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MC-17-2477
Perm+t iVo. MC-10-17-2477 Miami Shores Village - Per if Ty e.-Mechanical-Residential 10050 N.E.2nd Avenue NE r ..,. Werk C/assicatien:Addition/Alteration Miami Shores,FL 33138-0000 'Per im t Phone: (305)795-2204 Pennit'Status APPROVED FCORLOp Issue[tate: 10/18/2017 Fxpiration: 04/16/2018 Project Address Parcel Number Applicant 746 NE 94 Street 1132060141660 Miami Shores, FL 33138- Block: Lot: WILLIAM ARNOLD Owner Information Address Phone Cell WILLIAM ARNOLD 746 NE 94 Street MIAMI SHORES FL 33138-2915 Contractor(s) Phone Cell Phone Valuation: $ 5,980.00 COOL FREEZE AC CORP (305)591-9794 Total Sq Feet: 250 Tons: Available Inspections: Additional Info:NEW ADDITION TO EXISTING HOUSE. 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 $3.60 Invoice# MC-10-17-65381 DBPR Fee $3.14 DCA Fee 10/18/2017 Credit Card $ 177.13 $50.00 $2.09 Education Surcharge $1.20 10/17/2017 Check#:274 $50.00 $0.00 Permit Fee $209.30 Scanning Fee $3.00 Technology Fee $4.80 Total: $227.13 • r 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 ELE RICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFID I I c ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction nd z i Fu ermore, thorize the above-named contractor to do the work stated. October 18, 2017 A ho " i n re.Owner / Applicant / Contractor / Agent Date Building D partment Copy October 18,2017 1 Miami Shores Village `` J � Building Department BY: o 17 2017 ri 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 1 bj Tel:(305)795-2204 Fax:(305)756-8972 I INSPECTION LINE PHONE NUMBER:(305)762-4949 --'f FBC 20 I`f BUILDING Master Permit No. � '- PERMIT APPLICATION Sub Permit No. "BUILDING ❑ ELECTRIC , ❑ ROOFING REVISION ❑ EXTENSION QRENEWAL ❑PLUMBING Q MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:],SHOP CONTRACTOR DRAWINGS 746 ne 94 st 10B ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: I William A. Arnold & Vivian Gutter 305 490 7504 , OWNER: Name(Fee Simple Titleholder): Phone#: Address:746 ne 94 st, , Miami Shores Fl 33138 City: State: Zip: Tenant/Lessee Name: Phone#: Email: Cool Freeze A/C Corp 786 344 0439 CONTRACTOR: Company Name: Phone#: 11354 NW 56 St Address: Doral Florida 33178 City: State: Zip: Qualifier Name: Ernesto Rodriguez Phone#: 786 5862242 State Certification or Registration#: CAC18183222:4.2Certificate of Competency#: DESIGNER:Architect/Engineer: Ruben PUJOI Phone#: 786 344 0439 12237 SW 204TH Terr Miami FI 33161 T Address: City: State: Zip: Value of Work for this Permit:$5,980.00 Square/Linear Footage of Work: 250 Type of Work: ❑� Addition ❑■ Alteration ❑ New I ❑ Repair/Replace ❑ Demolition Description of Work: New addition to existing house Specify color of color thru tile: e--) (A Submittal Fee$ _ 03 Permit Fee$ ti V CCF$ 3' ra0 CO/CC$ q Scanning Fee$ �/'/� Radon Fee$ Z-• ( DBPR$ — ( Notary$ Technology Fee$ '7= Training/Education Fee$ - Double Fee$ J/�/'f�� Structural Reviews$ Bond$ 5� TOTAL FEE NOW DUE$ (Revised02/24/2014) --»-✓" ---- - - AOFLORID :' ; DEPARTMENTOFSBADPRFSSO:N,AL-R�E`GULA=T�I`O."`N , - CONSTRUCTION INDUSTRY LICENSING BOARD CAC1818322,�- .. -- -^-••_:r-'_ �~ ,, � f.��s r,.��'� . iS ::,Me CLASS AAIR CONDITIONING CO TRACTOR V -Named.'below IS'CERTIFIED:-- 'Under the provisions of Chapter'489 FSS Expiration date:-AUG 31,2018 RODRIGUEZ, ERNESTO kc COOL FREEZE AIC CORP. ;;t 11354 NW 56 ST :- DORAL F4317.8 ISSUED: 05/19/2016 DISPLAY-AS REQUIRED BY LAW y- SEQ# L1605190000755 RICK SCOTT,GOVERNOR ...... ._..._..._.._ _..__..-.__._..__.... ..�.•--�,•�r° . �� »---.- '�. .» •..,, _ . KEN LAWSON.SECRETARY "�.✓,!"" ,�-'".�.- - �-=--STATE OF FLORIDA ' •.,DEPARTME(51T OF AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD _ .CAC7818272 ' ��._.� •_ ,�. ,�„ �_ "- �«# `-° r':rri --The"CLASS,B AIR CONDITIONING CONTRACTOR z T } Named below IS.CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG.31,2018 _. RODRIGUEZ, ERNESTO COOL FREEZE A/C CORP•Zr` ,. 11354 NW 56 ST ..... - DORAL FL 33178 ISSUED. 05/1=016 DISPLAYAS REQUIRED BY LAW - SEQ# L1605180000-M5 i R362= E� ..� '�4s r f 1 Ac V CERTIFICATE OF-LIABILITY INSURANCE 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. I I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. It 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 CONTACT I NAME: Ivanta a Select Agency ivantage Select Agency Aic PHONNo,Ex $44-288-7998 Arc No): PO Box 5316 E-MAIL Binghamton,NY 13902 ADDRESS: commemintservice@homealle.com INSURER(S)AFFORDING COVERAGE NAIC t INSURER A: Midvale Indemnity Company 27138 , INSURED INSURER 8: COOL FREEZE A/C CORP INSURER C: v 7052 NW 77 CT INSURER 0; MIAMI FL 33166 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:03700668780809 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. NSR' TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MWD MWDDNY GENERAL LIABILITY EACH OCCURRENCE $1,000,000DAMAGE TO RENTED , A X COMMERCIAL GENERALUABILITY N N GLP1009179 07111/2017 07111/2018 PREMSESEeococcurrenp1, $100,000 CLAMS-MADE I—XI OCCUR MED EXP(Any one Person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,0001000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $2,000,000 7X POLICY .JIL-COT 7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT aGodan ANY AUTO BODILY INJURY(Per Mew) ALL OWNED SCHEDULED BODILY INJURY AUTOS AUTOS Per awden HIRED AUTOS NON•OWNEO PROPERTY DAMAGE AUTOS Faracaden ` MBRELLA LIAR OUR EACH OCCURRENCE$ XCESSLWB LAMS-MAGE AGGREGATE DED RETENTION$ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER _ ANY PROPRIETORIPARTNERIEXECU -TIVE OFFICERAAEMBER EXCLUOEDi NIA E.L.EACH ACCIDENT (Mandatory in NH) E'L •EA EAiPL If yes.descnbo under r DESCRIPTION OF OPERATIONS below E DISMSE-POLICY LIMIT PROFESSIONAL LIABILITY OCCURRENCE AGGRE DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(Attach ACORD IOt,Addigonai Reraarb ScMdub,K n we epwo N t*gQno Heating,Venting and Air Conditioning Services f r ` CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BUILDING DEPARTMENT 10050 NE 2 AVE MIAMI BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN SHORES VILLAGE FL 33138 ACCORDANCE NTH THE POLICY PROVISIONS. AUTHOROW REPRESENTATIVE 1 I ®1988-2010 ACORD CORPORATION. All rights reserved. Scanned by CamScanner CERTIFICATE OF LIABILITY INSURANCE oe o 12017 r'") THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATt 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 CONTNAMACT Paychex insurance Agency Inc PAYCHEX INSURANCE AGENCY,INC. 150 SAWGRASS DRIVE PHONE r=Xn, 877-266-6850 FAX 585-389-7426 ROCHESTER,NY 14620 E-MAIL Sam Certs@paychex.com INSURER(S)AFFORDING COVERAGE NAIC 0 INSURED INSURER A: NorGUARD Insurance Company 31470 COOL FREEZE AC CORP INSURER B: 8430 NW 68 STREET#1 MIAMI,FL 33166 INSURER C: INSURER D: 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. NRR TYPE OF INSURANCE IN SR POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMID GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Fa occurrence) $ CLAIMS-MADE[=JOCCUR MED EXPAn ( Y one Person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY �PROJECT LOC ri AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED SCHEDULED BODILY INJURY $ AUTOS AUTOS (Per person) HIRED AUTOS AON-0WNED BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ UMBRELLA LI AS OCCUR EACH OCCURRENCE $ EXCESS UAB CWMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND X WC STATU- OTH- EMPLOYERS'UABILrrY COWC821565 08/06/2017 08/06/2018 $ 1 TO UMITS ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT 100,000.00 OFFICER/MEMBER EXCWDEDT YIN E.L.DISEASE-EA EMPLOYEE $ 100,000.00 (Mandatory In NH) I_T I N/A E.L.DISEASE-POLICY LIMIT $ 500,000.00 H yes,describe under DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) COOL FREEZE AC CORP license#CAC1818272 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 10050 NE 2ND AVE DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY MIAMI SHORES,FL 33138 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. 1 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Qonding 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 Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no workor 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 The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this !/6 day of Of 0 Y .20 ,by •�; day of ©G�-445; - 20 by Vi !� 01 wAho' personally known to &&e2&40 ILWX ivy Z;who is personally known to me or who has produced 7rU as me or who has produced 0 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign Print: Print: Seal: �•� �•= MMI Y COMMISSION•FF9/4999 Seal: '•' ''� MY COMMIS:ION•FF91�9" EXPIRES 3909 n w 01.20" .�'.... r. EXPIRES S4ptnn�r Ot.2010 Noi,sie-0 Nor►H!-0'S7 Hora.Mar. .Quin LN APPROVED BY Pl nxa i�er ' Zoning Structural Review Clerk (Revised02/24/2014)