The URL can be used to link to this page

MC-17-1902Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 1050 NE 107 Street Miami Shores, FL 33161-7374 Owner Information GABRIEL MARTIN KUSKUNOV Address Pe mit Permit NO. MC-7-17-1902 Permit Type: Mechanical - Residential Worts Classification: Addition/Alteration Permit Status: APPROVED Issue, Date:12/5/2017 Expiration: 06/03/2018 Parcel Number 1122320280520 Block: Lot: 1050 NE 107 Street MIAMI SHORES FL 33161-7374 1050 NE 107 Street MIAMI SHORES FL 33161-7374 Contractor(s) AVEN AIR CONDITIONING Phone CeII Phone (305)332-0139 (305)332-0139 Phone Applicant GABRIEL MARTIN KUSKUNOV Valuation: Total Sq Feet: Tons: Additional Info: Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: NEW DUCT WORK NEW L.D SUPPLI Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $8.40 $7.14 $4.76 $2.80 $476.00 $3.00 $11.20 $513.30 Pay Date Pay Type Invoice # MC-7-17-64682 12/05/2017 Check #: 105 07/26/2017 Check #: 102 Amt Paid Amt Due $ 463.30 $ 50.00 $ 50.00 $ 0.00 Cell $ 13,600.00 0 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 / ertify that all th- -.oing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoni .. ��,...•�, orize the above -named contractor to do the work stated. Authorized S, *4��ewner. / Applicant / Contractor / Agent December 05, 2017 Date Building Department Copy December 05, 2017 1 Miami-ShoresVrFFage. Building Department 10050 N.E.2nd Av..enue; Miami SHares, Flarida3313& Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT, APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING PLUMBING [Q MECHANICAL J ❑PUBLIC WORKS JOBADORESS 1050 NE 107 ST City: Miami Shores Master Perm Sub Perm RECEIVED J L 26217 BY: G -141 FBC 20 I L G it No. ]Z r - ( O it No. ---- ("1G a - I ci 02 ❑ REVISION ❑■ EXTENSION ['RENEWAL CHANGE OF ❑ CANCELLATION ❑, SHOP DRAWINGS, CONTRACTOR Folio/Parcel#:11-2232-028-0520 Occupancy Type: RES Load: County: OWNER: Name ,(Fee Simple Titleholder): Address:1050 NE 107 ST , .lty. ,Miami"Shores MiamiRActe Zip: Is the Building Historically Designated: Yes Construction Type: Flood Zone: GABRIELMARTIN KUSKUNOV Tenant/Lessee Name: N/A Email: 9abriel@naturalistone.com Sty: ,EL BFE: NO X FFE: Phone#:186-488-,8315 • zip:33161-7374 CONTRACTOR: Company Name: AVEN AIR CONDITIONING, & HEATING Address: 8625 SW 10& ST City: MIAMI Qualifier Name: ALBERTO ACOSTA State: EL Phone#: N/A Phone#: 305,332'-0139 Zip: 331:56 Phone#: 305-332-0139 State Certification or Registration #: CAC042622 Certificate of Competency #: ZESIGNER: Architect/Engineer: "J`UAN FERNANDE—BARQUIN P E Phone#: 786-336-0881 Address:2520 NW 97TH-AVENUE ,City._ DORAL State: FL Zip: 33172 Value:,of1Nork for.thisPermit: $ 13,600 re/14oear. Footage of Work: 1500 SF Type of Work: ❑ Addition ❑ Alteration Description of Work: NEW DUCT WORK, 12 SUPPLIES , NEW RETURNS, 02 AIR HANDLERS, 02 CONDENSATOR NEW REFRIGERATION LINES, 03 EXHOUST FANS FOR BATHROOMS;, HOOD EXHOUST AT KITCHEN Specify color of color. thri&tilea 4/cFs Scanning Fee $ Radon Fee $ _+ r DBPR.$ -q • ) LI TecIinningy,Fee$ Training/Education Fe 'Structural iReviews'$ Submittal Fee $ SC)' ° Permit Fee $ ❑ New ❑ Repair/Replace ❑ Demolition CO/CC $ Notary $ $ Double Fees ,Bond $ T(3TAL,FEE•1lt WsD4JE $ _ 46- (Revised02/24/2014) Bonding Company's, Name (if applicable) Bonding Company's Address I City' r ti State a Zip. Mortgage Lender's Name (if applicable) Mortgage Lender's Address a City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has corny tced^pnor to'the-issaance•of .a. errnit avd tthat'alt work wit# be performed ;to'rmeet the standards of ati laws regulating, construction 'in 'this lur,'rsdiction. °'I'uriderstand that _a separate perni t- artist be seeured'f©r'ELECTRI'C, PLUMBING, SIGNS, POOLS, FURNACES,; BAILERS, -HEATERS, TANKS, AIR CONDITIONERS, ETC..._. OWNER',S AFFIDAVIT: 1 certify'_ that all the foregoing information is accurate and that dII 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 1pAYING Tflfl1C I=OR. IMOROVEMENTS TO VOLR- PROPEI(TY:_'IF YOU` I NTEN TO OBTAIN FINANCING :CONSULT'WITH=YOUR.,LENDER OR::AN- ATTORNEY'BEFORE'RECORDING YOUR NOTICE OF:COMMENCEIVIENT '` 'Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that,a copy of the notice of commencement and construction lien law brochure will be delivered to .the person whose property is subject to attachment: Also, a certified copy'of the recorded notice of commencement must be posted at the job site for the first inspection *uvh occurs seven :(7) ;days rafter .the.-bbikhng permit is ;issued. In the;absence irf such; posted notice, the lnspection<wcill ,be;�ippr>oved and a;r�einspe Trion fee wdll,be charged. , , Signature O �R or AGENT The foregoing instru nt was acknowledged before me this O 4 day of ---% GA�21- Zl Xosguo✓ Y UL ,20/7 ,by iy$ersonallyf know me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: -J Lc as JULIAN A CARDONA Notary Public - State of Florida Commission # FF 191910 Y Comm'Expires Jan 21, 2019 E '''O''lg es'' Bonded thro'h National Notary Assn. *********** r. Signature CONTRACTOR a P The foregoing instrument was acknowledged before me tliis O 3 day of. J4,e—y , 20:- / `by. eako r me or who:has produced' identification and who did take an oath. personally kno to+,- ,. as NOTARY PUBLIC: - Sign: 1- V 4 Print: ; t—II a a�Q •:ryY,, „ JUL AN A C ONA Seal:'. c. Notary Public - State of Florida T. • « �� : •= Commission # FF 191910 '* ini *.- ;,-��, My Comm. Expires Jan 21, 2019 - • r i s ° `o , Bonded through National Notary Assn. * ************** 'tit* *Y * k* *ii* *le* 9k*1k'** *Oik* r**i***i******** APPROVED BY V i Pn Examiner 4+y ' Zni'ng7 r (Revised02/24/2014) Structural Review Clerk MK SCOT GOvERNOR pCENSE NUMBER! KEN EAN„ SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSWINAL REGIRATION. CONSTRICTION INDUSTRY LICENSING BOARD The CLASS AAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 ES_ Expiration time_ AUG 31, 2018 ACOSTA, ALBERTO AVEN AIR COMA # TONING ALBERTO ACOSTA INC 8625 SW 108 ST MIAMI FL 331% 06 282016 DISPLAY AS REQUIRE BY LAW L16013731100002 COIXA Local Business Tax Maroc --Dade County, State of Florid THEtSMTARELL—DO MT PAY 1783704 ,OO. AVR4 AIR CONDITIONING CFO AO3STA 8625SW 108 SF 37 MIAMI R 33156 GINNER AVEN A/C ALBERTO ACOStAL MC Worker(s) 1 EXPIRES SEFTEMBER30,201? allesf be=place oft Taascacal le County Cede 2A-Ast_9&Th SEC. TYPE OF EALISXIESS 19 SPEC ilirEaMNICAL:. 1 CfQR CA pAnt a3ir RECEIVED .SY TAX COLLEOTOR 575110 07/27/2015 CMEOW-16: 102792 This teuatE sTa tedycceetespopmeectetelsconlasiacesres. The Recap" tismite pe aatara ccsacaffee offfisisi+Aas iadbkrauss rsestuamglgaAlba[ gmesuaeolat at trastastrlategytasas teepmrte" woes %Aapgyabitebla The' rNO.xbeieserabe efflad" -3=4eks Ea DilirEEZIMIKIONYYri CEFrI1FICATE OF 1.IABILPTY INSURANCE 04/13 t7 WSt i/ROUEI 'ASAMA'1<EROF 1RRIRIUMORCfttkYAEIOCORFERSscotassnsU OIL THE CERTIROCIEta tsEs -nos CEREFICATE Does um AFRIMATIVELVt t REGATIVIELY mem EMIDORPLIVRTHE COMMIX AF Wr "MEPOUCIE8 BELOW_ THIS CTEOPINSURANCE'DOES teinCONSTITIREA6BEIWEMITHEISSUIRSDISURERP4,411THORRED REPRESENTATIVE ORPRODUCER. AND THE Ai ' E 'ORFANFT: Mara e balderis ALEIMESUIL EISURED,ThepafficAes)zzesitlee:roemed."i6 T ISyo, the tem= ando atilte poncy. certain pondes* maAstateggentaalles=s doesnotcordisteftgtother cuebalder Wien atsedeask gqicioucsa Vogel instsanos Agency 3185 WT5 %Suite3 AO male MOM VIMEIEL PANE FAx ISSURESIMAPFCRIMMOSCCRISINGE misuse) Awn as CceslEming Aborts Acosta Inc 8625 SW JOB ST FL334SB MISUSERS - COVER OES CBMITCAIEWRAIREIt IMSURERF: THIS ISIOCERTIFY 1HAF THE INDIChTED..!NORY CERTIFICATE EXCLUSEMAND POUCIESOFINSURANCE ITHS3Jth1 G AldIffT. LIMED BELOWEMIESEEMEISUED"IOT E NPRIEDABOVEFOR11EP PERIO® RMINCI OS MOM TENSOROXE TION ANYCONTRRCiOR A M THEPOUCES 14A!Y4ltW&BERWEI 1iFINIiHitMPE•CT '+ WY BE =LED OR MY DfficalleamiEREINISSUM=TWILL TM 001WerioNSCFSUCHFOUCIESAMITSSHOW S:3331 BY PAIDCLIMS.,.. LIR TYPOS* asurteacE awn:', Fran= sozwit f POLmy ` POLICVEIP[Efts A G9iB ALui5ad YEACKOCUMMEIICE 04119l2Bi7.>0411392018 S Untee lin II r 0 :0 cL.Alrs>aA E '0 OaaMl affiat PRBISESIEarammessa$ $ jai PIEDpltq®e s56001100 VEasititUAL a ACOSODOCI 0 s 2,000,000.00 •msisz iur GUM AGGRERMEIRIT APPLIES PM S jai Remus 7S-emassa ►sse AUTOMUSSE1 LflY D At1IfAIM MEa EU $ SCOLYISSERIftespeosal s t_f ALL OWNED HOMY ItiMURYIR ff ;S 0 Im:msaras D. la eta ❑ n t ISICE . $ $ El UMEOIELIAIMES ID S caulOCCIMISEISCE El EX ESSIMs Do Ammigginp $ o DED 0 I $ s mittemesememessime AND ESPIMElerifll> liY' ion BlA L: ciI* $ ANY PROPREMRPRRIMMEMECIMVE ELraiGFIA B6 ittmodatatyis ua 7 IlagzsackerscibefLYIOFOPERMIONS'Odcrr :E,L -FA `S $ ELSASE-PC Vtr L ME IPTION iF SOUS ID0WROUSIVE /CLS 3al.I l Scbcdade 6ineespooaisap Air Condihming Systems- betiela4m, Servicing ter Rep*. Mechanical Sub Contractor OACO42622 rarnmit TE ASHORE V!UAGE glEPhiZ'di4llEiai7 NE 2AVE SHORES.`FL3 SHOULD ANY CIF TEE MOVEDESCIUSED NIXES 113ECXXCEUED BEFORE THE EXPIR TIONINITEitECBRIBRIBIT SICCORDASCESSIBTREPCILICYFROVISKOM REMRSSENINSIE paw Vogel Ac0Rt25 CW The siV2ORTheameatidlogsEretbe, ed toadsofACORD ACCPRIIIPr CERTIFICATE OF LINNLITY INSURANCE OWE (168110,11,1,11), 11128/2016 THIS CERTIFICATEIS ISSUED AS A MATTER OF 'INFORMIX:IN CRUX AND CONFERS WO RAEOTTS WON THE CEiTT/FICAME HOLDER. THIS CERTIFICATE DOES NOT AFRRHATIVELY OR NEGAIWELY ARENA OTTE= OR ALTER IRE COVERAGE ARFOROED BY THE PCUCTES BELOW. 'THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUITin HISUREFIS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CETRUICATE HOLDER. IMPORTANT: If the• cedificale holder is an ALTURIONAL INSURED. the paNcycies) naust be endorstetL if SUBROGATION IS WAIVED. subject to the tenvis and conditions of the yoficy, certain pothdesulay requite an enchirsesnent A stemma ea this ceitificate &restart confer tights to the certificate bolder bile° of such endosseinentft. POODUC1ER WT. Roemer Insurance -Agency, Inc. .47 fb NW 124 Avenue Coral Spr FL 33065 MUM) AVENA-1 Aven Air Conditioning Aitesto Acosta, Inc. 8625 SW 108th Sleet kronnifL 33156 rarer Certificate Depadnient An954-7316 c-mka.ent. ram* 954-73143438 -556 jismamosna. cestfficacesoneiner-ins. 1111515413454 AFFOROZYG,COVEMGE MSC* Essugum :Reba Fustinsutanoe Cosavany 107O0 torIOVICTSPIWNDO, THIS IS INDICATED- CERTIFICATE EXCLUSIONS TO CERTIFY THAT THE POLICIES NOTWITHSTAIIDING ANY FIEIDUIRELIEPa. MAY BE ISSUED• OR WY OF INSURANCE PERTAIN, POLICIES_ 7ZIPTPSUgsk— 15SO THE LISTED HELM HAVE BEEN TERM OR COMMON OF ANY ISSUED TO CONTRACT THE POLICIES BY POUCYEPF 'w nesencivirrn THE INSURED OR 017tIER — — — _ MANED ABOVE FOR THE POLICY Ply DOCUMENT WITH RESPECT TO WHICH THIS AIL THE TERMS, INSURANCE AFFORDED BY UNITS SHOWN NAY HAVEBE334 REDUCED DESCRIBED HEREIN IS SUISEECT TO PAW GAMS. AND ODIGNIXINS OF SUCH 1115R LIR TIME OF/MORAY= It 111111) POLICTIVAMER POLICYFINP i nentlefrfril 1 ISMS ; 7 1 A1,_1149) I GEHL I 1 COSOIERCIAL GENERAL MOLLOY 1 , 0 1 4' ,L.PC1251555&zoommourast , : EA01 OCCURROICCE i 4 -1 1 - I aAINSUADE OCCUR DPAMIZW/ ROMEO II $ ; MP (Peng age Bases) i, ! ,_ V $ $ $ . FERSCMIL at AWOL/MY .t AGGREGATE LOW APPLIES Plat POUCY [ 1 PRC3' r— Lac 1 i MHO t GENERAL PaGROGAIE , 4 " PROW= - OCSIRLP 04$1$ r , S AIIIDSIDOSE -- _ L i LAMM ANY AUTO ALL OW °- NED AMOS HIREDAMOS SCHEMED 1 ,. 1' '' 1 0055155E0SOVEUE LAU , iftaccrlentl _ OCOILY MOWRY parposixip , OCOILYSIMRY(PeraisidesiOil s S- S $ s -- J.- AUTOS NON-00155ED gums setrilgiiffiGE 14 , Ipasalateall-- f i 1 i ILICORELUt LIWO IELCESS UM 1_ i, L 5 0, EPOI OCCUAREINOE I CLAMS5,41AVE, AGGSIECAIE I __ _ _ _ $ T— T l 13/72CMIT ' i FM 4:111#' WORKERS COISPENS.111001 MID 155505CM2R5-1.1ABIWY Y f 91 0 0520-54626 i' x r 11311 stODMOCO .141010111E ,i E.1._ ErCoAcCOOPF1 ANY PROPOC1011PNOMPAEOECW1YE Flom, OFF1C815,1ENSERI000.11DED? (Mamiddey r-- EJ.-EAWYE il El_ DASEASE-POUDYL5151 $1,1160,,COD 51,003$00 1 1 0 , (AMMO SOL Asfalkaatitassochs Seiredane,. wow be allaclaraMisse spoofs weigpie4 DESCPSTITON OF OPERATIONS / LOCOUIONS/ YENECILIES Mechanical Sub Contractor CAC042622 CERTIRCATE'HOLDER CANCELLATION Miami Shan Village Buirfing Department 10050 NE 2nd Ave_ Monti Snares FL 33138 WOULD PAY OF THE ABOVE DESCRDIED POLICIES ISE CM:ELLE° BEFORE THE ERMAN= DIRE THEITEDF. MILL BE DELIVERED UV ACCORDANCE vinuThE POLicY PROVISIONS- dwiittm.4 iffete ACORD 2S WARM 18S12014 ACORD CORPORATION. MrilSniseived. The ACORD name and fogoate segisteted, !MACS of ACORD RICK SCOTT, GOVERNOR LICENSE NUMBER "' CAC042622 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The CLASS AAIR CONDITIONING CONTRACTOR -_.`°" r- Named below IS CERTIFIED • „ 1 -Under, the provisions of• Chapter 489 FS. 1°a.Ezpiration-date:"`AUG 31, 2018 ACOSTAALBERTO ,;HAVEN AIR CONDITIONING•ALBERTO ACOSTA INC �MIAMSW 108 S • -"`,�"r`a;, ISSUED: 06/28/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1606280000442 001360 _ Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL -D0 NOT PAY 1783704 BUSINESS NAME/LOCATION RECEIPT NO. AVEN AIR CONDITIONING ALBERTO ACOSTA 111 RENEWAL 8625 SW 108 ST 1783704 MIAMI FL 33156 — OWNER AVEN A/C ALBERTO ACOSTA INC Worker(s) 1 1BT� . EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPEC MECHANICAL CONTRACTOR CAC042622 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 07/27/2016 CHECK21-16-102792 9 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 holders qualifications, to do business. Holder must comply with any governmental z' or nongovernmental regulatory laws and requirements which apply to the business. !The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For more information, visit www.miamidade.gov/taxcollector .- 7/11/2016 /1 125% Report Viewer JE'FATWATE2 CHIEF RNANcIAL 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: 9/10/2016 EXPIRATION DATE: 9/10/2018 PERSON: ACOSTA FEIN: 571221683 BUSINESS NAME AND ADDRESS: AVEN AIR CONDFTIONING ALBERTO ACOSTA INC ALBERTO 8625 SW 108 ST MIAMI FL 33156 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 the chapter by fling 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 w ihn the scope of the business or trade fisted 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 fiThg of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of the 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 htlps://apps8.&ifs.comfcrreportvfewer/reportViewer.asp adata=lnivpgincc9D7Q3gH6TER6eP1KMZ%2FSz5bXKYtB>direkeESoPVyIv3NPOPN42XeirDRGXVNA-1... 1/2 A RD CERTIFICATE OF LIABILITY INSURANCE . 1 DAe00111011Pfren 04/27/16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY CERTIFICATE 1:i3ES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS POLICIES OR ALTER THE COVERAGE AFFORDS) BY THE 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 ate holder is an ADDI1IONAL INSURED,Itur poticy Les) must be endorsed- IT CATION IS WAIVE subject to A statement on this certificate does not ceder rights to Vie the banns and conditions tithe ply, certain policies may regtdre sn endorsement certificate holder in lieu of such ems). PRODUC8t Verge! Insurance Agency 3185 W 76 St Suite 3 Hialeah. FL 33018 Phone (305) 698-9976 Fax (305) 698-9973 CoiSEACT DANAY VERGE! IAIC Na F698-9976FAX wc. Nok (305) 698-9973 A room =IRMO AFFORINEG COVERAGE i NAM 5 mune A : ASCENDANT CO5 ERCIAL INSURANCE 1 BAUM Aven Air Coming Alberto Acosta Inc 8625 SW 108 ST Miami, FL 33156 (305) 332-0139 Items: INSURER C : _ INSURER D: ENSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF RNSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITKNI OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND tXNTIONSOF SUCH POLKAS. LBWS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DER LTR TYPE OFNISURANCE - GENBIAL. LJABlITY ❑ COMMERCIAL GENERALLAMM ❑ ❑ cA AIMS -MADE Ea OCCUR A GEM AGGREGATE LIMIT APPLIES PER ❑ POLICY ❑ ,M ❑ LOC AUTOMOBILE LtASLrTY ❑ ANY AUTO ALL esED ❑ AUTOS ❑ HIRED AUTOS ❑ Uir8AH1A uAB ❑ EXCESS L AB atei oz POI,JCY NUMBER GL-41962-3 POLICY EFF 04/192016 POUCY LIMITS EACH OCCURRENCE s 1,000,000.00 $ 100,000.00 PREMISES (Ea occurrence) MED E)P (Pot ow Winn) 04/19/2017 PERSONAL a NW AWRY ❑ • AUTOS0 ❑ OCCUR ❑ CI A MS1JADE DED ❑ RETBmoN s 5.000_00 5 1,000,000.00 GENEPA . AGGREGATE s 2,000,000.00 PRODUCTS - CONPIOP AGG 5 1,000,000.00 S CONED EUNIT 5 BOOLY INJURY (Pm pawn) S - �dd� S p9pDt�Y?iUURY¢'+a EACH OCCURRENCE AGGREGATE PIONEERS COMPENSATION AND BiPLOYBtS LUAEOJTY Y J N ANY PROPRIETORPAARTNER/EXECUTIvE O Illandatery MI NDESCyes,RrPTtON under OF OPERATIONS bakes N1A ri ❑ TO WC Y IAMMIUTE TU-❑ FOR E.L. EACH ACCIDENT $ FL DiSEASE-EAEMPLOYEE S EL =EASE - POLICY LIMIT s DESCRIPTION OF OPEFMTTONS 1 WCATioNSt VIES wawa ACORD 131, Additional Remz 5s Schedule tr mere space Is required) AIR CONDITIONING SERVICES AND REPAIR Ten Thousand Plaza Assodation is fisted as an Addrt)onal Insured. Blackbird Construction is listed as an Additional Insured. Manors of Inveunry Condo 1 is fasted as an Addlanal Insurer!. Bristol Tower Is fasted as an Ad:alonal Insured. Charles Monaco is listed as an Additional Insured. CERTIFICATE HOLDER CANCELLATION MIAMI SHORE VILLAGE BUILDING DEPARTMEWF 10050NE2AVE MIAMI SHORES, FL 33138 1FAX 305-795-2204 ACORD 25 (2010105) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPEIATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WRH THE -POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE d 1988-2010 ACORD CORPORATION- AO rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village (RECEIVED Building Department I Nov 18 zoos 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20/1/ BUILDING Master Permit No..& /j )262 PERMIT APPLICATIONAtiti Sub Permit No. //( ❑BUILDING ❑ ELECTRIC ❑ R5@'1N4 ,0 ❑ REVISION ❑ EXTENSION ❑RENEWAL El PLUMBING ®" MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 9Y: JOB ADDRESS: ,/Os2 /UE J03 City: Miami Shores County: (4Iy. ',.de Zip: 33/6, /` Folio/Parcel#: J>^ 2 / 32,• 025 `0S 20 Is the Building i totiZdlly Designated: Yes NO )a 414, Occupancy Type: ( Load: Construction Type: Flood dd•• (JSZone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address:.. JbS /U6 /(0 } Sr City: 'Yi) l'A r') Tenant/Lessee Name: 4b4(e ieL/Stc u)-7D tJ State: 2-- A t. Email: Phone#: ().-/S-6) L1R '331S Zip: 3 3 / (7 I• Phone#: CONTRACTOR: Company Name: live ti'1 MI n • c'0'7") 497 T/Or,i j / r C.Phone#: Address: 662S-OW.100sr City: y>7/44ir? 7 State: Zip: 3.3 /S6 Qualifier Name: Atl'7 • A GBorhckLL"'Phone#: 3QT - 33Z" 013 State Certification or Registration #: 0 Z Z r ifi • g ..��'' C. o%/ � Z Ce t caof Competency #: DESIGNER: Architect/Engineer: ,,,f l/�4Y1 ✓f/41 ' /2. ' 4. /U. 412 96 4c1 Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 121Goo t...619, Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace/f❑ Demolition Description of Work: A/ u / :DUG ( ®'%'K— f pie<A, ' • D. ` ,te, i> 1 oe(,(/' ;z itowAje,n, Specify color of color thru tile: l% Submittal Fee $ Permit Fee $ 4�1p 1 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ rj 1 '(C)9 (Revised02/24/2014) Bonding 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 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. //ff "WARNING TO OWNER: YOUR FAILURE TO RECORIIC OTCE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TiblifiOUR 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 ce a copy of the recorded notice of commencement must be posted at the job site for the first insp tion which occurs seven (7) do ehe"0ibuilding permit is issued. In the absence of such posted notice, the inspection will n a t b, appro :. and a remspection fee w l e `chcfrged/ 't Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of , 20 1 5 , by clabc e\ l�j o y U �O �/ , who is personally known to (me or who has produced ,D` t Q er )..iC S G. as identification and who did ilatn oa h9 v J r36S -° NOTARY PUBLIC: Sign: Print: Seal: A►'0 GEORGINA SALVATORE c MY COMMISSION # FF911140 '•, a' EXPIRES August 19. 2019 ftd 6o71:fMr.cs . t+anw.swrt .� ***************************** APPROVED BY Signature CONTRACTOR The foregoing instrument was acknowledged before me this ///? day of l rvalp /sign, , 20 / J' , by l6.' V , who is personally known to me or who has produced J t 1 cce."-sA. ' as lAZTi3-Ce8y_ identification and who did take an oath. NOTARY PUBLIC: Sign: AV.i rIANdiumia.s 1 .ptrjiv A4.y, JUUAN A CARDONA Seat' /4' , = Notary Public - State of Florida ' Commission 0 FF 191910 -;; -% a,, My Comm. Expires Jan 21, 2019 _: ice,; Bonded through National Notary Assn. ) Pri xaminer Zoning (Revised02/24/2014) Structural Review Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 10S'O kiE 10-4 ST • City: Miami Shores Village County: Miami Dade Zip Code: 331Cp( ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES] NO ❑ ARHI Sheet Attached: YES NO ❑ Contract Attached: YES [A UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER C`cfr1, AHU or PKG. UNIT MODEL # RA-t (G L - 1.+41 2171, COND. UNIT MODEL # (Zpq l'.— 010 KW HEAT NOM TONS / -C— AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 2O8/2 /0 4. Size Disconnecting Means: 30 A rYl,ps Contractor's Company Name: AVe4 la C'O'Y).O/Tln h l Phone: 3 S -332 State Certificate or Registration N • - ' C. r c/2.� ZZ Certificate of Competency No. Signature (Qualifier's signature) Date: 1p/i< tr (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): joss ,C Jo: - sr' City: Miami Shores Village County: Miami Dade Zip Code: 33/67' ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES NO ❑ ARHI Sheet Attached: YES [2 NO ❑ Contract Attached: YES .i UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER kH cc- m. AHU or PKG. UNIT MODEL # Re PAJ_ /1 - 3 COND. UNIT MODEL # fe 4SL - b3 9 KW HEAT JO NOM TONS 3 AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER 14/,5 YES NO REPLACING DUCTS NO YES NO REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLAB E NO YES NO NEW ROOF STAND eW YES NO NEW RETURN PLENUM BOX E NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 2-f3F3/2-40 4. Size Disconnecting Means: .SQ ) rye 9. Contractor's Company Name: Aver► 4//& d, i,e/ n ir Phone: State Certificate or Registr. on No. CAC 692- ZZ Certificate of Competency No. Signature (Qualifier's signature) 3 5-33Z -0/3" Date: 7/(9/%/.5— (Revised02/24/2014) RICK SCOTT, GOVERNOR KEN LAWSON. SECRETARY CAC042622 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The CLASS AAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date. AUG 31. 2016 ACOSTA, ALBERTO AVEN AIR CONDITIONING ALBERTO ACOSTA INC 8625 SW 108 ST MIAMI FL 33156 ISSUED: 06129/20/4 DISPLAY AS REQUIRED BY LAW SEQ it L'-Co491'"n..;7&: Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 1783704 BUSINESS NAME/LOCATION AVEN AIR CONDITIONING ALBERTO ACOSTA INC 8625 SW 108 ST MIAMI, FL 33156 OWNER AVEN NC ALBERTO ACOSTA INC Worlter(s) RECEIPT NO. RENEWAL 1783704 EXPIRES SEPTEMBER 30, 2016 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPEC MECHANICAL CONTRACTOR CAC042622 PAYMENT RECEIVED BY TAX COLLECTOR 75.00 07/15/2015 CHECK21-15-094233 This Local Business Tax Receipt only confirms payment of the Local Business Tex. 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 NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. M O D.5, j For more information, visit yyyrvya pia Trade govhaxcglieotor ACORD D DATE (MIMIDDtYYYY) 10/13/15" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO iGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER E 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. CERTIFICATE OF LIABILITY INSURANCE IMPORTANT: It the certiflcate holder Is an ADDITIONAL INSURED, the policy(as) must be endorsed. If SiJBROGATION IS WAIVED, subject to the terms and condlttons of the policy, certain policies may require an endorsement. A statement on this #ertiflcete does not confer rights to the certiflcate holder In lieu of such endorsement(*). PRODUCER Verge) Insurance Agency 3185 W 76 St Sutte.3 Hialeah, FL 33018 Phone (305) 698-9976 INSURED Fax (305) 698-9973 Aven Air Conditioning Alberto Acosta Inc 8625 SW 108 ST Miami, FL 33156 (305) 332-0139 COVERAGES CERTIFICATE NUMBER: CCOONTACT DANA'I VERGEL PHONE o.Esti:._. C,N(305)698-9976 ADDRELSS:. verge®g111ail.ODm INSVRER(SIAFFORDING COVERAGE INSURER A: ASCEN ANT COMMERCIAL INSURANCE INSURER B: INSURER C : INSURER 0 : INSURER E : _ INSURER F : SAX (A/C, No): (305) 698-9973 NAMC 0 THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEENISSUED TO THE INDICATEn REVISION NUMBER: NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR 0 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POUCIES DESC EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PA! INSR LTR A TYPE OF INSURANCE - POLICY EFF POLK:Y EXP - — -. _—INSR,.4Y! Dt POLICY NUMBER GENERAL LIABILITY - � -_ NUMBER • ( ). ❑ COMMERCIAL GENERAL LIABILITY 0 ❑ CLAIMS -MADE Q OCCUR GEM. AGGREGATE LIMIT APPLIES. PER: ❑ POLICY 0 gig- ❑ LOC OLSUBR; j� MM00 YYY)_�)rM/D YEXP 1 GL-41962-2 AUTOMOBILE LWaIUTY 0 ANY AUTO AU. ❑ AUTOS ❑ SCHEDULED ❑ HIRED AUTOS NON -OWNED ❑ ❑ AUTOS ! - ❑ _ ❑ UMBRELLAUAE� ❑OCCUR ! ---� -.. _... r.l. ❑ EXCESS UAB _❑ CLAIMS -MADE ❑ DEO RETENTIONS I 1 j WORKERS COMPENSATwN - - -- . AND EMPLOYERS' LIABILITY Y/N ANY PR OFFICER/MEMBER E DED7 ECG - NIA (Mandatory In NH) t yea _..1 DESCRiP OF gPERATIONS Eelav_ iI DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks -__ - AIR CONDITIONING SERVICES AND REPAIR Schedule, i1 more �a�a to required) Ten Thousand Plaza Association is listed as an Additional Insured. 04/19/2015 SURED NAMED ABOVE FOR THE POLICY PERIOD HER DOCUMENT WITH RESPECT TO WHICH THIS 18ED HEREIN IS SUBJECT TO ALL THE TERMS. CLAIMS. LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) 414/19/2016 MED EXP (Any one person) PERSONAL a ADV INJURY ! GENERAL AGGREGATE PRODUCTS - COMP/OP AGG 'AL CERTIFICATE HOLDER MIAMI SHORE VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVE MIAfifl'SHORES. FL33138 Fj AX 305-795-2204 ACORD 25 (2010/05) QF __CANCELLATION SHOULD ANY OF THE EXPIRATION ACCORDANCE AUTHORIZED' RE s 1,000,000.00 s 100.000.00 s 5,000.00 s 1,000,000.00 s 2,000,000.00 a 1.000.000.00 3 COMBINED SINGLE LIMIT S BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE . (Per accident) S EACH OCCURRENCE AGGREGATE ❑ TORY LIMITS L.— ER E L EACH ACCIDENT S S E.L. DI�EA EMPLOYEE s E L. DISEASE - POLICY LIMIT. S E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TE THEREOF, NOTICE WILL BE DELIVERED IN THE PO CY PROVISIONS. tTat;8.2010 ACORD CORPORATION: All rfghta reserved. 1 CORD name and logo are registered marks of ACORD PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION IND!JSTRY EXEMPTION cattattraltO eLacwaft TO BE EXEMPT FROM PL0R1OA WORKERS' CORAPENSATION LAW EPP/EC-ME DATE: .9/11r2'314 PERSON: ACOSTA *4 571221683 BU ESS NAME AND ADDRESS: EXPROOTON �ATE 9/102016 ALBERTO „ MEN AIR cortorrioNets ALBERTO ACOSTA INC SSW 108 ST KM i PL SCOPES OF BUSINESS ORTRA HEATING, VENTILAT(ON, 6IR-OONEL 33156 F 0 L H E R E IMPORTANT Pinuatititt Chapter440.05(14), F,S., an officer of cermtporation who elects exemption front this chapterby filing a certificate of erectiow under this SeCtiOn may not recover benefits ar c�matob tader this chapter. Pursuant to ampler 440.05(12), F.S., Certificates of election to be exerrifit— aPPIY et*/ witiOn the scope of the business ar trade listed on the notice deter:alai to be exempt. Pursuant to Cilantro 440406(13), F.S., s of electkin to be exempt and certificates defection to be exempt shall be subject to revocation if, at any‘re after the niIng ogle noce or the immerse of thiserafisate, the permnaMed on tne notice or certificate no Longer meets **requirements of seeker for Issuance of a certificate. The department shall revels) a cothicate at any Tune for failure of the Person named an the certificate to meet the requirements of Oris seen. OFS-f2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT IS 07-12 QUESTIONS? 13-1608 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Depait,nent of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compens insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING B L • YO AC 0 DGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owne State of Florida County of Miami -Dade The foregoing was acknowledge before me this l (p day of , 20 5 . By C7o )0 V 4 C'1 v fsO who is personally known to me or has produced ,On . use— NS - 293- 66 - 363 - o r; J e.r G as identification. �jalv�o�e. Aven Air Conditioning & Heating, Inc. Maintenance, Service, Installation Licensed & Insured 8625 SW 108 ST, Miami, FL 33156 - Phone: 305-332-0139 Email` aven2000@-bellsauth.net Date: October 19th, 2015 State of : Florida . County of : Miami Dade Before me this day personally appeared Mr. Alberto Acosta who being duly sworn. Deposes and says: That he or she will be the only person working on the project located at : 1050 NE 107 ST, Miami Shore, FL 33161 Sworn to (or affirmed) and subscribed before me this 16day of 20 kj ;'by Personally Know Or Produced identification 4. 4 Z Z 3 -Obe _s-v-O 'q- p Type of Identification Produced f�.ri:e VdrR. L+ c, - ir" ' 4.• ) tldit•ZAV—e4 ZL Print, Type or Stamp name of Notary ,.10o7' JUUAN'A CAR00NA Notary Public - State o1 Florida Commission 0 FF 191910 a;.' My Comm. Expires Jan 21. 2019 Bonded through National Notary Assn.