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MC-16-2616 Permit NO. MG-9-16-2616 RFs o, Miami Shores Village Permit Type:Mechanical-Residential 10050 N.E.2nd Avenue NE Per � It Work Classification:A1C Replacement Miami Shores,FL 33138-0000 PennitStatus:APPROVED Phone: (305)795-2204 FCORtVA '� Issue Date: 1119/2016 Expiration: 05/08/2017 Project Address Parcel Number Applicant 475 NE 91 Street 1132060140142 Miami Shores, FL 33138-3150 Block: Lot: AVANT PLACE , LLC Owner Information Address Phone Cell AVANT PLACE , LLC 7845 W 2 Court (786)566-2454 HIALEAH FL 33014- 7845 W 2 Court HIALEAH FL 33014- Contractor(s) Phone Cell Phone Valuation: $ 6,000.00 1. ARTICA LLC (486)566-2454 _..._..,. __ ....,.,�_.... Total Sq Feet: 1800 Tons:4 Available Inspections: Additional Info:REPLACE DUCT VENTALATION REPLACE UN Inspection Type: Classification:Residential Final Approved: In Review Review Mechanical Comments: Date Approved:: In Review Date Denied: Type of Work:REPLACE DUCT VENTALATION REP Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 DBPR Fee Invoice# MC-9-16-61434 $3.15 11/09/2016 Check#: 1478 $233.90 $0.00 DCA Fee $3.15 Education Surcharge $1.20 Notary Fee $5.00 Permit Fee $210.00 Scanning Fee $3.00 Technology Fee $4.80 Total: $233.90 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. I OWNERS AFFIDAVIT c fy that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo g. th rmore, I authorize the above-named contractor to do the work stated. November 09, 2016 Autho Sign ture:Owner / Applicant / Contractor / Agent Date i Building Department Copy November 09, 2016 1 � I I 0 ? "'20� Miami Shores Village c -- Building Department sip 222016 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 IU p BUILDING Master Permit No. 11016 PERMIT APPLICATION Sub Permit No.mc _ 1( " Z(D ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING EEr ECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 475 AI 91 S/ City: Miami Shores County: rL Miami Dade Zip: i Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: i FFE: OWNER: Name(FeeSimple Titleholder): /'4,4- ' lel-,4 G C, Pho7� � J 7 Address: 794 City: City: / 1 State: Zip: Tenant/Lessee Name: Phone#: Email: n 1 / •-7 CONTRACTOR:Company Name: /1C��C/a LLC _ Ahone#: Address: 70,5/ 5qj ZI 97- City:. TCity: iI // State: / Zip: Qualifier Name: )�/O &-1412 /� /�/1�'TivfZ Phone#:QA95)ZDO G7'f1-1 State Certification or Registration#: 67C It 7603 Certificate of Competency# � DESIGNER:Architect/Engineer: , Phone#: Address: City: State: Q Zip: Value of Work for this Permit:$ &000•e Square/Linear FootageLof;Work: Type of Work: ❑ Addition ❑ Alteration El New ❑ Repair/Replace E:1 Demolition Description of Work: �uCf, VAV 1��17,�'V 6LWA4%0-- Specify co/or�of colorthrdllle• Submittal Fee$ "�' F' �' rnmo ``�'rpe mit Fee$ CCF$ ' ` �� 'CO/CC$ Scanning Fee$3. Gla Radon Fee$ • 1� DBBPRR$.3 1 S Notary$ ;Q3 Technology Fee$ Training/Education Fee$ (i l� ' / Double Fee$ ,0 Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Z'5 2 y � t' l l Bonding Company's Nam (if applicable) �. i Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage 'Lender's Address 'h • 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure-will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. _ t Signature — Signature - OWNER o AGENT RACTOR The foregoing instrument was acknowledged before/me this The foregoing instrument was acknowledged before me this dayof �J� �� 20 by day of (.��� 20 r( by -(�•1Z�E? � �,who is personally known to who is personally known to ''..gy�pp s_-- me or who has produced���lJ� L�� as me or who has produced D VW Ll as identification and-wh'o did take an oath. identification and who did take an oath. t OTARY P NOTARY PUBLIC: Sign: Sign: _` � r� Print: (P p� �- _ Print: L( Seal: r �, �' }� """ Seal: Nage 'i�ii��ic$?a a of Florida SlPttiia Alz ,.. NOTARYunWsyY PUBLIC My C,50irtiission FF 156750 Expires 09/03 18 STATE OF , �pFgLpOpR�IDA Expires 11/3012019 APPROVED BY IalnS Examiner Zoning - .r. Structural Review Clerk (Revised02/2401' N., _ a P� 3 5�°RFm'r Miami Shores Village Buildirig'Department ■■■ a■■� 10050 N.'E.2nd Avenue Miami Shores, Florida 33138 Rapp► Tel: (305) 795.2204 Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA 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): 1175 1A V/ SC City: Miami Shores Village County: Miami Dade 12 Zip Code: 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 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 YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO 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 Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: �2�7fC.4 L/1- Phone: 5J2DDGyilI/ State Certificate or Registratio o. C/JC/f/ Certificate of Competency No. Signature Date: ature) i (Revised02/24/2014) RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD AJ CAC 1817803 ; I The CLASS B AIR CONDITIONING CONTRACTOR ^ Named below IS CERTIFIED Under the provisions of Chapter 489 FS. '�`�°we . Expiration date: AUG 31, 2018 MARTINEZ, JULIO CESAR, ARCTICA LLC �* ° 7051 SW 4TH ST MIAMI FL 311 44wy` ISSUED: 06/30/2016 DISPLAY AS REQUIRED BYLAW SEQ# L1606300000519 s. D06914 r t y t ,v •M»N r v 2d xi a,fvf� lF6�f , J a Miami-D'atle ' 57, ~ 7171410 t t E EXPIRES+<'' RECEIPT NO t Si) �+ BUSINESS NAME/LOCATION AO �. ARCTICA LLC RENEWAI.x " SEPTEMBER 30',. 7051 SW.4 STust bpe'displayed at'place of bushes§ MIAMI FL 33144 PCode ursuant to County , . >r" Chapter 8A`.=Art9&10 SEC.TYPE OF BUSINESS PAYMENT,AECEIVO OWNER 196 SPEC MECHANICALCONTRACTOR BY TAX COLLECTOR ARCTICA LLC CAC1817803 $45.00 00/30/2015 worker(s) CREDITCARD-1 5-053142 This Local Business TaxAece,pt onq eonfi►ms PeY�nt of!fis Loe°I Busmesa lax The Receipt,a nota license. peimitror a certificatioo of tbs lder, qq,u allficatioas,m do business Holder must comPlla?K!th'8ny Dov neatai or nongove`nmeMal regulatory laws sed'.requiremeata whiobapply to the bnstness c The RECEIPT ND.above must be diipleved on all co is,vehicles—Miami—Dada Cotle SecBa 27& For more inforaoadon,visit'ti^""'miamidade aovMixcotlecm[ t CERTIFICATE OF LIABILITY INSURANCE DATE{MMIDD)YYYY)os/13/2o1s THIS CERTI-CERTIFICATE DOE : ISSUED ASIA"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"INSURERS)_AUTHORIZED REPRESENTATIVE OR PRODUCER,AND..THE CERTIFICATE HOLDER. :" IMPORTANT: if the certificate 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 ofthe policy,certain policies inay"re'quire an'eridorserrtent: A'statement on: -this certificate does not confer rights to the_cert�cate holder in lieu of such endorsement(s). PRODUCER ... -.. ... . Popular Insurance cCAONT CT ALEJANDRO HERNANDEZ PHONE 305.456-2841 2123.Southwest 27th Avenue ra."N, 305-200-8910 ADD ESS:popularins mail.com . Miami FL 33145: " """ @g INSURERS AFFORDING COVERAGE NAIC A INuRER a GRANADA INSURANCE INSURED ARCTICA LLC INSURER B: .7051 SW 4TH ST." INSURER 0: MIAMI FL 33144 INSURERb:' . - INSURER E:, INSURER F i 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. N07WITHSTANDING ANY:REQUIREMENT,TERM ORCONDITION.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. INSRADDLSUBR - LTR :"..TYPE OF INSURANCE: - SR POLICY NUMBER _IPOLICY EFF-. POLICY EXP(MMYYY) .. LIMITS ,.. . 1 7 COMMERCIALGENERALUABILITY [PA HOCCURRENCE '$1;000,000✓ CLAIMS-MADE 0 OCCUR 0185FL0005T817 03/21/2016 03/21/2017MISEsrEaoc urrercel. 6.100,000 . A . ,`: MED EXP Arty one person) $5,000 PERSONAL d ADV INJURY: S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER - - : GENERALAGGREGATE -S2,000000 POLICY�JECT: �LOC .. PRODUCTS-COMP/OPAGG S 2,000,000 AUTOMOBILE LIABILITYS -, -- "_ I _ - - -COMBINED SINGLE LIMIT S ANY AUTO .. .--'- . . Ea accident) ' . .. - BODILY INJURY(Per person)': $ OWNED SCHEDULED - - AUTOS ONLY AUTOS HIRED NON-OWNEDBODILY INJURY(Per accident) $. . -_ AUTOS ONLY- AUTOS ONLY PROPERTY DAMAGE _ _ - - Per accidenPERTYt "S S . UMBRELLA LIAR OCCUR -- - EXCESS LIAR .-.. - - EACHOCCURRENCE- S . CLAIMS-MADE _ AGGREGATE: " OED RETENTIONS .: "" -. - WORKERSCOMPENSATION S` AND EMPLOYERS'LIABILRY - - STATUTE OTH .:ANYPROPRIETORIPARTNER/EXECUTIVE Y IN. - - - - OFFICER/MEMBEREXCLUDED? ❑ N/A1 _ - E.L.EACH ACCIDENT - $ - (Mandatoryin NH) - - . ..' yes:describe r T - _EA - `- DESCRIPTION If unde OF OPERAIONS below. - _- l -. " - E.L..DISEASE- EMPLOYEE�S E.LDISEASE•POLICYLIMIT Is DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES_(ACORD 101 Additional Remarks Schedule,may be attached ifmcre s Ac Equipment lnstailati pace is required) on.Repair,Maintenance,and Refrigeration." CAC 1817803 CERTIFICATE HOLDER CANCELLATION' Miami"Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BE `:. THE. EXPIRATION :DATE: THEREOF, NOTI WILL BE DELIVERED IN 10050:ne"2 ave, " ACCORDANCE WITH THE POUCY PROVISIO S Miami Shores Village f1,33138 ... "' AUTHORIZED REPRESENTATIVE LEJANDRO HERNANDEZ ACORD 25(2016/03) ©1988-2015 ACORD CL RP TION: All rights reserved.. :The ACORD name and logo are"registered marks"of ACORD Produced using Forms Boss Web Software.www,FormsBoss.com(e)Impressive Publishing 800-208-1977 - - 1 1 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION t'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. t EFFECTIVE DATE: 5/27/2016 EXPIRATION DATE: 5/27/2018 PERSON: MARTINEZ JULIO C FEIN: 465071696 1 i BUSINESS NAME AND ADDRESS: ARCTICA LLC 7051 SW 4TH ST MIAMI FL 33144 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, CLEANER-DEBRIS AIR-COND REMOVAL-CONST Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elect exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt..apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13),F-S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a V DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 { a 6 t COMPANY LETTER HEAD ARCTICA LLC 7051 SW,4 ST MIAMI, FL 33144 LIC#CAC1817803 Date: October 25, 2016 State of Florida f _ E County of Miami Dade k I Before me this day personally appeared Julio C Martinez who, being duly sworn deposes and says: That he will be the only person working on the project located at: 475 ne, 91 st Miami Shores, Florida 33138 t t Sworn-to, (or affirmed) and subscribed before me this 25 day October 2016, by Julio C Martinez. I ,. -- --- ----------"------------------.. Personally know x Or Produced Identification Type of Identification Produced 4 "aY.o°alOL OLMEDA — ' , t FF/6 v ugus , r4't of o�\0� Bonded mru Budget Notary services i Print, Type or'tamp Name of Notary } 9 - F inMiami shoresMVillage Buildin Department R p 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to owner— workers' compensation insuranceExemption. 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 orilimited 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-tim CONTENTS. e employees or subcontractors. AVE READ THIS BY SIGNING BELOW OU ACKNOWLEDGE THAT YOU HNOTICE AND UNDERSTAND ITS Signature: 0 , ner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of__QC'. b 20�, By wh personally own to me or,has produced as identification. Notary: t SEAL: ���t;/y.,, Zettie Jones ' 1 COMMISSION#FF209081 EXPIRES:March 14,2019 WWAARONNOTARY.COM