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MC-15-1248Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 ermit Permit NO. MC -5-15-1248 Permit Type: Mechanical - Residential Wart( Classification: A/C Replacement Permit Status: APPROVED Issue Date: 1 018120 1 5 Expiration: 04/05/2016 Parcel Number Applicant 5 NE 105 Street Miami Shores, FL 33138-2030 1121360060090 Block: Lot: RED RIVER USA LP Owner Information Address Phone Cell RED RIVER USA LP 3250 NE 1 Avenue MIAMI FL 33137- 3250 NE 1 Avenue MIAMI FL 33137- Contractor(s) Phone PHOENIX COOLING SYSTEMS CORP (305)744-2145 Cell Phone Valuation: Total Sq Feet: $ 3,500.00 0 Tons: 3 Additional Info: REPLACE OLD ELECTRIC. 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 Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $2.25 $2.25 $0.80 $150.00 $3.00 $3.20 $163.90 Pay Date Pay Type Invoice # MC -5-15-55704 10/08/2015 Credit Card 05/26/2015 Credit Card Amt Paid Amt Due $ 113.90 $ 50.00 $ 50.00 $ 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 regulation s 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 IMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that construction and zoning. Futhermore, I authorize the above-named contractor to do th .44 Authorized Signature: Owner / Applicant / Contractor / A Ii Building Department Copy a a will be done in compliance with all applicable laws regulating October 08, 2015 Date October 08, 2015 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 El BUILDING ❑ ELECTRIC ❑ ROOFING FBC 20th Master Permit No. ii 4 I Sub Permit No. MO_ \ E l2 ❑ EXTENSION ❑ RENEWAL ❑ REVISION ❑ PLUMBING [ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE` OF CONTRACTOR JOB ADDRESS: 6 A-)6 /0564 ❑ CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: NO BFE: FFE: OWNER: Name (Fee Simple Titleholder): Rec. Roca ')5A Phone#: Address: PO T505( 3-31-5R- City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: `+'kk) x l: ,Ottvtg 5 4aM . Phone#: .aOsr 1-4 Z l Address: 2'2.2 1 uJ 6 9 \° A-kkeAkEAN City: %-\ v..4Acp• k State: PC_ Zip: 011::, iaalifal-m7.71 cet% ORO 2 Q B Phone#: State Certification or Registration #: r21AC t \ A - t 3 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ a, roo ' Type ofWork: Y ❑ Addition ❑ Alteration Description of Work: t CLJ--) U'5461,1cl \ ,nv•\ Square/Linear Footage of Work: ❑ New Ain. Specify color of color thru tile: Submittal Fee $�� `° Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) ❑ Repair/Replace ❑ Demolition s -.t 1,0 S Permit Fee $ Radon Fee $ DBPR $ Training/Education Fee $ 1 Lf ©,V .CCF $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $I/3 _0(14 1. Bonding Company's Name (if applicable) t 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 approv d a • d a reinspection fee will be charged. Signature ,„ O 'NERorAGENT • The foregoing instrument was acknovyledged before day of c' 2i / ,20_ this by JQu[49-1-1 61 %.2/A - , who is personally known to me or who has produced d� as identification and who did take an oath. NO • ' PUBLIC: Si: I l 0,0 pue„ LUCIA ESTRELLA Print: Seal: * MY COMMISSION # EE 880165 EXPIRES. Jiily 2:9017 roc, Bonded Thru Budget Notary Service: ******************************* APPROVED BY (Revised02/24/2014) Signature t �. CONTRACTOR The foregoing instrument was acknowledged before � this day of , 20 S , by � Qi..t ©rogc o, , who is personally known to me or who has produced identification and who did take an oath. Sign: Print: Seal: f as LUCIA ESTRELLA * MY COMMISSION # EE 880165 EXPIRES: July 2, 2017 19T6.0F F\ 0 Bonded Thr Budpat Notary Service; ******************************************************** Plans Examiner Structural Review Zoning Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 OROZCO, EDY PHOENIX COOLING SYSTEMS CORP 2221 WEST 69TH STREET UNIT 1 HIALEAH FL 33016 Congratulations! .With this licenseyou 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 Department's 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 (850) 487-1395 .,STATE -OF FLORIDA DEPARTMENT.OF.,,�BUSINESS AND ,. PROFESSIONALxREGULATION CAC1817.135� ISSUED.`07/01/2014 ;CERTIFIES AIROCONDS„.CONTR OROZCO,EDY PHOENIX C00tiNG SYSTEMS CORP ,...^ DETACH HERE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION -CONSTRUCTION INDUSTRY LICENSING BOARD . - ,IS CERTIFIED under the provisions'of Ch.489 FS... .,Expiration'date"'AUG 31, 2016 ,, „..,;,J .. L1407010000931^^--, KEN LAWSON, SECRETARY LICENSE NUMBER ', '•-,Vk+t`" `rCAC1817135"' ... ,.Q .` �`.,'"*"°"'",, >.w ` .,t The'CLASS.BAIR CONDITIONING CONTRACTOR,*° Named below IS CERTIFIED T= • Under the provisions of Chapter 489 FS: • Expiration date_ _ AUG;31 OROZCO EDY } PHOENIX COOLING,SYSTEI ,S'CORP' ---2221' WEST 69THSTREET . } ` UNIT 1p • #HIALEAH— ,AFL 33016'A ISSUED: 07/01/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1407010000931 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7012453 BUSINESS NAME/LOCATION PHOENIX COOLING SYSTEMS CORP 6540 W 12 AVE HIALEAH, FL 33012 RECEIPT NO. RENEWAL 7288103 LBT EXPIRES SEPTEMBER 30, 2016 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PHOENIX COOLING SYSTEMS CORP 196 SPEC MECHANICAL CONTRACTOR Worker(s) MIAM I.DADE Sa w CAC 1817135 PAYMENT RECEIVED BY TAX COLLECTOR 49.50 10/06/2015 0243-16-000096 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a 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 8a-278. For more information, visit www.miamidade.gov/taxcollector 05/26/201526 13:19 AC+Q,i? 6 TAx) P.001 /001 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDO/YYYY) 05/26/15 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and cond(tlona oldie policy, certain policies may require an endorsement A etatomont on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). co PRODUCER NAME: Lucia Estrella Accurate 8300 West Flegler Suite 114 Miami, FL 33144 Phone (305)226-8727 INSURED, Phoenix Cooling Systems Corp 2221 West 89th Street Apt 1 Hialeah, FL 33016 - Fax (305)226-8787 PHONE ((//UUc Ne Fa)` (305 2 ) 26.8727 ADDRESS; luciaestrella®Dellsouth,net INC. NO): (305)228-8787, INSURERS) ATPORDINO COVERAGE NAIC INSURER A : Insurance Company INSURER B ; Ascendant Insurance Company INSURE({ C INSURER 0 INSURER E : 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 TYPE OF INSURANCE ADDLSUBR INSR WVD A GENERAL LABILITY 121 GENERAL LIABILITY ❑ ❑ CLArM8-BADE OCCUR GENL AGGREGATE LIMIT APPLIES PER: RI POLICY ❑ IFRT ❑ LOC POLICY NUMBER ( M/D rF) IMM)ODY EXP 1 VBA326793-00 B AUTOMOBILE LIABILITY ® ANY AUTO ALL OW ❑ AUTOS NED ❑ HIRED AUTOS 0 0 D NICOlOJJTO LINED D AUTOS ❑ UMBRELLA LIAO 0 OCCUR ❑ excess UAB 0 CLAIMS -MADE ❑ DEP 0 RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) It yes,describe under DESRIPTION OF OPERATIONS borer CA -34609 LIMITS 08/21/2014 08/21/2015 05/21/2014 05/21/2015 EACH OCCURRENCE PREMISES (Ra oo jrrenoa) $ 1,000,000.00 $ 100,000.00 MED EXP (Any one person) $ 5,000,00 PERSONAL & ADV INJURY e 1,000,000.00 GENERAL AGGREGATE S 2.000.000,00 PRODUCTS - COMP/OP AGO s 1,000,000.00 COMeccldeBINEDntSINGLE LIMIT Ca ) S • 10,000.00 BODILY INJURY (Per pollen) e 20,000.00 BODILY INJURY (Per accident) rPK icclRdgnt) AGE $ 10,000.00 8 EACH OCCURRENCE s AGGREGATE i NIA ❑ TORYLIMITa ❑ ERH a E.L EACH ACCIDENT 1 E.L DISEASE - EA EMPLOYEE. $ DESCRIPTION OP OPERATIONS r LOCATIONS I VEHICLES (Attach ACORD 101, Addltlonat Remarks Schedule, If mora apace re required) License # CAC1817135 CERTIFICATE HOLDER E.L. DISEASE . POLICY LIMIT a CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 305-756.8972 ACORD 25 (2010/05) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREO•TI VERED IN ACCORDANCE WITH THE POLI •tO AUTHORIZED REPRESENTATIVE Lucia Estrella ®1988-2010 AC• = a CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 11 , $i ii1fl0% I. JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCtAL SERVICES DIVISION OF WORKERS' COMPENSATION `• CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW" CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 8/18/2014 PERSON: OROZCO FEIN: 451009815 BUSINESS NAME AND ADDRESS: — PHOENIX COOLING SYSTEMS CORP EXPIRATION DATE: 6/17/2016 EDY 2221 WEST 69TH ST #1 HIALEAH FL 33018 SCOPES OF BUSINESS OR TRADE: HEATING, VENTILATION, AIR-COND PWasaK toChaps[a40.5(u),F.S; an officer of aarperation Wo eedsesanptk° boot Ns' dupe(bY als aam'4ds aft=krthis sec*. may not recover Dermas arcoa6on underlies chapter. Pummel to Chaplet 440.05(12). F.S_ Cert5lesies or NeWmbb• smolt- 4ppl erdhia tlr snipe of the boom. ortrade Wed c the nobs ofelection tomon gaLPurowntbCh,orad°.05(ts).FS..Noticesofekdiaibbemnptandcesfi6rnfesa ei.etIotr to be esenrpt slue be withect to eireoobov d et gny hem alter bas Rig olffie Mike or tee lagoon. of Ole MefiYe, 0. person mord. the notice ca. war dote so iMprmeatethe raghfsemuis ot this section la issuance of a cerlalkato Thedep.:nog Saab revoked easbfeateot any fine tot Whoa ot ter poison named. breceraLcete ba meet the rtluire' menK of this section OFS-F2-OW0252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED OT -12 QUESTIONS? (850>413-1609 file:///CiUsers/RUTHL/AppData/Local/Temp/Low/PL95Z68J.htm 6/19/2014 MAGIC FLORIDA GROUP. DATE: STATE OF FLORIDA COUNTY MIAMI BEFORE ME THIS DAY PERSONALLY APPEARED PA 51ea/2-tl SWORN, DEPOSES AND SAYS: WHO, BEING DULY THAT HE OR SHE BE THE ONLY PERSON WORKING ON THE PROJECT LOCATE AT 5 NE 105 ST SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME THIS b) DAY OF A4rz/ 1 2015 PERSONALLY KNOW 1/ OR PRODUCE IDENTIFICATION TYPE OF IDENTIFICATION PRODUCED DRIVER LICENSE PAU° Oefi-nA 5(000- cp0-5$-z -t PRINT,TYPE ORSTAMP NAME OF NOTARY. LUCIA ESTRELLA * MY COMMISSION 1 EE 880165 EXPIRES: July 2, 2017 Bonded Thru Budget Notary Services 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 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. CONTENTS. I BY SIGNING BE q W Y • Signature: CKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS State of Florida County of Miami -Dade , The foregoing was acknowledge before me this(/ day of r�'2 T e'2Gv/ , 20 IS— . By n :s SEAL: MY COMMISSION y EE 1iiu EXPIRES: August 5, 2015 d'1'40F 0. 4- Bonded Thru Budget Notary Services /ice who is personally known to me or has produced as identification.