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MC-16-2930
Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. MC-10-16-2930 Permit Type: Mechanical - Residential Work Classification: Addition/Alteration Permit Stetus: APPROVED Issue Date: 11/2/2016 Expiration: 05/01/2017 Parcel Number Applicant 440 GRAND CONCOURSE Miami Shores, FL 33138- 1132060170030 Block: Lot: EDUARDO & XIMENA CALLE Owner Information Address • Phone Cell EDUARDO & XIMENA CALLE 440 GRAND Concourse MIAMI SHORES FL 33138 (305)751-2707 440 GRAND Concourse MIAMI SHORES FL 33138 Contractor(s) Phone ULTRACOOL AIR CONDITIONING & I- (305)461-0720 CeII Phone Valuation: Total Sq Feet: $ 5,200.00 0 Tons: 3 Additional Info: REPLACE A/C 3 TONS , NEW LINES TO A Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 2 Date Approved: : In Review Type of Work: REPLACE A/C 3 TONS , NEW LINES Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $3.60 $2.73 $2.73 $1.20 $182.00 $6.00 $4.80 $203.06 Pay Date Invoice # 10/27/2016 11/02/2016 Pay Type MC-10-16-61809 Credit Card Credit Card Amt Paid Amt Due $ 50.00 $ 153.06 $ 153.06 $ 0.00 Available Inspections: Inspection Type: Final Rough Duct Review Mechanical Underground 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 info construction and zoning. Futhermore, I authorize the above - on is accurate c. tr for stated. Authorized Signature: Owner / Applicant / Contractor / Agent ork will be done in compliance with all applicable laws regulating November 02, 2016 Date Building Department Copy November 02, 2016 1 Miami Shores Village Building Department lGX M) N.E >?nd Avenue, Miami Shores, Rorida 33133 Tel: (30S1795 2704 fax (3O) 7S6-8972 INSPECTION LINE PHONE NUMBER:1305) 762.4949 BUILDING PERMIT APPLCATION E8uit.DiNG 3 fi, C1RIC FING ®RE ORM'. RING Occupancy Type: _. OWNER: Na rn (fee S City` tut\,‘,.. EC1f7N if Master Per RECEIVED OCT27 2016 BY• FBC2014 No„, P C �8b1 Sub Permit No .MC tO �,. 2130 1SiON R; )(TENSION CJRENEWAI, P(WIC WORKS f' tvt A GE Of 0 ple Titleholderl.s,,,., T Artk.rmtiLesse N mutt ,.,, EmaiL CONTRACTOR: Company Nome: Address: „ City a „' Qu'oli(ii N«tYYit`' State Ccr:iiiu tron or legistrati DESIGNER Architect/Ennlace.* Address: 4t. Value of Wo Type of Work: DEKV Specify color Submittal Fee S; Scanmeg Pee $ Technology Fern Structural Revie' • Addition CONTRAC f'O f �A\ 1ertifl TIO ! SIOP i)ftAWINGS Phonerr:K Phoncr$d Ph t Corr 1,,.. State: Squareftinear footage of Work: a Ant t;1'6011 t#E v+ Iti N sIItN�1t.�K color thru tile: Permit t (0 Roos Fee $ Tralnfng/Educ, Lion ccr $ DBPR TOTAL:f: tlmraba.�I;t i�ar� 3 coke s Notary $ Double Foe,. $ blond$ NOW DUE Banding Company's Name 1if tip lie itit � Bonding Company's Address City Mortgage tender' . Name tit apptir tbit-) Mortgay tender's Addrry, City State State: Zip Zip. Application is hereby made to obtain a permit to do the work and installations as indicated_ 1 certify that no work or installation hat eorruY►rnced prior to the is;uante of a Permit untS that all work will be performed to meet the sthndards of all law, rtFgufating construction in thi,; jurisdiction. . 1 understand that a separate_ permit must be secured for ELECTRIC, PLUMBING, SIGNS, P(XILS, FURNACtS, BOILERS; HEATERS, TANKS, AIR CONDITI,INERS, ETC — OWNER'S AFFIDAVIT: I certify that all the forepoiry, information is accurate and that III work will be dons in et n tiarice tai ill applkable 4tr..5 regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT 1N 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 App(i i i t:: its a condition to the icsuonce of a building permit w,`ttr on estimured value exceeding .7Vitl, the opolunnt must promise in noon' faith that a copy of the notice of commencement and construction lien lowbrochure wilt be delivered to the persnn whose property is subject to.ottochrnent, Also, n retrif*d copy of the re;:orde'notice of'commencement must te posted ut the job site for the first inspect' r 'lair It occurs seam 7) do ' •fret* the tuitclinq permit ,s issued in the absence of st:ch posted rtaiitT, th, inspretrrur wig! rtt7 vr.rtand o rein pection - l; will her thurged. Sip aline The foregoing instrume day of OYattR 0: AGENT s jf9krJwled ;.;d beforeme this , 20 /b%... by who is per OE11.314v known to - car wttO tea produced irtrntiiicatinn and who did take an n;rth. NOTARY PUBLIC: Sign: Print: Seal: 4titAmy Osbome Foti.. = COMMISSItN1-#F7903740 * EXPIRES: August 3, 2019' t---Q- APPROVED BY iKu.iii i3 r241211341 The foregoing instrument knowle i d daY of \its personally known to is ram ur who has produced identification and who did takes 7n Ctath. NOTARY PUBLIC: Sign: Print' — ------ — — — ttIt 4 Seal_, ;?��` '�e�, LORI L MONTIEL 1' Notary Public • State of Florida My Comm. Expires Mar 21, 2018 % o , Commission # FF 099897 • a* 44441,wi,♦a=a ladar4i aaaf ti'aY+t'�►Nf �l �11k'W}a+Fa+1. J.,Yx+ t,, Structural Re iew Zoning Clerk Miami Shorp,s ViUag fiuilding Department 10050 N.E.2nd Avenue Miami Shores, florida 33138 TeL (305) 79'.;.2204 Fax:MS I 756,897? AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany AU. air conditioning replacement permit applications. E ch ortil change -out muSt be on its own data sheel_ Multiple unit on ,.aogle &heets are n acceptable, Job Addrect; (where the work is beisr,1 done); City: Nliarol Shores VilLtge County: Mimi Dade Zip Code - ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB AU. UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH AU. SURMITALS AHRI DATA SHEET REQUIRED Change disconnectinmeans: YESO NOD ARHI Sheet Attached: YES 0. NO 0 Contract Attached: YES 0 UNIT BE NG EPLACED DATA NFW ( NIT t 41 FACTUREll Atill ot PX(1„ LINtE MOO EL , ,— CON 0 A iNET FACIOEL # Air 0 CU PEG PEG SW FAT AHU CU — N M TONS 1) M ,CA PRO Ar4L1 CU 2) Fil,O,P An U ASIU CIE CU PRG PKG ANU CU MEG 3) VOETS -PICG UNIT / RKG T ELK/SEElt .—....-- rs NO . REPLACING DUCTS YES NO 'YES . ' LRLAC/ NO THERMTAT yrs, NO —.... NEW 4"CONCRETE SL.AB YES NO YES NO NoN ROOF STAND YES NO Yrs NO NEW PETkiiir4 PLENUM OX YES NO 1. Minimum Orwt Am pactty (Wire Size) 2. Maximum Overcurrent Protection (f use/Breaker 54e). 3. Voltage of Circuit i7OR,// 40/480y 4. Sire Disconnecting Mean: Contractor's Company Name; Phone: State Certificate Of tratton No Certificitte of Competency No Signature . Date: lOisorttrt txpo#MO7,1.1.112e1.4) AcoRa CERTIFICATE OF LIABILITY' INSURANCE �--- DATE(MMIDDIYYYY) 10/21/2016 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(ies) must have ADDITIONAL INSURED provisions or 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 SUNZ Insurance Solutions, LLC. ID: (Howard) c/o Howard Leasing Inc. 6302 Manatee Ave. r/V Bradenton, FL 34209 CONTACT Sondra Kelly PHONE FAX (A/c No Extl 941-761-7704 (A/C,No): 941-761-7706 E-MAIL ADDRESS: skelley@howardleasinginc.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: SUNZ Insurance Company 34762 INSURED Howard Leasing, Inc. Howard Leasing II, LLC. Howard Leasing III, Inc.; Howard Leasing IV, Inc. Howard Leasing V, Inc. 6302 Manatee Avenue West, Suite K Bradenton FL 34209 INSURER B : INSURERC: INSURERD: INSURER E: INSURER F : COVERAGES CERTIFICATE 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYYI POLICY EXP IMMIDD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENII AGGREGATE LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY(Per accident)$ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A AND WORKERS EMRS COMPENSATION ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N y N/A WCPE00000040 07 WCPE00000040 06 5/14/2016 5/14/2015 5/14/2017 5/14/2016 I STATUTE ✓ OERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1 ,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Coverage provided for all leased employees but not subcontractors of: Ultracool Air Conditioning & Heating, Inc. Location Effective: 4/12/2011 CERTIFICATE HOLDER CANCELLATION 1224 Miami Shores Village Building Department 10050 NE 2 Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Glen J Distefano ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 32474148 I Master Certificate WCPE00000040 07 I receptionist 110/21/2016 9,39,48 AM (EDT) I Page 1 of 1 \II,t\ JUL) I I, UUVCItINUM KEN LAWSON, SECRETARY STATE OF FLORIDA' DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION. CONSTRUCTION INDUSTRY- LICENSING BOARD The-CLASSBAIR;CONDITIONI� I Named below IS CERTIFIED w.- Under the:j5rovisions of Chapter:489 FS ,Expiration,date-•AUG31,-2018 -s LICENSE NUMBER r CAC1813382 SINGH NEIL DHARMENDRA ULTRACOOLAIR COND13 & HEATING INC 1D1.44 NW 47TH STEET""' - SUNRISE ..0 ISSUED: 06/01/2016 DISPLAY AS UIRE'D 13 LA SEQ # L1601010001500 " SINGH NEIL DHARMENDRA ULTRACOOLAIR COND13 & HEATING INC 1D1.44 NW 47TH STEET""' - SUNRISE ..0 ISSUED: 06/01/2016 DISPLAY AS UIRE'D 13 LA SEQ # L1601010001500 " 714M1,4 7) BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30, 2017 DBA:ULTRACOOL AIR CONDITIONING & Business Name: HEATING INC Owner Name: NEIL DHARMENDRA SINGH Business Location: 10144 NW 47 ST SUNRI SE Business Phone: 954-658-7678 Rooms Seats Employees 1 Receipt #:?,-,U -1742 riZATI Di L.,/ a I RCOND IT ION CONT Business Type: (AIR CONDITIONING/HEATING Business Opened:o9/20/2003 State/County/Cert/Reg :CAC18 13 3 8 2 Exemption Code: Machines Professionals For Vending Business Only Number of Machines: VendingT e• Tax Amount Transfer Fee NSF Fee ' Penalty , Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0 00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: ULTRACOOL AIR CONDITIONING & HEAT'. 10144 NW 47 ST SUNRISE, FL 33351 Receipt #1CP-15- 00011412 Paid 07/12/2016 27.00 2016 - 2017 46) A RE CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/21 /2016 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(ies) 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 BB Insurance Marketing Inc 10167 W Sunrise Blvd 3rd Floor Plantation FL 33322 CONT NAMEACT Bonnie Krigsman Ext 313 PHONE 88$7280817 FAX No): 954-452-0450 (A/C_No. Fe).). - E-MARILSS:bkrigsman@bbimi.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Ohio Security Insurance Co 3491 INSURED ULTRA-2 Ultracool Air Conditioning & Heating Inc. 10144 NW 47th Street Sunrise FL 33351 INSURER B: INSURER C: INSURER D : INSURER E : INSURER F : OVER • ISI VIJIV,v IVUIVIDCR. 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY BKS56651874 6/20/2016 6/20/2017 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $300,000 MED EXP (Any one person) $15,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE X LIMIT APPLIES PECOT- PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OPAGG $2,000,000 A AUTOMOBILE X _ X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS BAS56651874 4/26/2016 4/26/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB EXCESS LIAB - _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / NSTATUTE N / A PER OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) HVAC contractor. ATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2 Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD