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MC-17-644 Permit NO. MC-3-'17-644 N5"°mss°,� Miami Shores Village Permit Type: Mechanical-Residential r10050 N.E.2nd Avenue NE Pertillot Work Classification: New A/C System Miami Shores,FL 33138-0000 Permit Status:APPROVED `tea` Phone: (305)795-2204 FCORtD4' Issue Date:3131/2017 Expiration: 09/27/2017 Project Address Parcel Number Applicant 1255 NE 99 Street 1132050090100 Miami Shores, FL 33138-2642 Block: Lot: JOSH WOLLOWICK Owner Information Address Phone Cell JOSH WOLLOWICK 1255 NE 99 Street (305)531-0970 FL 33142- 1255 NE 99 Street FL 33142- Contractor(s) Phone Cell Phone Valuation: $, 16,516.00 ARCON AC (305)512-4111 Total Sq Feet: p Tons:5 Available Inspections: Additional Info:NEW 5 TON SYSTEM NEW DUCT WORK LInspectionType:Classification:Residential Approved:In Review Comments: Date Approved::In Review anical �L�]Date Denied: Type of Work: Scanning: 1 i Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $10.20 Invoice# MC-3-17-63256 DBPR Fee $8.67 03/09/2017 Credit Card $50.00 $ 575.60 DCA Fee $8.67 Education Surcharge $3.40 03/31/2017 Credit Card $575.60 $0.00 Permit Fee $578.06 Scanning Fee $3.00 Technology Fee $13.60 Total: $625.60 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 authorize the above-named contractor to do the work stated. March 31, 2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 31, 2017 1 A el Miami Shores Village RECEIVED BuildingDepartment� p MAR 0 9 Uf7 O 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 yS FBC 20k l ' BUILDING Master Permit No. ((D PERMIT APPLICATION Sub Permit No. �� BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC+.WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP n rrr s CONTRACTOR DRAWINGS JOB ADDRESS: / J� AIC—C (7 7 City: Miami Shores County: ; Miami Dade Zip: i Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy.Type: Load: ' Construction Type: Flood Zone: , BFE: FFE: OWNER: Name(Fee Simple Titleholder): iaS (,c>6vwt c1c Phone#: �3a3�� 20 j'1Z' g _ �s Address: l L SS t'j R-- 9 9 S ) City: /7 /h' e'1I State �L Zip. 33 /3 Tenant/Lessee Name: // / Phone#i I Email: ��S `1 sz>,s c ic, wtc, CONTRACTOR:Company Name:_ 412 L0 A ��l Phone#: Address: -79�avv- ' 2� TI-4. A'VE, �- �c-; City: L-IF P— •``_ 11 State: ) �— Zip: 3® I Qualifier Name: A a Y Yt4 y �C1A1 a Phone#: State Certification or Registration#: M Z� 3 �—Certificate of Competency#: DESIGNER:Architect/Engineer: IV Z—A -Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ( (o. Sa (a r Q Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New E] Repair/Replace ❑ Demolition Det scription of'Work••—, J� r i.0. Specify co/or'of colorthruaile:,-.;..' Submittal Fee$ ,156Permit.Fee$ yj CCF$ Z'� CO/CC$ a Scanning Fee$ Radon Fee$ • CDS DBPR$ `-. Notary$ Technology Fee$ 1 • (00 Training/Education Fee$ 5 ' Q'0 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ S�- 5• (Revised02/24/2014) t Bonding'Company's Name(if applicable) R0'', Bonding Company's Address 4 ' City: State Zip Mortgage Lender's Name(if applicable) Mortgage Lenders Address City State Zip Application is hereby made to obtain a permit to do the work and installations as iridicated. 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 on 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 4yCONTR4r(CT0tF6 The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 1744-(- ;20 /7 by day of Y C� 20 - ,by; ySL, W dlldw��-� who is personal) known to y �k• #0 who is personally kno to me or who has produced as me or Jo has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: "4— Sign: 69�1low Print: A-rrA, k0e%Gt Cae)fL Print: A e of Floiida Seal: My Comm.E pins Oct •• ., i Seal: -'• ' : ' �+ { o••' Commission#�FF 146194 ;.•,,�.'F�.S.,, i-t�� a .;>ttit v "'.'eoFr°�`� PlatiOnaiNOtaryAsSn. ' , 4c .4; 2018 ,. . M ° APPROVED BY Plans Examiner Zoning r Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND'PROFESSiONAL REGULATION , !f CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 i JAGAT, HARRY HARDEO ARCON AC 12150 NW 77TH MANOR PARKLAND FL 33076 Congratulations! Witte this license yyou'become one of ttie nearly one milOon,Floridians licensed by the Department of Business and Profess Regulation. Our profeasionals and businesses range *STATE OF'FLAR)DA_from architects to yacht brokers,from boxers to barbeque T, �#,.r!DEPARTMENT OFBUSINESS AND restaurants,and they keep Florida's economy strong- ' .-PI�QFESSIONL=iiEGULAT)ONt Every day we work to improve the way we do business in order CMC1249332+. ' �s�SSLIE" ?'''06/a412016 to serene you better. For information about our services,please log onto�rrwwj"floridailconse.com. There you can find more x -CERTIFIED,MECRNt�?tL 4aS3 RACTOft; I ` information about our divisions and the regulations that impact .- HARRY.: e9 P . JAGAT; HARDE4 , you,subscribe is department newsletters and learn more about r+ t=. the Department's initiatives: �RCON AC� �w - i— � ti 4,' ' i Our mission the Department is:License Efficiently. Regulate �' • ", ,. — _ n Fairly.We constantly strive to serve you better so that you earl �"'r .�-" ,, serve your customers. Thankyou for doing business in Florida. � iS,CERTIFIED under.i e-provisians.ot chrAes F5. A-45" " 4; and congratulations on your new license* ew� DETACH HERE RICK SCOTT, GOVERNOR KEN L4WS0_ .a-,--.� �--�- „�-- = —•�- _ � � _ __, �N,SECRETARY Iv STATE OF.,FL'ORIDA``''' DEPARTMENT OF BUSINESS ANQ_PROFESSIONAL REGULATION r .CONSTRUCTION++I`INDUSTRY,LICENSING BOARD' . 0 A2 3 til♦ The MECHANICAL CONTRACTOR �; : 4 •-:~"*`' y Raw `,' ,``. , ., ' 1 'Named'be9 ,IS CERTIFIED ,� -Und r the-pro"vistons of Chapter,489 FS. '�i:' 4 - ' ' �^� > ""' ,,Ea,piiratioii N. dace,AUG 31p201$ `r` ,LY.f�r �..+.. M✓r.rlw"' .+�4 w. � a....�� .�� ��.�1�..,. r1 � •1 E`� *L�,4 N.,'.`.4 !r.,—._„ _ ," w '-ate �„`M'",,�`` yah -• • s ,•rJAGATr HARRY HARDEO•- _ -•a* ' `' }p ? s`F a -x'121 0 NW77T ,�TM �, .� �» .�. � , `. - :PARKLAND "F.,-L 33076,r� '; , ~,- � y,,- .�. � �,' �+ r ` J°� " �e"`,,�- �r.«�-� -�,k_-"--�,,.�,,,�,�' #• `i�'t.*a�'`�'`,.r. ��+ _�'y'�;• ���1. 1. , ,ISSUED. 09/0412016 DISPLAY AS REQUIRED BY LAW SEO# *-1608040001528 r r - r r local Busioess Tax Receipt (yJ ami-Dade County,,Slate of Fiorida'� -76!131,NOT A ffld--d7O'NQT PAY 13882348 LBT , ll llk)$fH EAZ n/AaYlWWCATUM ACCEIPT NO., EXPIRES , ARCON!AC INC , RENEWAi. SEP�"E1111��� �4. 2�a7 788[114 20 AYE.35 4052841 N i;%. ±'t'siiypulliy(-<t a-1 plzf*Ot lieca+nrss r H14EAH FL f'w5uanc m coyrny Coon Chalktrq VOA-An,19 i&,V r 4 _ r e I tYbVtSr 1S sec.TYP H Op duliNess. ARCON AL INC 1WSPEC MECHAWCAL CONTRACTOR v 13Yt x C 4KGTOR CMCT2R M2 t 1+Vtsxi4 r�yj 3 s4mp 67/12/2015 I ECIIECK-15-159938 t This twil ankiesi Tia tfe6ipt 001Y 6rifirnte parmiist all the Local Business Tax,TYe Receipt is not a license, tiemtit of a C"ifroaffas of dte Iipfdei squaJNicicFarm.to do businasS.Holdet must cromply vMh say goverom"Kal r. or:rrongovernm*M?teOtitnry fxwa earl rsquirernentswhiab xppFY to The bushless. The`REWFT NO.above mast ea ell commewiaf vehiclas=Miam}-Dade Code Stns fa.-27C t � r st bee FOS»mre WIDn"btion,v sit w�v"w rrfitrm+g p,nvy/(.t+�yvflet for � i t C y t .. i • a Y l , Y 1 � r i _ E ° M t t l r t f I a A ' I { 1 A� DATE wwai IYYYY) CERTIFICATE OF LIABILITY INSURANCE 03/03/17 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: N the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. H 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 NAME: Maw Lopez Diaz FAX -4854 Enstirgroup PHONE . (305)559-0999 No (306)226 12804 S.W.Sth Street AE-MAIL nsumuP•aom Miami.FL 33184 INSURER(S)AFFORDING COVERAGE MAIC s Phone (305)559-0999 Fax (305)226-4864 INSURER A: GRANADA INSURANCE COMPANY INSURED INSURER 13: PROGRESSIVE EXPRESS INSURANCE CO.'! Ancon A.C..Inc. INSURER C: ASSOCIATED INDUSTRIES INSURANCE COMPANY + 7880rW 20th Avenue #35 INSURER D: INSURER E: Hialeah,FL 33016- 305 .. 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 t 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. 111115111 I TYPE OF INSURANCE ADD U POLICY NUMBER POLICY /ID YY MKM 1 POLICY YY L GENERAL LIABILITY k EACH OCCURRENCE r S 1.000.E-00 DAMAGE TO RENTED s 100,000.00 © COMMERCIAL GENERAL LIABILITYPRFJdI E ❑ ❑ clams-mwF 0 OCCUR 0185FL000219395 WnamPefO11 s 5'�.W A F-1NEDEXP 9/15/2016 09/15/2017 PERSONA.a AM INJURY $ 1.000,000.00 GENERAL AGGREGATE s 2,000.000.00 GEN L AGGREGATE LWT APPLIES PER PRODUCTS-COMPIOP AGG $ 2.0W.0W.00 r ' ,[:] POLICY ❑ PRO-JECI ❑ LOC s I AUTOMOBILE LIABILITY ECOMB, SINGLE LIMB ❑ ANY AUTO BODILY INJURY(Per person) s 10.000.00 B .© AUTOS ALL00SvMw El'SCHEDULED 01/08/2017 01/082018 AUTos 01985674 80DILYur,URY(Persedam S 20.000.00 — ❑ HIRED Auros ❑ AUTN ON-OWNED P RTM°A s 10.000.00 ❑ ❑ s UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE _ $ '❑ EXCESS LAB , ❑CLAN SWDE AGGREGATE S El WORKERS�tPENSATION$ ❑we STATu- ❑ETH- s t AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORPARTNERjEXECUTNE AWC1059424-0 EL EACH ACCIDENT a 1,000,000.00 C OFFICERIMEMBEREXCLUDED? NH) ❑N/A 01/142017 01/142018 (Yanssdatory in N E L DISEASE-EA EMPLOYE s 1.000.000.00 DESCRIPTION OF OPERATIONS below UrKW E.L.DISEASE-POLICY 1e+11T S 1.000.000.00 z ` I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is required) Air Conditioning Sales and Installation. t f CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village s, THE EXPIRATION DATE THEREOF,NOTICE YALL BE DELIVERED IN ' ACCORDANCEPOU Y PRO NS. 10050 NE 2nd Ave Miami Shores,FL 33138 , AUTHORIZED NTATIVE k 19 2 AC D CO RPO TION. All rights reserved. ACORD 26(2010105)'QF a AC RD name and logo registered marks of ACORD , } o k _ g i -7�`�� r� 3 y ' e L d t e ' d M f ti