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MC-17-2229 Permit Na. MC-9-17-2229 `50 11 t,� Miami Shores Village Pem it Type:(Mechanical-Residential 10050 N.E.2nd Avenue NE Pen � �"t workClassifica#ion:New A/C System -' Miami Shores,FL 33138-0000 Phone: (305)795-2204 Permit Statics:APPROVED 1 issue date: 10/23/2017 Expiration: 04/21/2018 Project Address Parcel Number Applicant 1430 NE 102 Street 1132050240230 BROWSING HOUSING LLC Miami Shores, FL Block: Lot: Owner Information Address Phone Cell BROWSING 4 HOUSING LLC 1430 NE 102 Street (917)703-6010 MIAMI SHORES FL 33138- 1430 NE 102 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 7,647.00 GRANA ELECTRIC 8,AIR CONDITIONI (772)206-1381 _ __ .. ,...... .. _ w,. _. ...... Total Sq Feet: 3146 Tons: Available Inspections: Additional Info:INSTALL NEW A/C SYSTEM Inspection Type: Classification:Residential Final Approved: In Review Rough Duct Comments: Date Approved: : In Review Review Mechanical Date Denied: Type of Work: Underground Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $4.80 DBPR Fee Invoice# MC-9-17-65074 $4.01 10/23/2017 Credit Card $240.14 $50.00 DCA Fee $2.68 Education Surcharge $1.60 09/06/2017 Credit Card $50.00 $0.00 Permit Fee $267.65 Scanning Fee $3.00 Technology Fee $6.40 Total: $290.14 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 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zorK,1 F I authorize the above-named contractor to do the work stated. October 23, 2017 Authorized i ature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 23, 2017 1 5�OR91 LI Miami shores Village ""'R' Building Department �e 10050 N.E.2nd Avenue ORIDp' 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 i 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: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this nid day of ()C+0 )3C1r 20_LL. By 'U QCI Q V 1I M- �}'�. O who is personally known to me or has produced vt V { as identification. Notary: YANADYPRIErO MY COMMISSION#FF 214031 -f •`a EXPIRES:March 25,2019 SEAL: I q,,Fy1R'� Bonded Thru Notary Public Underwriters Miami Shores Village P a o» Building Department 10050.N.E.2nd Avenue, Miami Shores,Florida 33138 B Tel:(305)795-2204 Fax:(305)756-8972 t INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 ( `{ BUILDING Master Permit No.7ko _c� - I �'n 3 PERMIT APPLICATION Sub Permit NolAo ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION- ❑EXTENSION ❑RENEWAL k , ❑PLUMBING ® MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP- CONTRACTOR DRAWINGS JOBADDRESS: 1 ��� 1� \0-2- City: 02City: Miami Shores County: Miami Dade Zip: :�1 Folio/Parcel#: 1 l-?�ZoS-oZ� _023 , Is the Building'Historically Designated:Yes 'NO Occupancy,Type: s ;Load: Construction Type: ,Flood Zone: BFE:'t FFE: . erl 6 OWNER: Name(Fee Simple Titleholder): 1•l7iTJ�� � `�1Nt^7t U--� Phone#: Address: boQ oT S S2E5=-t City: u1&+-A State: L Zip: - =� Tenant/Lessee Name: Q14 Phone#: Email: CONTRACTOR:Company Name: n a, 6 le Cel d-AIV ed'14 M �` Phone Address: y V S w/ //a ", c i s City: O v S C Vc State: /� Zip: 3 y 9 S-? Qualifier Name: (�U �;5� (�i_. C' v 0H G N ?1.0 Phone#: 07-7z) z0C-/3S7/ State Certification or Registration#: e l49< $-S- Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: / City: State: Zip: VV alue•of-Work for this Permit:$ LY a Square/Linear Footage of Work: -Type oof Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Descries ptio oaf Work: TNS T-9 N�e i,— Specifylcolor of colornthry tyle -J !i7 "d•.�..._-.. �,' cG Ill w'�. b°A+:' .. j­q r Submittal Fee$ wPermit•Fee�$ ti CCF$.i } .rCO/CC$ _ Scanning Fee$ '25 • G� Radon Fee$' 1y DBPR$ Notary$ / Technology Fee$ (0• '1 Training/Education Fee$ 60 Double Fee$ Structural Reviews$ Bond$ XJ TOTAL FEE NOW DUE$ 240. . (Revised02/24/2014) T may{{ Bonding Company's Name(if applicable) Bonding Company's Address4i City State Zip Mortgage Lenders Name(if applicable) { ' Mortgage Lenders Address City :, State Zip F 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 p6rformedL 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..... CC NE'SAkIDAVIT. 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. •t 'T ARNING TO.O013 N8FE YOUR FAWFE TO POFD A NOTICE OF OOMMENaM8VT 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 NOTICEOF OOM M ENCEM aVT." Notice to Applicant: Asa 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. AIsD,-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. Signatu Signature OWNER or AGENT CONTRACTOR The fo going instrument was acknowledged before me this The foregoing instrument was acknowledged before me-this << day of _- - ,20 1' , by day of_ ' U C U A "��/ ,20 1 �- ,by who is personally known to (� eVti mho is personally known to me or who has produced L\ct!�L- as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: `_ — Sign: ( 41-4i ✓ �' Print: ►wvl= Print:v i O ✓ �i l , icardo Dominguez Seal: _ Commission # FF958686 Seal V1 M GALEGO * »= Commission M GG 59501 Expires:February 8,2020 My Comtnissio'n Expires Bonded thru Aaron Notary January 03, 90111 APPROVED BY Plans Examiner Zoning Ctnirtiiral Rpvipw Clark . ' DEPARTMENT' OF BUSINESS ANDrPROFESSIONAL REGULATION — � CONSTRUCTION.INDUSTRY LICENSING BOARD (850)487=1395 •.�,,, 1940-NORTH MONROE STREET TALLAHASSEE FL 32399`=0783 GRANADILLO;.JORGE F GRANA ELECTRIC&AIR CONDITIONING,INC- 144 S.W DALTON CIR. PORT,SAINT LUCIE, FL 34953 r Congratulations! With this license you become one of the nearly one million-Floridians lioensedlby the Department of Business and. Professional Regulation. Our professionals and businesses range. - ,- -. from architects to yacht brokers,from-boxers to barbeque `DE AF_FL0�21D ' restaurants,and.the keepFlorida's economy . ~strop A13� RE�.`loQ�F BCtNESS-ANi3 g ...,r�'PIWDFE Every day we workao:improve the way we do business in order G,�G5557 �'F472Lt6 , to serve you better. For information about our services,please !og onto www.myfloridalicense.aom. There you can find more r ERCjFtED�1t -- information-about our divisions and.thesregulations that impact G 'plop• tom'_' Y be to department newsletters and leam;more about you,subscribe the'DepartmenYs initiatives... rI r -Ouromission at the Department is:License Efficiently,Regulate Fairty.We constantly strive to serve you getter so that'you can serve your customers. Thank you for-doing business in Florida, ' ts�C ,,1F1Et�-viider me lrco+�*srorrs.01-7 4es-Fs- and oongratulations on your new license! eos`- . rr �aoaooi2s DETACH HERE RICK SCOTT GOVERNOR_ - _.._... -� _ __ KEN LAINSON,SECRETARY• OF FL-OR 1NkSS4ND kidfi ...— 3557'"` �_,..,----•—..^.-.•,~.��.�,`..""'A"~-^". *' ''�s..„.~�;'�```~`-��+`-4-•,,�, \.`� •��,~,4 :El ,`• ,...+ N Ai '"`-...".�"'"'� ,,, '�t III �! "+ '� ��• � •`� '` 'w ff � i oo�oas Local Business Tax Receipt Miami-Dade County, State of Florida THIS IS NOT A BILL-DO NOT PAY 6472377 LL B BUSINESS NAMWLOCATION z 'r . RECEIPT NO:- EXPtRES f:' " :.•r GRANA ELECTRIC&AIR CONDITIONING INC RENEWAL SEPTEMBER 30, 2018 DOING BUS IN DADE CO 8741682 Must be displayed at place of business MIAMI FL 33000 Pursuani.*to County Code s Chapter 8A-Art.8&10 • � t OWNER SEC.TYPE OF BUSINESS GRANA ELECTRIC&AIR CONDITIONING 196 GENERAL MECHANICAL CONTRACTOi YATAENT RECEIVED CAC1815557 Y x COu ECTOR f Wo!ker(s) 2 $75.00 07/18/2017 ` FPPU11-17-012806 j This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, j permit,or a certification of the holder's qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory Ism andrequirements which apply to the business. -The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Bede Code Sec So-M For more information,visit www.miamidade.sov/hxcellector j AC01?©� CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) `rrr� 088/04/04/17 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 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 CNAOME:NTACT Betania Dias M.E.Glennon And Associates Inc a°NN : (772)879-1307 A No; (772)785-8986 1344 SW Bayshore Blvd E-MAIL bdias@meglennon.com Port Saint Lucie,FL 34983 INSURERS AFFORDING COVERAGE NAIC If Phone (772)879-1307 Fax (772)785-8986' INSURERA: Western World Insurance Company INSURED INSURER B Grana Electric Air Conditioning Inc INSURER C 144 SW Dalton Circle INSURER D: Port Saint Lucie,FL 34983 (772)342-9713 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 CONTRACTOR 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 INSRIWVDI ADD UBR POLICY NUMBER MM/DDYEFF/YYYY POLICY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100 000,00 PREMISES Ea occurrence $ A F-] ❑ CLAIMS-MADE FV] 03/17/2017 03/17/2018 OCCUR NPP1458881 MED EXP(Any one person $ 5,000.00 El PERSONAL 8 ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 © POLICY ❑ PR0JECT ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ AUTOS ALLOWNED ❑ SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ ❑ HIRED AUTOS ❑ AUTOS Per accident ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WC STATULIMI- [:]OTH- AND EMPLOYERS'LIABILITY Y I N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) F-1 E.L.DISEASE-EA EMPLOYE $ If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space is required) Electrical Work/Air Conditioning-Heating Jorge Granadillo AIR CONDITIONING LICENSE:CAC1815557 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Dept THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE Betania Dias ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)CIF The ACORD name and logo are registered marks of ACORD 0l7 ReportViewer • + �' 'i1 110096 =FIN/1NCLlL OFFICER STATEOF.FLORIDA, DEPARTMENT OF FINANCIAL SERVICES DIVISIONOOF WORKERS'COMPENSA710N •'CERTIFICATE OF ELECTION:TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW:• CONSTRUCTION INDUSTRY EXEMPTION This carNfies that Ow individual istacitelow has elected to be exempt tom Florida Workers'Compensation law. EFFECTIVE DATE: 2/14)2017 EXPIRATIONDATE: 2JI412019 PERSON: GRANADILLO JORGE F ' FEW: 010830009 BUSINESS NAMEAND ADDRESS: GRANA ELECTRIC&AIR CONDITIONING,INC w 144 SW DALTON CIR PORTSAINTLUCIE FL 34953 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL HEATING,VENTILATION, CONTRACTOR AIR-GOND MrtbCJkpr4Q.p5(1'tj.F.S artmoardaar rwtodak+csp6v+trom fidyitrb� S an7QAeddSc9Mwds Vim r0endsawlePli olrrir.Pra�etbChpYrM0,pa1�F.8.f.�tiAni �isdJr.'Yanbb►wmPt-Oi�Y bwep�e=ww dd*aft ftW miaiafteddb6R I.IL.A Npkeed bbe gum= MnPkdaeidfi�>�bBwaneeY}vda ndimYd�oe �odtlroe/!o� 6 eYQarwtatd raakaa 1 DFS4:ZVV -M CERnFICATE OF ELECTION TO BE OCEMPT REVISED W13 01JESTIONS7(8&6)413.1809' t i htlpaJlepps8.Illila.6bmkrreporivlewrkgMMIewecespehWt�--kdvpginc9D7taWMF ER8eP1KMZ%2fSZz5bJ(KYfBxkr *'4opWlv4NPOPN4Z W rDRt3XML.. 122,, GRANA Electric &Air Conditioning August 31st, 2017 State of Florida County of Miami Dade i Before me this day personally appeared JORGE GRANADILLO who,being duly sworn, deposes and says: That he will be the only person working on the property located at 1430 NE 102nd Street Miami Shores FL 33138. Sworn to (or affirmed) and subscribed before me this31 day of 201--1 , by �uQ Personally Known OR Produced Identification ��,� ,, 9 Type of Identification Produced bl_ ,. ..��/�,; Ricardo Domin uez commission # FF958686 Excirm February A.2020 a�llx, Bonded thru Aaron Notary ry Print,Type or Stamp Name of Notary 144 SW Dalton Circle, Port St. Lucie FL 34953