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MC-17-2312 Permit NO. MC-9-'17-Z3'1 Z `stjO1R L� Miami Shores Village Permit Type: Mechanical-Residential 10050 N.E.2nd Avenue NE Perl�11 't I WorkGtassr5cation:Addition/Alteration Miami Shores,FL 33138-0000 Permit Status.APPROVED Phone: (305)795-2204 f�oRlDp` Issue mate:9/2812017 Expiration: 03/27/2018 Project Address Parcel Number Applicant 1075 NE 96 Street 1132060143690 NICOLAS TERZANI FRANZISKA Miami Shores, FL Block: Lot: Owner Information Address Phone Cell NICOLAS TERZANI FRANZISKA HINZE 1075 NE 96 Street (786)246-8759 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 14,000.00 RB AIR CONDITIONING INC (305)216-7766 Total Sq Feet: 0 Tons: Available Inspections: Additional Info:INSTALLATION OF THE 2 MINI-SPLIT W/ Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved: :In Review Review Mechanical Date Denied: Type of Work: INSTALLATION OF THE 2 MINI-SPLIT Underground Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $8.40 Invoice# MC-9-17-65166 DBPR Fee $7.35 09/27/2017 Check#:2008 $50.00 $485.10 DCA Fee $7.35 Education Surcharge $2.80 09/28/2017 Check#:2011 $485.10 $0.00 Notary Fee $5.00 Permit Fee $490.00 Scanning Fee $3.00 Technology Fee $11.20 Total: $535.10 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 accurate and tha all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above- contract r to do t work stated. September 28, 2017 Authorized Signature:Owner / Applicanttor / Agent Date Building Department Copy / c September 28, 2017 1 . 11 2 �o Miami Shores Village 7BY: P 7 2017 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 FBC 20 ( ,- q BUILDING Master Permit No. ?1 C t-7-13 / PERMIT APPLICATION Sub Permit No. i" c'—j 1] ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP ry f� A e CONTRACTOR DRAWINGS JOB ADDRESS: 'O /-�J /v oo qk d City: Miami Shores County: Miami Dade Zip: J23 128 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: co �Q 4 OWNER: Name(Fee Simple Titlehol er): l ` 7�,� / Phone#: � - � `87s7 Address: S jAj. -E6 o City: State: Zip: 1 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Compan Name: /��" 1-n e#: A, Address: City: State: �` Zip: 3 Qualifier Name: 0ZiAl Phone#�� State Certification or Registration#: C�C��t�� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 00 o Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ~.i, New ❑ Repair/Rept-ice ❑ Demolition e C 6VIi A,O Description f Work:.. �' oL N� �. �� ^.?!�S -�f'-h: � yer 11 � �C's.f:; •a �� .c:'c.t t�'�rl.:.r•✓ 1�-x . 1� I J - _ _lor�„ Specify�color of cothru tile: ! j n 1ALI. Submittal Fee$ ) 1 1Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ i Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 7 V E;° (Revised02/24/2014) i Bonding Company's Name(if applicable) Bonding Company's Address _ City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip , I 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR t The foregoing instrum t was acknowledged before me this The foregoig instrument was acknowledged before me this day of 20 /e', by Z(O day of SCC A-- ��n( 120 , by who is rsonally kn n to 9)� (D () &,I0IJI.l1ilrh'd••i�personally known to me or who has produced as me or who has produced -n l�<�C/1 )se as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Si •...... MAVA r MY I K.GONZgLEZ Print: L Print: ?,r COMMISSIO '= MY COMMISSION#FF097297 •'�;FORF;o;° Bo�� S November2,ppPO Seal: ,� ° Seal: Thru Notary Public llndenvrite ' t,° EXPIRES March 2, 2018 ry (407)398.0153 Florida Notaryservice.com ********************** ***** ******** ********* * * ************************************************ APPROVED BY Plans xamin Zoning Structural Review Clerk (Revised02/24/2014) WSTATE OF FLORIDA PROFRESSIONNTALL REGULATION OF BUSINESS AND CAC057175 ISSUED. O8r0 O16 CERTSED AIR COM CONTR BENDANA,RICARDO R 8 AIR COED INC IS CERTIFIED under the proviSions at`h 4 S.. Exp" mdor AU831.M8 KEN LAWSON,SECRETARY RICK SCOTT,(3OVM'OR STATS OF FLORIDA PROFESSIONAL TION DEPARTS BUSINESSNASENSING BOARD INDUSTRY X067175 NTRACTOR The CL.A$S AAIB CONS - Named bebw LS CE�QED 489 FS. ChaPW �ne��UG 31,2018 µ- AIR CONDI' �• � i AVENUE :r 14125 NSN•8D - — " ,retie DISPLAY AS REWIRED BY LAW SEGS L160e09=149K YP:'N 4 t t K RecOlPt Lucel Usiftess Tax Miami-Dade CoU ty. Stateof Florida -THIS 1$NO A OILL 00 AY .3576817 �1► AncelpT NO. ` PIKE Cum$IYAMWLOCATION RENEWAL '"Y'+ NI i 30, 17" RB Alli CClI t? f4N IN 37. 7777 3 ��;,l;;�r�`ciiscleyed m plane of business 141�»- "8 ;S 1 .. Ft rsuant to County Cods W N11 1 1 ` 016 , Chtlpter 8A-Art.9 8110 815C. TYPE OF GUSINHS$,x h - 1?!AYMgUT RECLINE© 4 awl�lrt i r, 196 SPEC MECHANICAL.CONI RACT4R by sax COLLEC=R RB AIRCONDITIQN6 tNC Q R(CARD�BENp/1NA CAC057175 $45.00 07118/2016 mikorCs) } V.. CREDITCARDw-1'6-041696 TAta tail#luslaair3 To I;oceipt only CoaGrms paymortt of the Local Business Tax. The Receipt is not a license.' pfntdi<or.a rartiffwtica of the holder's qualifications.to do business. Holdsr must comply with.any governmeotat or nos0gvrrnt"Aw1 repuistory laws atul reolremenb which apply to the busies. Ylte'RECEIPT NO.above most 6a displayed on all corn mrcial vehicles�Nlsmi-i3ade Cala Sac is-216. For more information,:visit wwwjDismidade,gavha_xcotlector ` Ail f 0 .1 II t s 1 FYI ter' r. { f ACo® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD(YYY1) 14� 09/26/2017 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 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 NAME:CONTACT LISSET BETANCOURT Floridian Choice Insurance Group PNONE , (305)857-9880 �No); (305)857-9836 2353 Coral Way ADDRESS: tom@atinsurance.us INSURERS AFFORDING COVERAGE NAIC# Miami,FL 33145 INSURERA: GRANADA INSURANCE INSURED INSURER 0: R.B AIR CONDITIONED INC INSURER C: NORMANDY 14125 NW 80 AVE 301 INSURER D: INSURER E: MIAMI LAKES FL 33016 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 ADDLSUBR TYPE OF INSURANCE POLICY NUMBER POLICY UDY EFF MMIDO EXP LITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED CLAIMS-MADE FRI OCCUR PREMISES Ea occurrence $ 1,000,000.00 MED EXP(Any one person) $.5,000.00 A N N 0185FL00093091-0 02/24/2017 02/24/2018 PERSONAL BADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 POLICY JET LOC PRODUCTS-COMPIOPAGG $ 2,000,000.00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Fa accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOSAUTOg (Per accident UMBRELLA IJAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETORMARTNERIEXECUTIVE YIN E.LEACH ACCIDENT $ 1,000,000.00 C OFFICERIMEMBER EXCLUDED? FY N/A NHFL0066042017 03/21/2017 03/21/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H mora space is required) AIR CONDITION INSTALLATION SERVICE AND REPAIR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES FL 33138 `C ©1888-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD