MC-18-1804Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Parcel Number
Permit NO. MC-7-18-1804
Permit Type: Mechanical - Commercial
Work Classification: Addition/Alteration
Permit Status: APPROVED
2018 Expiration:01/01/2019
Applicant
9501 NE 2 Avenue
Miami Shores, FL 33138-
1132060133920
Block: Lot:
DVS LLC
Owner Information
Address
Phone
Cell
DVS LLC
201 NE 95 Street
MIAMI FL 33138-
(305)756-3711
201 NE 95 Street
MIAMI FL 33138-
Contractor(s)
DELTA-T HVAC SERVICES LLC
Phone
(954)938-3767
Cell Phone
Valuation:
Total Sq Feet:
$ 250.00
0
Tons:
Additional Info: RELOCATE EXISTING REGISTERS AS SHOW
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 1
Date Approved: : In Review
Type of Work:
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.25
$2.00
$0.20
$150.00
$3.00
$0.80
$158.85
Pay Date Pay Type
Invoice # MC-7-18-68112
07/02/2018 Check #: 1348
07/05/2018 Credit Card
Amt Paid Amt Due
$ 50.00 $ 108.85
$ 108.85 $ 0.00
Available Inspections:
Inspection Type:
Ventilation
Final
Rough
Rough Duct
Duct Detector Test
Review Mechanical
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 a ent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFI and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and tat all work iIl be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do he work ted.
Authorized Signature: Owner / Applicant / Contractor
Building Department Copy
gent
July 05, 2018
Date
July 05, 2018
1
Miami Shores Village
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
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC ❑ ROOFING
❑ PLUMBING
JOB ADDRESS:
City:
[Folio/Parcel#:
FBC 20p a GC
Master Permit No.
Sub Permit No. m C. I — 1 a. OM
❑ REVISION ❑ EXTENSION ❑ RENEWAL
%MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION El SHOP
CONTRACTOR DRAWINGS
�SQ3 Arc
Miami Shores P
t 3 1p(.. OIL 3et2_sb
County:
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee
(Fee Simple Titleholder):
Address: )-v\ Nz' 4 S
City: 1I (f v \ c 1C I
State:
Tenant/Lessee Name: 0/KAC.0 9m►�L
Email: Imo` ^i(E4& e PAc a, 'or
Miami Dade Zip:
Is the Building Historically Designated: Yes NO
Flood Zone: BFE:
FFE:
Phone#: 3a S-7 5j _ 2-22‘)
CONTRACTOR: Company Name: e..1►`rt. T [lIkC
Address: 3 fl )4.) k) 1+1 COO iV
RA 4.714,. State: t tit 6(42,,
City:
Qualifier Name:
Lt.C-
era i N AO A MILo
Zip: 33138
Phone#: .S7(1
Phone#: QS`f' ' g 3 ?h 7
zip: 33301
Phone#: 9S4 t'Qo J' 86 z,
State Certification or Registration #: CAC 181 S ? 'i 7 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:'
Value -of Work for this' Permit: $ (?-6-0 ` rD Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description -of Work: C cS1& / 5 S <5LIA,JJ
fi.��s TFJ2.S
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ ` Ov C) CCF $ CO/CC $
Scanning Fee $ Radon Fee $ 2 DBPR $ 2-" Z S Notary $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ /CO 9-g
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Zip
Application is hereby ma• - to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to t e 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
OWNER or AGENT
The foregoing instrument was acknowledged . efore me this
day of , 20 / . by
nL�Y/7Q.aym , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
r
Sign: (t—/ a,
Print: /f'74411-'h /Orii'a a
0.kikiN:. EL1LAMUTH ELORRIACjA
: ••: MY COMMISSION $ FF053530
XPIRES Ja
?a E
. +
• • nusry 25.2020 I
Ai 2 Plans Examiner 1V.S r
Seal:
************
APPROVED BY
CONTRACTOR
The foregoing instrument was acknowledged before me this
02— day of I , 20 )' . by
M,Qf3,
me or who has produced
identification and who did take a Loath.
NOTARY PUBLIC:
is personally know
Sign:
Print:
♦
Seal:,
/214-60
MARIA JOSE RAGO
Notary Public - State of Florida
•• •%v • Commission # GG 083739
`• My Comm. Expires Mar 15, 2021
' Bonded through National Notary Assn.
r r-fir 10._ ♦ _ _` . MI ******************
0
as
Zoning
(Revised02/24/2014)
Structural Review Clerk
ACORd
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 PRCDUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT; if the zal hosts hatdsr Is so ADDr11ONAL INSURED, the patky(Isa) nun be endorsed. If SUBROGATION 13 WANED, subject to
the terms and conditions of the 'obey, certain policies may reculre an endoraement A statement on ITIN cant csto does ilo, confer rights to the
castiscsrts holder In Sou of sucl► andorsem.ntts►.
PRcouaeR
Florida post Insurance
3543 N. Andrews Ave.
()Wand Park, FL 33309
Phone (954) 66643323 Fax (954) 566.4784
•, ACT
,, (954)b68-8323 I M. t+ (554rse4-4744
f,�:=} . eorldafltstt 1( yst►oo
rvauRa'Ia1__FroRresci =mum
uric e
WSURp A. FEDERATED
SWAM a
De::ta-T Ileac Services Lit TOMAS NAVARRO CAC 1815745
317nw47d
Oakland Park. FL 33309 (954) 364 3GS5
U1;<ilRER g . PROGRESSIVE
C,
MOROID:
°iNSM.11 °
W3uRtRPc
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER;
THIS IS TO CERTIFY THAT THE POUGES OF 94SURANGE LISTED BELOW HAVE BEEN ISSUED TO THE of SURE° NAMED ABOVE FOR 114E t'OLICY #+=.R 0
INDICATEDD, NOT MINSTANDE'VG ANY REQUIREMENT, TEMP OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT To WHICH TMaS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM*
EXCLUSIONS AND CONDR10NS OF SUCH POLICIES, LY,RTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAM,
L
TYPE OP tr$IJRANtt
pdt11,►01PC1
NUNS [it
MUM -tgallgt
UNITS
A0
cEWRAa LLAaMM
R cossetsCSAt. Gerturu, taA8 UTT'.
C 0 0.Aors•Avos 0 IOCCUR
Y
NGL0806012727-0
01UO8
E ! 1.( }ti
�I�� 3 0 Ei4' Q4_
01/O:1O19
aEAPWry, creportgo s 5.030 00
nRStMut a ADY;HAFR .s 1.0:O.00,0O
WOOL AGGREGATE
s 2,070,07100
G.EEVL AGGRPOATTE t iT.*pP ES PElt
0 POLICr L. �_ D ILOC
PRODUCTS - CONSNOP ACC,
a 2,0 '0,00O.00
a
B
AUTOMOIMLA NABILITY
R *wr AVM
0 A I6AtakE°078509714
o AM eclibs 0 AI i3t
El Q
I
04502018
04f3A1 019
t arauttarrr s
OOOILY *CAW (Per F to ) $ 1 O.DOO.00
*0OaYe4"4.1. tfet.446.1 a 20,00C 00
li ,(S ff a 10,000.00
Ss
0 oieBRI .IA UAf, Q oceuR
L 1 EJreESS tags El walsione-
�OZ EQATE a
I *1cERBCOMPENSATION
APIO SIP IAY'CRY I.L$aa ITY Y I N
N7 A
0 TA fl 9
L EAGI AGGtr%€NT
P�t lk..LWE'97
AmatoritAndawary it WI
OPERATIONS
tE I. D $E*6£ • FA BI�F't ttYEE I
EL OISE4Sr = PC ►G'F I �aai a
D*_$CJl3PTON OF OPESItAT10N3 / LOCATIONS I VEICC121
(Aster AWNS? ICI, AildfOorai ft y, is $m,.a/sk it pont sp►co Is Apdntq
CAC 1815745
CERTIFICATE HOLDER
CANC
Miami Stores village
13ultalm department
10060 NE 2 AV
MIsm Stores. FL 33138
ACORD 28 (2010105) OF
SHOULD ANY OF THE
?NE EXPEtATION DATE
ACCORDANCE WITH:
ALITNORSOID REPIPCSENTATPft
IOEO CIES _ CANCELLED BEFORE
NOTICE BE 13 �L�il N
OVl NS.
r
iORPORATMON, All rights reserved
ago are registered marks ofACORL