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MC-16-3214Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. MC -11-16-3214 Permit Type: Mechanical - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 12/9/2016 Expiration: 06/07/2017 Parcel Number Applicant 541 NE 105 Street Miami Shores, FL 1122310140260 Block: Lot: TARIK & CATHERINE GUETARN Owner Information Address Phone CeII TARIK & CATHERINE GUETARNI 541 NE 105 Street MIAMI SHORES FL 33138- (404)395-7245 541 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) AVEN AIR CONDITIONING Phone CeII Phone (305)332-0139 (305)332-0139 Valuation: Total Sq Feet: $ 600.00 0 Tons: Additional Info: INSTALL NEW DUCT OPENING IN HALLWAY Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 3 Date Approved: : In Review Type of Work: INSTALL NEW DUCT OPENING IN Hi Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $9.00 $0.80 $114.60 Pay Date Pay Type Invoice # MC -11-16-62175 11/28/2016 Credit Card $ 50.00 $ 64.60 12/09/2016 Check #: 01094 $ 64.60 $ 0.00 Amt Paid Amt Due 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. OWNERS 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. Futhermore, I authorize the above-named contractor to do the work stated. December 09, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 09, 2016 1 BUILDING PERMIT APPLICATION ▪ BUILDING ❑ ELECTRIC ❑ PLUMBING 0 MECHANICAL JOB ADDRESS: 541 NE 105 ST 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 ❑ ROOFING ❑PUBLIC WORKS 1l NOV 2 S 2016 BY: 9-4 5 FBC 201(-I Master Permit No. 12.. C 1 (C) - 3 2 12 Sub Permit No. C_ 1(i) - 3 2111 ❑ REVISION ❑ EXTENSION RENEWAL CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2231-014-0260 Occupancy Type: RES Load: Is the Building Historically Designated: Yes Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): TARIK GUETARNI CATHERINE GUETARNI Address: 541 NE 105 ST NO X BFE: FFE: Phone#: 404-395-7245 City: MIAMI SHORESState: FL Zip: 33138-2044 Tenant/Lessee Name: N/A Phone#: Email: tguetarni@aol.com CONTRACTOR: Company Name: A ler, A//2 @Q77l)i7% 2.7 / Phone#: 30P- 332-0/3c Address: eG2s- S(•,u dog Sr City: yY) /ems r State: F L. Zip: 33 JS743 Qualifier Name: Aueg,reiii Acv -g VA— Phone#: .3O5 ` 332 -0139 - State Certification or Registration #: CIO C Oct 2622--. Certificate of Competency #: DESIGNER: Architect/Engineer: OSCAR POSADA ARCHITECT Phone#: 305-554-1195 Address: 9231 SW 12 ST City: MIAMI State: FL Zip: 33174 Value of Work for this Permit: $ 6,0t ' 00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑� Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: INSTALL NEW DUCT OPENING IN HALLWAY & NEW GRILL FOR NEW DINING/KITCHEN OPEN AREA. NEW EXHOUST'FAN4IN'BATHROOMS S L , • . Specify color of color. thru:tile:- d (3:- r'V • Submittal Fee $1" ''''''' '''"*.'' "P'er'mit Fc'e'$ '• -.1 e Ov CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) GLI -c12° 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this 14t1-' day of r4o VENt$t>✓-- , 20 t 1.0 , by e. c• n C. S 4'u et -re, l , who is personally known to me or who has produced 365 -137-81- 6 30 - Oas identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Ui' .;45.0 SJ APPROVED BY GEORGINA SALVATORE MY COMMISSION 9 FF911140 EXPIRES Atigust 19, 2019 Signature CONTRACTOR The foregoing instrument was acknowledged before me this a-'• day of 11y4:%0E" x. 20 (O , by pLl0ex-T0 ,,cosi who is personally kn to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as Notary Public Stats of Amide 11 Catherine Pe* Ay My Commission FF 957875 ��` • a Expires 02/07/2020 *********************,F,; 14 (Revised02/24/2014) xaminer Structural Review Zoning Clerk ARb® CERTIFICATE OF LIABILITY INSURANCE 1/411......----- DATE (MM/DD/YYYY) 11/28/2016 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 policy(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 W.F. Roemer Insurance Agency, Inc. 3775 NW 124 Avenue Coral Springs FL 33065 CONT NAMEACT Certificate Department PHONE 954-731-5566 FAX 954-731-8438 (A/C,No, Futy (A/C. NM: ADI KESS: certificates@roemer-ins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Retail First Insurance Company 10700 INSURED AVENA-1 Aven Air Conditioning Alberto Acosta, Inc. 8625 SW 108th Street Miami FL 33156 INSURER B : INSURER C : INSURER D : $ INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 779793920 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 LTRINSD TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/1Y'YY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED HIRED AUTOS SCHEDULED NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 0520-54626 8/12/2016 8/12/2017 X I PER I OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) CAC042622 - AIR CONDITIONING SUBCONTRACTOR CERTIFICATE HOLDER CANCELLATION Miami Shore Village Building Department 10050 NE 2nd Ave. Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRJBED POLJCJES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE --geate ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD