct Hialeah EL 33015- INSURER 8 : 09/18/2016 INSURER C : EACH OCCURRENCE INSURER D: PRED Ea PREEMIMI ESESS ( (Ea occurrence) INSURER E : MED EXP (Any ono person) 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 _�1 _ A TYPE OF INSURANCE ADD INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIUDIYYYY) POLICY EXP (MMIDDIYYYY} LIMBS n COMMERCIAL GENERAL LIABILITY • CLAIMS -MADE n OCCUR • DED 500 01851100021523 09/18/2016 09/18/2017 EACH OCCURRENCE $ 1,000,000.00 PRED Ea PREEMIMI ESESS ( (Ea occurrence) $ 100,000.00 MED EXP (Any ono person) $ 5,000.00 • PERSONAL &ADV INJURY $ 1,000,000.00 GEML AGGREGATE LIMITAPPLIES PER • POLICY • JE i ❑ LOC GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 ■ OTHER $ AUTOMOBILE UABIUTY ❑ ANY AUTO ■ ALL ❑ OWNED SCHEDULED AUTOS AUTOS COMBINED SINGLE UNIT(Ea $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ NON -OWNED D HIRED AUTOS NI AUTOS • • PROrPPERTY DAMAGE (Per $ $ El UMBRELLA UAB ❑ OCCUR II EXCESS UAB • CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVC OFFICER/MEMBER EXCLUDED? N 1 A � r -I , S ATUTE • E� EL EACH ACCIDENT 8 E.L DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY UNIT $ DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, (Ignore space le required) AJC INSTALLATION SERVICE AND REPAIRS. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores FI 33138 ACORD 26 (2014/01) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORI EDREPRESENTATIVE ©1986-2014 ACORD CORPORATION. All rights reserved. The ACORD name and Logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION 10-01-2015 * * 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: PERSON: FEIN: 09/20/2015 EXPIRATION DATE: 09/19/2017 DIAZ CASIMIRO 270721831 BUSINESS NAME AND ADDRESS: AMERICAN A/C CORP 19742 NW 60 CT HIALEAH FL 33015 SCOPES OF BUSINESS OR TRADE: 1- HEATING, VENTILATION, AIR-COND IMPORTANT: Pursuant to Chapter 440. 051141, 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(131, 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. QUESTIONS? (850) 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 09/20/2015 EXPIRATION DATE: 09/19/2017 PERSON: CASIMIRO DIAZ FEIN: 270721831 BUSINESS NAME AND ADDRESS: AMERICAN A/C CORP .19742 NW 60 CT HIALEAH, FL 33015 SCOPE OF BUSINESS OR TRADE: 1- HEATING, VENTILATION, AIR-COND 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 L under this section may not recover benefits or compensation under this D .;hapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to H exempt... apply only within the scope of the business or trade E the notice of election to be exempt. R E 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. be listed on QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11