MC-17-2127Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. MC -8-17-2127
Permit Type: Mechanical - Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 911/2017
Expiration: 02/28/2018
Parcel Number
Applicant
1055 NE 105 Street
Miami Shores, FL
1122320280810
Block: Lot:
NAKUL JATHAR
Owner Information
Address
Phone
Cell
NAKUL JATHAR
1055 NE 105 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone
SOUTHEAST MECHANICAL SERVICE (954)967-7200
Cell Phone
Valuation:
Total Sq Feet:
$ 1,000.00
0
Tons:
Additional Info: RELOCATE SUPPLY DUCTWORK INSTALL NE
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 1
Date Approved: : In Review
Type of Work: RELOCATE SUPPLY DUCTWORK IN
Fees Due
CCF;
DBPR Fee
DCA' Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.25
$2.25
$0.20
$150.00
$3.00
$0.80
$159.10
Pay Date Pay Type
Invoice # MC -8-17-64963
08/23/2017 Credit Card
09/01/2017 Check #: 1172
Amt Paid Amt Due
$ 50.00 $ 109.10
$ 109.10 $ 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.
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. F ermore, I authorize the above-named contractor to do the work stated.
September 01, 2017
Authorized Signature: Owner
Building Department Copy
/ Applicant
/ Contractor /
Agent
Date
September 01, 2017 1
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
PLUMBING
ECHANICAL
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
Master Permit No.
Sub Permit No.
RECEIVED
AUG 2 3 1017
FBC�O t(--1
Rc 13-1Sn
MCI -212
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: I0S5 NE )051 ST
City: Miami Shores County:
Folio/Parcel#: 1 1 -2232- 02S - Og I 0
Occupancy Type:
❑ CANCELLATION ❑ SHOP
DRAWI NGS
Miami Dade
Zip:
Is the Building Historically Designated: Yes
Load: Construction Type:
Flood Zone:
OWNER: Name (Fee Simple Titleholder): NA -Wu L ..AT WAR.
Address: 10 5 S NE 105 TN- 51"
City: M 1 AM 1 51-10 1ZE S State:
FL-
NO )t
BFE: FFE:
Phone#: 30 1 - 46 I -1823
Zip: 33 13B
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 5nAea ST A4C(Mil (Co ( 5 /1'(e Phone#: q511- I V 7 ` 0?0l/
Address: ISIS SW C4, Watt
City: \k-n1k1 ,t4 / State: F t,
Qualifier Name: Geo?? SG4,47 1 Phone#:
State Certification or Registration #: C �pC 1 71 S I 1 Certificate of Competency #: I
Zip: 3'3 071
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $
(.003" °o
Type of Work: ❑ Addition ❑ Alteration / /,
rf loca-' ii,t(� c cfu�OrE, 11 s -i ii' ,.�w /4p -Un- 9•.r/ 7Y
Description of Work:
Square/Linear Footage of Work:
❑ New. ❑ Repair/Replace 1-1 Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ t Y, 7D . v/�
� CCF $ CO/CC $
1
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ t/� G 1
TOTAL FEE NOW DUE $ ►6 / • 0
(Revised02/24/2014)
t
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 understandthat 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
OWNER or AGENT
'The foregoing instrument was acknowledged before me this
D—tSi- dayof A20,by
Wq1a) Jci11"q r , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Thom'
01111111111%
///
/� ,
so
Y� n�dteay" C�`�P`aL�Zo St • • *•Z �5 4
Print: l71 91 tt$11E2 •S" • 'Is...
Seal:
****************
APPROVED BY
(Revised02/24/2014)
I
si OSI --7/4F.: LT
�l
tomoso
%/
***************
ILO 0
as
CONTRACTOR
The foregoing instrum nt was acknowledged before me this
Q�'g• day of , 20 / 7 , by
_EUel( solhi'j/ 1
, who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
\.1 L
3viner
Structural Review
Zoning
Clerk
RICK SCOTT, GOVERNOR
•
STATE OF FLORIDA
KEN LAWSON, SECRETARY
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION. INDUSTRY LICENSING BOARD
1141.140-14‘111111:14.1
CA61.815121
The CLASS AAIR CONDITIONING CONTRACTOR::
Nameb below IS CERTIFIED
Under the provisions of•Chapter 489 FS. .
Expiration date: AUG 31, 2018
_ . _ ,....._ . .
ISSUED: 06/21/2016 DISPLAY AS REQUIRED BY LAW
SEQ # L1606210000630
AC-OJ?p`
OCOPART-01
CERTIFICATE OF LIABILITY INSURANCE
)(KENNEDY
DATE (MMIDD/YYYYI
08/2212017
THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cettlflcate holder is an ADDITIONAL INSURED. the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder In lieu Of such endorsement($).
ligOrcT Suzanne Nelson
Collinsworth, Alter, Lambert, LLC
23pnooucsa
( Ho, (5611868.8291
Eganfuskee Street
Suite 102
. SneIsonelcallIc.com
Jupiter, FL 33477
INSURED
Southeast Mechanical Services
Partnership, Inc..
2315 Southwest 58th Way
W. Hollywood, FL 33023
COVERAGES CERTIFICATE NUMBE12:
FAX Nc (561) 427-6730
INSURERIS) AFFORQIN0 COVERAgE
RNR A : National Trust Insurance Co
INSUREgg : FCCI Insurance Company
NAIL X
20141
10178
INs_ggEnc:Monroe Guaranty Insurance Company
IkSURER9
WIRER!:
INSURER F
32506
Tris IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUI
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHEI
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIO ES DESCRIE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSRTYPE OF INSURANCE iSs PouCY NUMBER (MID000FYI MlYYYI MPPOu
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE n OCCUR
B
GENT AGGRE UMIT APP1,49 PER
POLICY I Xljg& LOC
OTHER:
Au ormaIL E LIABILITY
X
X
ANY AUTOE
AUTTOSO
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253r6S ONLY
X
0L00148008'
11/01/2016 11/01/2017
AUTOS LEO
SIF$
CA10000754301
11/01/2016 11/01/2017
A
X
UMBRELLA (JAB
EXCESSIIAB
X
OCCUR
CLAIMS -MADE
OED
X
RETENTIONS
10,000
UMB00153415
11/01/2016 11/01/2017
C
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WORKERS COMPENSAnON
AND EMPLOYERS LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
iania=itraEXCLUDED?
H describe under
SCRIPTIQ(NOF OPERATIONS bebw
Equipment Floater
Installation Floater
YIN
NIA
CM00072075
CM00072075
11/01/2018 11/01/2017
11/01/2016 11/01/2017
DEscanor NDE OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 1 e1, Additional Memories Module, maY be atdalled Ir me space ie raqui
Certificate holder is named as additional Insured to Include ongoing, products and completed operations for gre
CAU059 and umbrella liability when required by written contract Genera! Liability is primary and noncontrlbutc
by written contract. Waiver of subrogation applies to genera! liability and auto liability for the additional insured
extends over general liability, and auto liability. Cancellation applies as per policy terms and conditions
License: *CAC 1815121
ION NUMBER:
leo NAMED ABOVE FOR THE POLICY PERIOD
t DOCUMENT WITH RESPECT TO WHICH THIS
ED HEREIN IS SUBJECT TO ALL THE TERMS,
Mfrs
EACIj 0OCURRENCE
S 1,000,000
MI. TO
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1i 100,000
MED E(An!moil one onl
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8 6,000
PERSONAL&Am/mum,
$ 1,000.000
GENEBALAGGREGATE
$ 2,000,000
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_g5QOUCTS .
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. BODILY INJJ Y(Perperion)
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Limit:
Limit:
36,000
250,000
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neral liability per CGLOB4, auto liability per
Try for the additlonal insureds when required
s when required by written contract. Umbrella
CERTIFICATE MOLDER
MIamI Shores Village
10050 NE 2 Avenue
Miami Shores, FL 33138
_ 1
ACORD 25 (2016/03)
CANCELLATION
SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL 1
BE DELIVERED IN
ACCORDANCE w1TH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
®1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
!,
CERTIFICATE OF LIABILITY INSURANCE
3OUT042 OP ID: M6
bATE (MM10orYYYY)
08/22/2017
THIS CERTIFICATE 15 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 terns 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
BROWN & BROWN OF FLORIDA INC
149110 NW 79th Court Sulte#200
Miami Lakes, FL 33016-5869
Tom Csnterbefry
COACTATom Canterberry
E.,),305-364-7800
ADDRESS:
FAX
,y y. 305-714-4401
INBURER(S) AFFORDING COVERAGE
NAM*
mune :FFVA Mutual Insurance Co
10385
DIlURED Southeast Mechanical Service
0 C 0 Partnership, Inc.
2315 SW 58th Way
Hollywood, FL 33023
INSURER e :
INSURERS,:
1NEURER D
INSURER E ;
INauRER F
COVERAGES CERTIFICATE NUMBER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 6ELOW HAVE )SEEN ISSUE() TO THE INSUR
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1NER
LT*.
A
TYPE OF INSURANCE
co>IMIRCIAL GENERAL LJABILrTY
CtMMS-MADE n OCCUR
Galt AGGREGATE LIMIT APPLIES PER:
POLICY ❑ IECT LOC
OTHER
AUTOMOBILE LLASILITY
ANY AUTO —
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS _ AUTOS
uNGRELLA UAB
L� EXCESS LUIS
OCCUR
CLAIMS -MADE
AWL
JNSD
DED
RETENTION S
WORKERSCOMPENSATION
AND EMPLOY Ra LMBILRY
ANY PRg P IETORIPARTNER/EXECUTIVE
oPFICEWMEMBRR EXCLUDED?
(MandaWty in NH)
dyers, describe under
DEScRIPT1ON OF oPERATIONS below
Y / N
NIA
GUM
wVo
X
POLICY NUMBER
WC/14000328442016A
RNM/DD/YYYY)
Eno
11101/2016
Mom OLP
11/01/2017
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 151, Additional Remarks schedule, may be attached IF Mere space k recItl
Re: Uc#CAC 1815121.
Waiver of Subrogation applies to workerecompensatlon when required by
Written contract. Cancellation applies as per policy terms and conditions.
CERTIFICATE HOLDER
Miami ShoresViltage
10050 NE 2 Avenue
Miami Shores, FL 33138
ACORD 25 (2014/01)
MIAMISH
CANCELLATION
REVISION NUMBER:
:D NAMED ABOVE FOR THE POLICY PERIOD
)OCUMENT WITH RESPECT TO WHICH THIS
) HEREIN IS SUBJECT TO ALL THE TERMS,
LIMITS
EACH OCCURRENCE
$
DRI NTED
PREMISES (Fa occurrence)
S
MED EXP (Any one parson)
S
PERSONAL & ADV INJURY
S
GENERAL AGGREGATE
5
PRODUCTS - COMP/OP AGG
S
S
coMB(NED SINGLE unit-
(Ee accident
f
EDGILY INJURY (Per person)
$
BODILY INJURY (Per accident)
S
peoreeIY DAM,ciE
(Per @OEM()
S
$
EACH OCCURRENCE
S
AGGREGATE
S
S
X STATUTE ERS
E.L... EACH ACCIDENT
S
1,000,000
E.L. DISEASE - EA EMPLOYEE
S
1,000,000
E.L DISEASE - POLICY OMIT
s
1,000,000
UoA)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED !N
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIME0 REPRESENTATNE
Brown and Brown of Florida, Inc,
®1988-2014 ACORD CORPORATION. Ali rights reserved.
The ACORD name and logo are registered marks of ACORD
k"•
Address:
Activity: .
Issued to:
CITY OF WEST PARK
LOCAL BUSINESS TAX RECEIPT
FOR PERIOD OF OCT 1, 2016 THRU SEPT 30, 2017
(954)989-2688
2315 SW 58 WAY
WEST PARK, FL 33023
850 CONTRACTORS - SPECIALTY -NC
O.C.O PARTNERSHIP INC dba SE MECHANICAL'
JOHN OLIVER
2315 SW 58 WAY
WEST PARK, FL 33023
THIS LICENSE MUST BE CONSPICUOUSLY DISPLAYED TO PUBLIC VIEW
LICENSE
PENALTY
TRANSFER
Total Paid
OCTOBER
NOVEMBER
DECEMBER
JANUARY
No: 276
105.00
105.00.
0.00
0_00
0:00
0.00
ROW RDCOUNTY-LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2016 THROUGH SEPTEMBER 30, 2017
DBA:
Business Name: SOUTHEAST MECHANICAL SERVICE
Owner Name: GEORGE C SCHMIDT
Business Location: 2315 SW 58 WAY
HOLLYWOOD
Business Phone: 954-967-7200
Rooms
Seats
Employees
10
Receipt #:HEAT NG/AIRCONDITION CON
Business Type: (AIRCONDITION .CONTRACTR)
Business Opened:01/04/2007
State/County/Ce rt/Reg :CAC 1815121
Exemption Code:
Machines
Professionals
For Vending Business Only
Number of Machines:
•
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection .Cost
Total Paid
27.00
0.00
0.00
0.00
0.00
0.00
57.40
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT
WHEN VALIDATED
1 Mailing Address:
GEORGE C SCHMIDT
2315 SW 58 WAY
HOLLYWOOD, FL 33023
{
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.
l_2016_. -2017
Receipt #10B-15-00005815
Paid 07/07/2016 57.40
"Vs
CTR