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MC-17-871 Permit NO. MC-3-17-871 Miami Shores Village Permit Type:Mechanical-Residential 10050 N.E.2nd A venue NW Pen � � WOTiCC/855�Gc?tlOil:Addlti+�flllAiter�ItlOn' "t - Miami Shores,FL 33138-0000 Permit Status:APPROVE Phone: (305)795-2204 FtORiDp' Issue Date:5/3012017 Expiration: 11/26/2017 Project Address Parcel Number Applicant 10804 NW 2 Avenue o 1121360020140 Miami Shores, FL 33168- Block: Lot: ANGELA M HENAO Owner Information Address Phone Cell ANGELA M HENAO 10804 NW 2 Avenue (305)793-2495 MIAMI SHORES FL 33168- 10804 NW 2 Avenue MIAMI SHORES FL 33168- , i Contractors) Phone Cell Phone Valuation: $ 2,500.00 COOL WIND CORP (305)879-6580 Total Sq Feet: 0 Tons: Available Inspections: Additional Info:SERVICE AND REPAIR EXISTING A/C SYS Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work:SERVICE AND REPAIR EXISTING A/C Underground Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee Invoice# MC-3-17-63504 $2.00 05/30/2017 Check#: 1719 $67.80 $50.00 DCA Fee $2.00 Education Surcharge $0.60 03/30/2017 Check#: 129 $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $117.80 f In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore I a0morize the above-named contractor to do the work stated. May 30, 2017 A ignature:Owner / Applicant / Contractor / Agent Date Building Department Copy May 30, 2017 1 F Miami Shores Village RECEIVED . d d Building Department 3 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 S t FBC 201q BUILDING Master Permit No. 12-C co- 31 PERMIT APPLICATION Sub Permit No. MC !F)- "g 9-- d .BUILDING F� ELECTRIC E] ROOFING REVISION EXTENSION RENEWAL PLUMBING K MECHANICAL PUBLIC WORKS Ej CHANGE OF CANCELLATION ❑ SHOP Ap CONTRACTOR DRAWINGS JOB ADDRESS:__ - I0soq City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: l t OWNER: Name(Fee Simple Titleholder): Ate) &OA 1 l,'1�,>�n Phone#: i Address: r'�Iy19 V3;7�-ek—, K)e -A 2.D(o � City: M�AM1 60CIt State: �L- Zip: Tenant/Lessee Name: Phone#: ' Email: ! CONTRACTOR:Company Name: Co0k �ni� �ni�1� Phone#: = � j d Address: q3 s) w 1 S4 ?L. City: f \l hM 1 State: Zip: 331 g S Qualifier Name: Ybiex- A7r-L vG/'AI A, Phone#: ��6-'Zlb 4402 State Certification or Registration#: ^��C I `gllI '$ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: Addition =i Alteration '� ED New KI Repair/Replace. EJ Demolition Description of Work: Ol cc ` ry4 VS ` t g 1-! t, '1�;'$."S � :S"�kl�`l�`�ISi�w•:?..x��,�Dy+` f ... ' . �, dt3,J�-��.,:"1 ,,.,r�s '!)i 7 P;,;sT. ' r it i.• t i I` �Sbu" r1 llll� , M' fk� L. .t 1L �YxE��Myz ,Srl r Specify color ofr`color,thrii:t�le:. r:: "� 1]!"G(�tdF.. E'+rC�C=!f�(`�"..i - ('� �.�i,.i.�rr:..G.`.µ;, ��,rui':.., _,t..'(.i•�S4Rd3 Submittal Fee$`"" Permit Fee$ CCF$ CO/CC$. Scanning Fee$ Radon Fee$ DBPR$ Notary$_ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ r '] TOTAL FEE NOW DUE$ b F (Revised02/24/2014) Bonding Company'sl Name(if applicable) Bonding Company's Address City r State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City `State Zip w Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that nb 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. r , "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&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. y x t)k J e -, �\ Signature Signature OWNER or AGENT CONTRACTOR`- The ONTRACTORThe foregoing instrument was acknowledged before me this The foregng instrument was acknowledged before me this — 20( day of /vlAV-G+� 20 / by 7-�—day""of{ NIA-Rei=� 20 1 by A1GcIJ gur"^O who i onally know to y0(=L ' ` A44,,yucr Xt Ar who is sonally know to me or who has produced 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: 1 r Print: G Print: eax :►1" CHRISTOPHER,COX, Seal: Seal: CHRISTOPHER COX MY COMMISSION#GG011522 MY COMMISSION#GG011522 '., EXPIRES July 13,2020 EXPIRES July 13,2020 4 (407 b91�163 FwWoNomyservice.cm (107) a-als3 F ry yryg� APPROVED BY UsExaminer Zoning Structural Review Clerk (Revised02/24/2014) ' I i i RICK SCOTT, GOVERNOR _ KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT.OF.'BUSINESS'ANUPROFESSIONAL REGULATION CONSTRUCTION INDUSTRY,LICENSING'BOARD My CAC1817188x ` The CL'ASS.B AIR CONDITIONING CONTRACTOR w Named below IS CERTIFIED- Under the ERTIFIED-Underthe provisions of Chapter 48TFS. Expiration date: AUG 31, 2018 ARENCIBIA, YOEL ~'` •a- COOL WIND CORP '°="` 16612 SW 114TH CT,- MIAMI T MIAMI F,L 33157 r-r`- Kf' �e� I•Y� ...,.�ill•.«.,..+,.:...;;:t`3a'S`*S"` a...•.�1>�.���"� .`5��a_���. �._.—+....._..::.., ' ISSUED: 08/16/2016 _ DISPLAY AS REQUIRED BY LAW SEQ# L1608160002030 I 010617 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT ABILL-DO NOT PAY \ILBT 6395677 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES COOL WIND CORP RENEWAL SEPTEMBER 30, 2017 OPERATING IN DADE COUNTY 6663570 Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS COOL WIND CORP 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED C/O YOEL ARENCIBIA QUALIFIER CAC1817188 BY TAX COLLECTOR Worker(s) 1 $75.00 07/09/2016 1 CREDITCARD-16-037502 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 N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec Ba-216. i For more information,visit www.miamidade.gov/taxcollector ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `..� 03/29/2017 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 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 Yaritza Morris The Insurance Guy, Inc. (305)668-7100 (888)236-8036 4928 S.Le Jeune Road ADDRE • Yadtza ThelnsuranceGu Inc.com INSURER(S)AFFORDING COVERAGE NAIC q Coral Gables FL 33146 INSURER A: GRANADA INSURANCE COMPANY 16870 INSURED INSURER B COOT Wind Corp. INSURERC: 16612 SW 114 CT INSURER D Miami FL 33157 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. ' INEXP TR TYPEOFINSURANCE ASR SWVD POLICYNUMBER MM/DDUBR Y EFF MM%DPOLICY YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS-MADE I X I OCCUR MED EXP(Any one person) $ 5,000 A 0185FL00038175 08/06/2016 08/06/2017 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PE O LOC $ AUTOMOBILE LIABILITY COMBINED SINGLETT9rr__ Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL SCHEDULED Pe INJURY BODILY INJUr accident OWNED AUTOS ( ) $ AUTOS NON-OWNED PROPERTY DAMAGE-- HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- DRY LM TS I JOTH- AND EMPLOYERS'LIABILITY Y/N I FIR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ti DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CAC 1817188 CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 Nw 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL 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: 8/6/2016 EXPIRATION DATE: 8/6/2018 PERSON: RODRIGUEZ FREDDIE FEIN: 455603430 BUSINESS NAME AND ADDRESS: COOL WIND CORP 16612 SW 114 CT MIAMI FL 33157 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-COND Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 •�ROD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL 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: 8/5/2016 EXPIRATION DATE: 8/5/2018 PERSON: ARENCIBIA YOEL FEIN: 455603430 BUSINESS NAME AND ADDRESS: COOL WIND CORP. 16612 SW 114 CT MIAMI FL 33157 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-COND Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 l