MC-16-627 Permit NO. MC-3-16-62?
`SHORES��` Miami Shores villager Permit Type: Mechanical-Residential
10050 N.E.2nd Avenue NE Wbik Classification:Addition/Alteration
Miami Shores,FL 33138-0000Pen t Permit Status:APPROVED
Phone: (305)795-2204
�caxvA 09/27/2016
Issue Date:3/31/2016 Expiration:
Project Address Parcel Number Applicant
9879 NE 13 Avenue 1132050090490
JACQUELINE BARRANTES
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
JACQUELINE BARRANTES 9879 NE 13 Avenue (917)698-2863
MIAMI SHORES FL 33138-
9879 NE 13 Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone $ 16,000.00
Valuation:
ULTRA WEATHER CORP (786)615-4559 Total Sq Feet: 0
Tons:4 Available Inspections:
Additional Info:NEW DUCT WORK AND NEW AC 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 $9.60 Invoice# MC-3-16-58959
DBPR Fee $8.40
DCA Fee $8.40 03/31/2016 Check#:316 $555.40 $50.00
Education Surcharge $3.20 03/09/2016 Credit Card $50.00 $0.00
Permit Fee $560.00
Scanning Fee $3.00
Technology Fee $12.80
Total: $605.40
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all wor done by-eI er myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAFINDDORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foreg ccurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize tntractor to do the work stated.
March 31, 2016
Authorized Signature:Owner / 4plVani I Contractor / Agent Date
Building Department Copy
p
March 31,2016 1
RFT `�* �(`g/1
Miami Shores Village
8092016_
(, Building Department �,l
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 I ��
BUILDING Master Permit No. (C )S - I5��
PERMIT APPLICATION Sub Permit No.
❑BUILDING F, ELECTRIC ROOFING, ❑ REVISION :. E] EXTENSION ❑RENEWAL
F'PLUMBING4.hIEC I.HANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLAtION ❑ SHOP
CONTRACTOR ,DRAWINGS ,
JOB ADDRESS: 1 i I I AVC- 13 h-C p
City: Miami Shores- County: Miami Dade. j - ".Zip: , 331 3 O
Folio/Parcel#: -04 q D'- Is the Building Historically Designated:Yes NO 'b
_Occupancy Type:. Load:1 Construction Type: Flood Z6hb-, BFE: r+/ L FFFE: /1
OWNER: Name(Fee Simple
"Tit�l-e-holder): �/ G� �r,(,p� �l.Q �r(/ /')'GC�1��uv,/ Phone#:
Address:
City:l �.�.(G�.f�l/lU �I/u �.J State: Y L. Zip: 33139
i
Tenant/Lessee Name: "°Phone#:
Email s�w '
CONTRACTOR:Company Name: W-t-Y a. �r ow C) • Phone#: —1?'l..r- ILD IS 4559
Address: Q4-
City: la"I State: K L Zip:
Qualifier Name: 'LQD U l Phone#: - 4s�9
State Certification or Registration#: C\AC. I$ 1 VS 9 S Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ i 15b ,
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration /❑ New ❑ Repair/Replace ❑ Demolition
X._Description of VNork: Iy
4 11,A r aj
Y n
5Oeq color gcolor thru,tile: n=.
Submittal Fee$ Permit Fee$ 6 - CCF$ C!- G, . CO/CC$ "`
Scanning Fee$ 3 -(A Radon Fee$ 9 ` W 0 DBPR$ 45 Notary$
Technology'Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
� TOTAL FEE NOW DUE$_
(Revised02/24/2014) i � V
r'
Bonding Company's Name(if applicable) ,
Bonding Company's Address. 5 • , ,
City State ZipJ
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address i }
City t State Zip `
r
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-'per`mit 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.....
R
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.
1
"WARNING TO OWNER: YOUR -FAILURE TO RECORD-A NOTICE IOF COMMENCEMENT-MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR 1PROPERTY. 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 oved and a reinspection fee will be charged. i
t
Signature I Signature '
Ftwas
orAG CONTRACTOR
fThe foregoing instrum acknowledged before me this The foregoing instrument was acknowledged before me this
day of.o �• j 20 by / o day ofMO(C h 20 l(� by
�— o is nally known ,46 Mb-Pik who i ersonally know
me or who has produced as me or who has produced ' as
identification and who did take ari oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
I
Sign: Sign:'
rida rint:
Notary public
Seal: r ""°cf. loannam a pnc Fnoe2�5s Seal: My COMMISSION 9 FF924576
°4 .
r MYCe5pt11212WS EXPIRES Ocftw05.2019
°R EXP 401 19e oibl
OF OOIP
1 ` ♦ +
APPROVED BY . Plans Examiner Zoning
Structural Review Clerk
. i
(Revised02/24/2014)
�5N° s y� Miami Shores Village
Building Department
�... �...�� 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
oIRIDp' Tel: (305)795.2204
Fax:(305)756.8972
1 AIR CONDITIONING REPLACEMENT DATA
I
PERMIT NUMBER: MC
This form must accompany ALL air conditioning replacement permit applications. Each unit change'-out must
be on its own data sheet. Multiple units on single sheets are not
�acceptable.
Job Address(where the work is being done): � l
2 1-:) 1.12�,
City: Miami Shores Village County: Miami Dade Zip Code:
I
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
AHRI DATA SHEET REQUIRED
Change disconnecting means:YES❑ NO❑ ARHI Sheet Attached:YES ❑ NO ❑ Contract Attached:YES ❑
UNIT BEING REPLACED DATA NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL#
COND. UNIT MODEL#
KW HEAT
f NOM TONS
AHU CU PKG 1) M.C.A AHU CU PKG,
AHU CU PKG 2) M.O.P AHU CU PKG
AHU CU PKG 3)VOLTS AHU CU PKG
PKG UNIT / ;/ PKG UNIT
EER/SEER apt-r
YES NO 1 REPLACING DUCTS YES NO
YES NO I REPLACING THERMOSTAT YES NO
YES NO 1 NEW 4"CONCRETE SLAB YES NO
YES NO NEW ROOF STAND YES NO
YES NO NEW RETURN PLENUM BOX YES NO
1. Minimum Circuit Ampacity(Wire Size):
2. Maximum Overc a rrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit,(208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: -LI-lir C Weo ?y (n Phone: -?Y(4 (0 l
State Certificate or Registration No. C pr� _ S( � (9 Certificate of Competency No.
Signature C_�ZDate: — (-o —,'10 �9
(Qualifier's signature)
1
(Revised02/24/2014)
1 I `
t STATE OF FLORIDA. TION
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULA .
�. CONSTRUCTION INDUSTRY LICENSING BOARD (850),487-1395
a�. •� 1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
ALBERTO, LAZARO K
ULTRA WEATHER CORP
17851 SW 152 CT I
MIAMI FL 33187
I
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 rangey'!'ic: STATE OF FLORIDA
from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND
and they keep Florida's economy strong. PROFESSIONAL REGULATION
Every day we work to improve the way we do business in order to CAC1816585 ISSUED:' 06/16/2014
serve you better. For information about our services.please log onto CERTIFIED AIR COND CONTR
www.myftorldaticense.com'. There you can find more information
about our'divisions and the regulations that Impact you,subscribe ALBERTO,LAZARD K
to department newsletters arid learn more about the Department's ULTRA WEATHER CORP
initiatives.
Our mission at the Department is:License Efficiently,Regulate Fairly.
We constantly strive to serve you better so that you can serve your iS CERTIFIED under the provisions of Ch 489 FS.
customers. Thank you for doing business in Florida, EMpirotandate AUG31.2016 1.140616WOM79
and congratulations on your new license!
DETACH HERE
CRICK SCOTT.GOVERNR KEN LAWSON, SECRETARY
STATE OF FLORIDA
i DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION +
CONSTRUCTION INDUSTRY LICENSING BOARD �.
1!CAC!1!816585
The CLASS B AIR CONDITIONING CONTRACTOR <.
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2016
� o a
ALBERTO, LAZARO K
ULTRA WEATHER CORP
17851 SW 152 CT
MIAMI FL 33187 j
c�
n
00171
Local Business.Taw Receipt
Miami—Dade County, State of. Florida
_TWS IS NOTA 9JLL 00 NOT PAY
d 6775549
o SUSSW881VAMWL0CA1rt0a NoEXPIRES
UL WEATHER CORP RENENA# SEPTEMBER 30#
x
.
usoi
7049000 '
17651 SW 1 52 GT
pursuant to CosssnY CaSff
MlAA�!# EI, 331 7 -ars,s&10 -
y GhaAter 8�+ »;e,
SEC.TYPE OF su$1 ES& } V'Pa tEINT RECEIVE.0 ra ,�'k X#4
p QUVI'�1EFi /� f� .lg$. C MECHANECAI CONTRACTOR eY TAX COLLECTOR
:UITRA WEATHER C � CAC i81 is585 "37500. � �
CREDiTCRU-15-(xa2s "
Worker(} ,�
k � y iota tice W6 f
C�
o lyr coniirats p oet of tb�a I.oca1 S sis ss;Tax.The Re P xo azul
This Umal'Business t'ax f cei vaidt any a
boldsq to tla_business. ' 1
casb+fecittion ttfso�lewstarid fnqu ro�e�is wh eh apP1Y $ibu lsust ce�npfy '{
c vorntnente$090" 4 E
a.niva be dispied on altcercial veh4c{cs-AIliatnf- aIle Coda Sec&�-Z!h
aKi l }�1 N0.abav
Cr1 ti far i[s(otlfiabian.viSi�
N -
�o
'b
o ,oh
o�
f
f CERnFiCATE OF UABIUTY INSURANCE 3%7/20016
� -NM CERMFEMME 25 I95111M AS.A MLXFMEN OT An COMMM=i MI=w=718E cmwmm 10=10M ima ;
j iBTDiF6'KM 1DIX5 1AW ARNOW11VIELT OR 111MANIUMIr MMGX MnEW OR ALTM 7RE DOVOLMA£ AFFUMED BT 7W POLICES
TRE CIF MMMMCE MGM Uff CMZ=MME A PJB 'N =�f
LfrAMM(A PRODIICM AM TfE CBn* ME PXXAML J it
1111PPOBiwlfl: #Q!eaM ,- hoMw'bjnABONMKftMVSURMBapoft~vnMbe atdorsed ■SusR Dsw7 =Is WMvw sdbPM b 1i
-me- and Otto EI>tr pofieles IIIXF requie ae adOfaOIDelt w ztdmnert oe ffiTs oeB®eale does eat ofoW dgbls b)go J
to-OF" bolder it feu of aeeb r w"IN NOW
PRODUCER CONTACT
CJG INSORANCB CORP N PHO
mc. _ (305)221-8099 (305)221-8049
12525 N Okeechobee Road ADS camnennc'ginsurance_can
Hialeah Gardens, FL 33018
Ir9MEM xscmwe MO ACF wua
jMMERA-AsceIIdaIIt camnarc&ai Tnsnrancs
INSURED, Ultra Weather Corp. WSURERs:
RMRER C:
17851 SW 152nd Ct VMRER D:
Miami, FL 33187- iiSIURER E:
WMRER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
7*11S 1S TO CE3 n'AFY TkW TiIE PQ :4 OF NAR"PICE LISTED EELM"AVE BEEN ISSUfED TO THE lAOLSURED NADA ADOME FOR UC POLICiI PEMD
ID4ADlf'ATML NOWUHMIANSM ANY TOM OR CMMM OF ANN CIOIRRAsCT OR+OWAM DOMMW m14M REWECT TO OHM TM
d ATE lbUH1M 155 UTA1tr 1POWA ft TW DMAWCE AfHMMED BY Td1E PQXXS ID IS E'TO All-TiEfE TE
E)MIAISAMSA MC IIOl4SOIFSIICffiIPOLIM&LMSSHfB1116 W11111f EM PA DC ANI6& JI"
AWL SUM POU1C)f EFF POLICY am
7R sw treD POY.IR:Y IYIIt� Lam
X Coal m"&�u ELffv EACH OCCURRENCE s 1, 00,000
CtAAIS4A RDE ®a PHASES $ 100,000
GL 48859-0 7/26j15 7j2bj16
uEdD'Oftmeepe i s 5,000
A X DED: 500 PERSONAL.ADVia tIRY s 1,000,000
GERL AGGEM,UQE LMT APPUEs PEW GENERAL POSAIrME $ 1,000,000
POLICY LDc Pis-CMVVOPAM s 1,000,000
oOTHER: i -
AurDaomLE o.mmnx s
AIWAtUF® ,
eODdx PLIURY(Pbr f
ALL OWNEDSOi®IA ED BODILY INJURY(Pff accident) i
AUTOS AUTOS
"Nam AUTOS xnw rl®
f
s
O'er acddw*
UIIBREIIALIAR , EACH OCCURRENCE s
EXCESS um CLAOrrUADE Ac ►7E $
HOCCU
DED RE�noH s � s
WOR1OERS COMPENSATION
AEMELOYERS LIABLrrY TAM STATUiE ER
tm
,pry PFKWR1EF0FWVRTNEFt003MRW EL.EACH ACCIDENT s
U'fF DELUDED? NAA
ryaWwY tb M E.L.DISEASE-EA ENPLOYEE s --
Iyes,desaiVetadOF
OESCIiS'RitDN OF 04MATMM bobw EJ-DISEASE-POLICY LWT f
DESCRJ -FM OF OIEMIJO ILOCATiONS1 vEHKO ES(AGOW til.Addliand R Schad&mW be a 'Rome zPwo s
AC SEEMCE MSTALT_ TIONS AND RWAZR
CERTIFICATE HOLDER CANCELLATION
Niami. Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLL ES BE:CANGE lED BRAE
Building Department ACCORnANCE TM wFION DATE THE THEREOF, WILL BE DELIVERED w
10050 N.E. tad Ave
Miami, FL 33138 AUTHOR"REEF MMA71VE
r
®1988-2014 ACORD CORPORATIOK AN d9hlo reSOMX.
ACORD25(2044101) The ACORD name and logo are registered maks o1 ACORD
Page 1 of 1
. r
�yM rr.I
JCFF AIWATFR
CWF FINAMCIA1:CATICFR STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
ۥ DIVISION OF WORKER::COMPENSATION
t '`CERTIFICATE OF ELECTION TO Or-EXEMPT FROM FLORIDA WORKERS`COMPENSATION LAW''
CONSTRUCTION INDUSTRY EXEMPTION
This ceft c,,j ftt the Wdit,ridual"ted W-ow hos d tted to San exbrrtpC fog"1"Iotwd l Wotkltl!cutrpellsatiotl Taw-
EFFECTIVE DATE: P.'111014 EXPIRATION DATE: I3MMOIG
PERSON: ALBERTO I.AZARO K
FEIN: 272723717
BUSINESS NAME AND ADDRESS:
ULTRA v. Kr14-R CORP
17&51 SW 162 CT
IkAIAIM I - KI. 33187
SCOPE'S OF BUSINESS OR TRADE:
HFA111W,WNYILATION,
AIR-COND
hru.wl,Ll4'1'a/Arl44().1',6{/t),f.s..nn etc.-that+vl�vutl;vl�eff}•Atl,t d
ls�yn^,trX thta,•�'A�M-6yR1rry)dEHrtr„N tlttl4c*cr.seerHIt1 wcto+s v,uy
•tfl R'rdRN tm3ftv"s d M✓�YM.Y.CN.lfl'JH Pifl kimt gg-,I'Mtwp14 ft C"`j�Se♦AO 0112h vs.,."'�C.1tNs t(.1�M o 6e eY,!(f®t..,maw—t1'-WinTe stYt`a.`
411tH CUYrIeN L-AFJdb v#wl,-ti W tl+l!rwrrp Pythum A 10 Cf}q:W+'ekY.f;�f 731.x.."r,7U:.�ce94j N�,COSJ�GT br nr�Mn(IA q�•d1 e4YKunY.l0
lflwwamV li t.'1l..w%c S!ml M Y.."o w,*WK,e11pi.0,e10ry tine ars'r tKe 450,E 4t�Ae"Ag*-4.**n-Mtrm O tfC �JULO e.
rAftllrjl�(.�7 kr15Y"w.tdl.Mtt.fN4MY.K4S*I r,s!^ttp0 La jsuiso'dC.i 1;4 A leit:f.4.lpt.The Gtf%I fP.bn1&hal,*wmk*Jww%*Atn le SKj Irnu fal Ntcs'e AMA
(.efY,ro l.Mkltl tel It*4 wWww1m if.m*vl the pmtlpu"* N/r1 i2s.41n�5tYf: } r
OFS.f2.0&'r. xClA111711.01;OFEIECrIONrO4L; -01"TREVISCO07•12 S7JErTIC1tIS?f,!!$(t)�171(SC9 f
t
k
1
F
file:///C:/Users/javie_000/AppData/Local/Microsoft/Windows/1NetCache/Low/IE/11Y98S... ` 1/6/2016
Ultra Weather Corp
17851 SW 152 CT
Miami,FL 33187
Tel:(786)615-4559
License#CAC1816585
Date:
State of F�u l l A o--
County of �
Before me this day personally appeared �2�ryl C KJ who,being duly
sworn,deposes and says:
1
That he or she will be the only perso woVdng Vn the pT ject located at:
909 NE How
Sworn to(or affirmed)and subscribed before me this1 day of __ ( .20-L�
by
Personally known
Or Produced Identification
Type of Identification Produced
i
&WHELL SANCHIR
'•' ••= My COMMISSION•FF924618
EXPRES O&AW 06,2019
got �
i
Pri , ype or Stamp Name of Notary
r
SCORES
s� � ►Q 1-93
Miami shores Village
1111 ""'� Building Department
`tiF�l10050 N.E.2nd Avenue OR1UA
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.
' I
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,BELPW Y CKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. 1
r5
S
Signature:
`Own r
State of Florida
I
County of Miami-Dade
The foregoing was acknowledge before me this 1�qh day of "(h _,201(,0
By�aW who is personally knowq to me or has produced
y
{
L as identification.
Notary:
1
SEAL: .......'—
MARML OLSEN
'i MY COML41SSION 0 FF201726
(407)398-0153 FloriftwowyServM.com 1
i