MC-16-3043Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit tun. MC-11-16-3043
Permit Type: Mechanical - Residential
tr erk Classf cation AdditionlAlteratlon
Per nit Status: APPROVED
Issue Date: 1112812016
Expiration: 05/27/2017
Parcel Number
Applicant
135 NE 98 Street
Miami Shores, FL 33138-
1132060132310
Block: Lot:
FLORIDA MINORITY COMMUNIT
Owner Information
Address
Phone
Cell
FLORIDA MINORITY COMMUNITY
7210 N MANHATTAN Avenue
TAMPA FL 33614-
(813)598-6361
7210 N MANHATTAN Avenue
TAMPA FL 33614-
Contractor(s) Phone Cell Phone
APEX -TECH ELECTRICAL & AIR CONI (786)206-6444
Valuation:
Total Sq Feet:
$ 6,500.00
0
Tons:
Additional Info:
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 1
Date Approved:: In Review
Type of Work:
Fees Due
CCF
DBPR Fee
DBPR Fee
DCA Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$4.20
$3.41
$0.00
$0.00
$3.41
$1.40
$227.50
$3.00
$5.60
$248.52
Pay Date Pay Type
Invoice # EL-11-16-61974
11/07/2016 Credit Card
11/28/2016 Credit Card
Amt Paid Amt Due
$ 50.00 $ 198.52
$ 198.52 $ 0.00
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Mechanical
W. W.
Review Electrical
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 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.
November 28, 2016
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
Building Department Copy
November 28, 2016
1
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
2601 BLAIR STONE ROAD
TALLAHASSEE FL 32399-0783
•
FADER, WILBERT EDWARD
NATECON, CORP
435 NE 164 TERRACE
MIAMI FL 33162
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque
restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order
to serve you better. For information about our services, please
log onto www.myfloridalicense.com. There you can find more
information about our divisions and the regulations that impact
you, subscribe to department newsletters and learn more about
the Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate
Fairly. We constantly strive to serve you better so that you can
serve your customers. Thank you for doing business in Florida,
and congratulations on your new license!
RICK SCOTT, GOVERNOR
STATE OF FLORIDA
4 DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
CGC 1517242 .."
CERTIFIED GEN
FADER, WILBER
NATECON, CORP*:.
U€D 08/21/2016
CONTRA'CTOR
Apo- k
IS CERTIFIED under the provisions of Ch.489 FS.
Expiration date : AUG 31, 2018 L1608210003175
DETACH HERE
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
LICENSE NUMBER
CGC1517242
The GENERAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2018
FADER, WILBERT EDWARD,
NATECON, CORP
435 NE 164 TERRACE.'
MIAMI F3312
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
2601 BLAIR STONE ROAD
TALLAHASSEE FL 32399-0783
FADER, WILBERT EDWARD
NATECON, CORP
435 NE 164 TERRACE
MIAMI FL 33162
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque
restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order
to serve you better. For information about our services, please
log onto www.myfloridalicense.com. There you can find more
information about our divisions and the regulations that impact
you, subscribe to department newsletters and learn more about
the Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate
Fairly. We constantly strive to serve you better so that you can
serve your customers. Thank you for doing business in Florida,
and congratulations on your new license!
RICK SCOTT, GOVERNOR
CCC1329000
CERTIFIED ROO„
FADER, WILBER
NATECON, CORD -
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
UED:- 08/21/2016
CONTRACTOR
IS CERTIFIED under the provisions of Ch_489 FS.
Expiration date : AUG 31, 2018 L1608210002798
DETACH HERE
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
LICENSE NUMBER
CCC1329000
The ROOFING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2018
FADER, WILBERT EDWARD
NATECON, CORP
435 NE 164 TERRACE-kto
MIAMI FL,33.
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)_795.2204
Fax: (305) 756.8972
BUILDING CRITIQUE
DATE: 10-12-2016
PERMIT NUMBER:16-2244
Pending the following items.
3. Bathrooms should comply with the following code sections
> R307.2 Bathtub and shower spaces. Bathtub and shower floors and walls
above bathtubs with installed shower heads and in shower compartments
shall be finished with a nonabsorbent surface. Such wall surfaces shall
extend to a height of not Tess than 6 feet (1829 mm) above the floor.
4. Provide a window and door schedule. Make sure to include the SHGC and the U-
Factor for the glass.
5. Reflect the location and provide dimensions of the required mechanical equipment
attic access.
6. Do not remove void sheets, Cloud in all change.
If you have any questions you may send me an e-mail at naranioiAmiamishoresvillaee.com
Ismael Naranjo, B.O, CFM
Building Director
Piw5.tS
D (4-)P(CktED lOO 5Arg'
ELEVA---i7OlkJ ,)(-(
j Pkov(DED ba/upou3 c,,rt cH,6-Pc-tE
IT
b 7 3
T
A RE-epoirc61111'Eg
� CrC�k 28c4- Ft-roi2-5
610 S r(r A -1
�E�y-� l�Q l GA�0 Dl � FC�l�-
7-7-(6
(G 67. 4-1� �G(v�I ��GUC !�'�
J
aeloriLor irnsi v
fnemfiscle0 prnibl1u8
3UOTLW 01410 'IU8
eunsvA bnfZ.3.14, poor
8FIV, Ethorg irnsiM
4osE.agv (aoc) T
ETe8,321- (0E)
;ITAO
513SVIIII4 nrinsia9
.erneti pniwalloi ed:terlibnoci
emit:pea oboez niwoflo srU dliw vJornoo bluone ernoolninEl
el;sw bu elooti leworia bns duldts8 .auescialovvade bra dutatca S.TOCR
ainerntisqmowode ni brio ebsed iswor(e bellstnni fitiw adoldtsd evods
tIsde eeasliue nevi noue. oostwe inridloedrinon s diiw bedeinit ed hri
:molt odt evods(rncnes8I') test a nscit esei Joni.° tripted o bnetxr.4
-U erti bns3H8 ibu3ni ot on.fa .eltibednzloob bns wobniv,, Gbivo
.casip edtlollotocl
mernqiupe Insdoetn belit.spel eat Io enoienernib obiyaig bnG noli$301edt tostle9
..eee:)as
.egnsdo lIs ri buol0 teteeria biov evornei ion DC :(74
mo:i.9.2rdii.iliniPinscinir.s3iniilliatm )1; itetn-t) if.cm tint moli?Itgp vim Ireol u'C11
MRD 0.8 onM losrnel
gnib'.1u8
Address:
City:
BUILDING
PERMIT APPLICATION
El BUILDING ❑ ELECTRIC
El PLUMBING
JOB ADDRESS:
City: •
MECHANICAL
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
❑ ROOFING
PUBLIC WORKS
11s Ala qgit') sd-
Miami Shores
❑ REVISION
REC Fri,/ ` 7c1
NOV_7, 2016
BY:
S .
FBC 2014 nn
Master Permit No. "J.C. - j, dolt(
Sub Permit No. ( .1(0 ' 30Cf..
❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
County: Miami Dade
Folio/Parcel#:
Occupancy Type:
Load:
OWNER: Name (Fee Simple Tit (ehgIer):
Address:
City:
7aO fl'G
-704114
Construction Type:
Zip:
Is the Building Historically Designated: Yes NO v
State:
Flood Zone: BFE:
Phone#: G%
Zip:
FFE:
8 4a25
33af
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: \\)( -"cede) FI ec i CciJ
Ip-Icto NE 1 /we `-vi 2os-
Nor( i 1(oi r
State:
�.L
Qualifier Name: c 7hovx Oleic SSO fr)
State Certification or Registration #: l� �� t U I 5 H Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $C7 a Square/Linear Footage of Work:
i
Phone#: 1 2 —2-0(0 -(0!`/ /
Zip: 33 1 RLJ
Type of Work: ❑ Addition ❑ Alteration
❑ New
Phone#: ((CD—Li(o3 Zf3q
❑ Repair/Replace ❑ Demolition
Description of Work: A /6 (_"PA Q Lit h' 1 L i e1 J l f 7A Irk
r
r,��..a+r..,en�1-ki+k+..ifis.e.'Sn..+�.." •rvs:-x::iow •ri�rt��.
Specify color; of color tu.tJle, i
R r r : I•~ .; I Nc� �� co./LS
Submittal Fee $ •.rs: I ,.: Permit�Ee $'" d.'-T �5t�F $ (
2 co/CC $
SC s t ,' � 1 —1
Scanning Fee $ i4F•.,, Radon<Fee$vM { DBPR $
(
Technology Fee $ 5". Training/Education Fee $ ` U° Double Fee $
Structural Reviews $
Notary $
Bond $
TOTAL FEE NOW DUE$ ICi 13
•
(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 Iav's 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: Asa 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 approv • nd a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of D 6PY , 20 , by
.i Q ivy , who is personally known to
me or who has produced •v Q\,3w as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
�a�""�""y,, VERUSNKA OM TEGA
+° ��°`��s Notary Publk,_,�State of Florida
y Commission 0 FF 197898
„,., ,`�,?.• My Comm. Expires Feb 9, 2019
APPROVED BY
tt, 119
Signature
The foregoing instrument was acknowledged before me this
day of
tst L , 20 t. P , by
S30
who is personally known to
me or who has produced ..1, 9 ((,,f.v
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
1
*******************
Plans Examiner
--��,`--
as
VERUSHKA ORTEGA,
�s£ Notary Public - State of Florida
Commission 0 FF 197898
��throup i * Iiotahric n.
**h l s *9eb , 19 *#*****
Zoning
(Revised02/24/2014)
Structural Review
Clerk
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.
"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: Asa 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 approv : • nd a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
-5L day of D , 20 t L , by
VW:Ai Q cv‘.Q. , who is personally known to
me or who has produced vejcr,„q\ki��,�.t
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
"'r'".'�"��., VERUSNKA ORTEGA
r:+ '► i Notary Public -jta1e of Florida
,�i�"i Commission • FF 197898
SA,. --�� ,,Az My Comm. Expires Feb 9, 2019
�� OF Flo`'
*********# vIA***SAr#R4ib4txllghiNalienekNOtarplesn:
APPROVED BY
,L
as
Signature
The foregoing instrument was acknowledged before me this
day of b� , 20 t. LP , by
SkplIctiV ahres3u()who is personally known to
me or who has produced �-,y,J� ((,t,��,� as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
a•"""'�• VERUSNKA ORTEGA
i
�_•. Notary Public - State of Florida
•p Commission ! FF 197698
*******************:: ,; Comm. Exolres Feb 9, 2019
(f) Plans Examiner
gr�+P� Zoning
(Revised02/24/2014)
Structural Review
Clerk
RICK SCOTT, GOVERNOR
KEN LAWSON, SECRETARY
STATE OF FLORIDA'"
DEPARTMENT OF BUSINESS•AND;PROFESSIONAL-REGULATION`
CONSTRUCTION INDUSTRYLICENSING:B-OARD ° ,
LICENSE NUMBER
,,_. _ ..
....,...
b
- • .,,,,
w...
,'
»CAC1815545- f
,mac „_. _.
-w _
M
r
..
»,.
The»»CLASS.°B AIRCONDITIONING:CONTRACTOR;y
ANamed below IS_CERTIFIED ._ _ °
-'Under tFie,provisions of Chapter.489:ES.�
- Expirat ondate:-AUG-31, 2018'1 ' -,:
r' LHERISSON, STEPHANE ,.,
`"APEX„TECH ELECTRIC; 8�#° R"C ONDITIONING`INC
685.NE•126°STREETS}
,,., NORTH:MIANII 1' FL 3161,. "..
ISSUED: 08/01/2016
DISPLAY AS REQUIRED BY LAW
SEQ # L1608010000839
005657
Local Business Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A BILL -DO NOT PAY
7164418
BUSINESS NAME/LOCATION RECEIPT NO.
APEX TECH ELECTRICAL & AIR CONDITIONING INC RENEWAL
12490 NE 7 AVE #205 7442687
NORTH MIAMI FL 33161
LBT\
EXPIRES
SEPTEMBER 30, 2017
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
OWNER SEC. TYPE OF BUSINESS
APEX TECH ELECTRICAL & AIR CONDITIOIVIEIOM MECHANICAL CONTRACTOR
C/O STEPHANE LHERISSON PRES CAC1815545
Worker(s) 1
PAYMENT RECEIVED
BY TAX COLLECTOR
$45.00 08/05/2016
CHECK21-16-109273
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 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.
For more information, visit www.miamidade.gov/taxcollector
ACOR»
CERTIFICATE OF LIABILITY INSURANCE
DATE(MI JODWYYY)
11/7/2016
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(8), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certfic ate holder Is an ADDITIONAL INSURED, the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the teens 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 Ileu of such endorsement(s).
PRODUCER
Pettineo Insurance Agency, Inc.
2430 E Commercial Boulevard
Fort Lauderdale, FL 33308
INSURED Apex —Tech Electrical G Air Conditioning
Inc.
12490 NE 7th Avenue Suite 205
North Miami, FL 33161
786-463-2139
COVERAGES
RTIFICATE NUMBER•
ASS:
CONTACT
NAME
PHONE 954-493-9424
FAX
(A/C,
!ARMOUR) AFfORDINO COVERAGE
NAIL!
tNSURERA: Scottsdale Insurance Company
INSURER B : Technology Insurance Company
INSURER C :
42376
42376
INSURER D :
INSURER E :
INSURER F :
•
' GVV .•III INUVVIGIG(1.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSUREDNAMED 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 POUCIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
R
LTR
TYPE OF INSURANCE
ADOLAMER
NtgR
earn
POLICY NUMBER
(PPOLICY YY�Y)
(MP LIC„Y QiP
,,,,,TTt
LIMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL
LIABILITY
OCCUR
CPS2385502
4/28/164/28/17
EACH OCCURRENCE
$ 1,000,000
X
POAPAAGE REAISESO(Ea RENTED
S 100,000
CLAIMS -MADE
NED EXP (Arty one person)
$ 5,000
PERSONAL&ADVINJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER
POLICY n jEOT ri LOC
PRODUCTS - COMPRIP AGG
$ 1,000,000
$
AUTOMOBILE
LIABILITY
ANYAUTO
ALL OWNED
AUTOS
HIRED AUTOS
—
SCHEDULED
AUTOS
NON -OWNED
AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
5
_,
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA i.i n
EXCESS UAB
[..._
OCCUR
CLAMS DE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTIONS
$
A
WORXERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY E OCCLUDED?OCECUrIvE
t+Artndatory In MG
YIN
❑
NIA
TWC3550012
4/16/ 164/16/
WC STATU- OTH-
X TORY LIMITS ER
E.L EACH ACCIDENT
$ 100,000
belrnr
17
EL DISEASE - EA EMPLOYEES
500,000
$ 100,000
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Atta ACORD 101, Additional Remarks Schedule, it mom apace Is required)
Apex -Tech Electrical 6 Air Conditioning, Inc.
CANCELLATION
Miami Shores Village Bldg Dept
10050 NE 2ND AVE
Miami Shores, FL 33138
ACORD25(2010/05)
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
01988-2010 ACORD CORPORATION. Ail rights reserved.
The ACORD name and logo are registered marks of ACORD
Miami Shores Village RECEIVED
Building Department
EP 1 1011
1� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 54—+
FBC201Q
BUILDING Master Permit No. 12C ((Q - 22LI
PERMIT APPLICATION Sub Permit No. MC t (O — C) -13
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING
JOB ADDRESS:
City: Folio/Parcel#: \t3g6 W 69,110
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee Simple Titlehold
TA.lp N
City: IU'^A �t
Tenant/Lessee{Jame: Phone#:
Email:
Address:
""MECHANICAL ❑PUBLIC WORKS "CHANGE OF ❑ CANCELLATION ❑ SHOP
DRAWINGS
CONTRACTOR
Miami Shores County: Miami Dade
Zip: 33 i347
Is the Building Historically Designated: Yes NO
Flood Zone:
p(ISM Alt nal CQ vYl t
State:
BFE:
Phone#:
sr(
FFE:
Zip: 13,,/Y"
CONTRACTOR: Company Name: Phone#:
Address: Ath*P-‘8td`
City: �u1
tate:
Qualifier Name: Phone#:,�,
State Certification or Registration #: Certificate of Competency #: C cc )XcX
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
d
d Value of Work for this Permit: $
if Type of Work: DescriPdo of Work:
Vr ❑ Additio ❑ Alt ation
-� P 614s.
Square/Linear Footage of Work:
New ❑ Repair/ place
VAC4i a -
Demolition
CIC((,
45
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 510k,04cFs CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ " 5 `
(Revised02/24/2014)
57/S
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.
"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 d r�iiJ pection fee will be charged.
Signature
The fore
•
as ackno
OWNER or AGENT
ing instrument
day of
ledged before me this
by
e sonally known`
o has produced as
'cation and who did take an oath.
Y PUBLIC:
**************
APPROVED BY
Signature 181V2P
CONTRACTOR
The foregoing instrument was acknowledged before me this
d
of
me or who has produced
20
, wh. s personally know
, by
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
illeaRTIffa
=A' fS COmftr,.: : a • r.J.,1230141
Expires: Aupusr it, 20I0
Bonded t ru Ann Notpy
as
***************************************************************
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
; STATE -OF FLORIDAW .--
,..- —DEPARTMENT OF,BUSINESS,AND"
'"PROF,ES,SIONALREGULATION`.
CMC125..0+-0�68 _ SSUED: ,09/Q4/201,6------
4wa"r3 way ailS-
CERTIFIED"MECHANICAL CO RAC OR
RECARTE'MEDARDO,DANIEL
--*M DD:R. PLUMBING &IRE L LC
I,S CERT�F,IED,under the-provsions of Chr4'8,9 FS.
jExpiratiortdafe r'AUG31 09040002647.
't
et
4
000683
SB`n
mi✓•-C ade,COE'
-THIS IS NO11 A
)241646
BUSINESSNAME/LOCATION
MDR"PLUMBINC & FIRE LLC •
•14282 SW 146 AVE
M i Mi FL 33186'
•
OINNE R
:MDR PLUMBING-& FIRE LLC:
C/O MEDARDO E RECARTE
Worker(s) 1
veer
tate'ef FI`v rida:
•
LC.- DO NOT PAY
RECEIPT NO
ENEWAL
4,8085 :: Mu tlbe d splay ct t. Ea e f business
Pursuant to County Code
• EXPIRES
SEC. TYPE OF ''BL 1t% ESrS
796 'SPECIALTY PLUMBING CONTfiACTQR PAYMENT RECEIVED
FPC 12-000148 tizA"*"ECT°R
;$86.25 11 /02/2016
:'CREDLI'CARD-47- 003088.
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
pweittera eerliticatien of the beIder"sgaeliticatiotmn, to de business. Holder Must ca Ilywith any govermseataL
as neestne esamental regulatory laws and requirements which arm lgcto the business." .,
TtreRECEIPT DEL sieve moat he dispinyed eaMiscoranremintirehiefesltIKiamwDndeCodeSecBa,-2i&.
Poc more « ao rixlEwvww.miamidada morit� x at tot
000964
w
urines
- ade:Cobh tat-e Alf
-7'F11518 roaTIA 8$Lt. -Op tilCITn AY
;671-0322
BUSINESS NAME/LOCATION
A+4 D R PLUMMB1N& & FLRELLC
T4282 S1A11'48AVE
'MIAML FL 33186 -
OWNER;
M:D`R PLLIMSMIC & FIRE LLC
Workers) 1.
EXPIRES
P 'EMEMR 3O 2#r?
anmati tba 4401 i ye4 4-`Mice of sir mess
PearSuantto Cou tty Cotle;
ChaPtetr 8A=Art:
PAYMENT RECEIVED':
BY TAX COLLECTOR
193.75 01/12/2017
` RE13tfCARD--I14120850
'This Local BosineasTaxlieceMtonly confirms,payment efthel:ocatituiinessTax. TtreReceiptis.not-alicenae,-.
perintt7oroCortifrcationbettheholdefsMia11#icanons.todobusfnese..:kdider t omplyeiithymy;goven ai
ornoidnrernme ntai regnlaimrylarr.sa►r"dre ere,neats wb ch.apply hr tke_'6ps mess `
The larcEtPTNO. above mustOOeia layedoaeli Commercial;aides *fiaiat-Oade'Code Sec Ba-ti6.
riorrmoie,ialermstioa, risitwrterrtniawidederpodtanc cheater
SEC. TYPE Of BUSINESS,;
196' PLUMBING CONTRACTOR'
CFCi427548
AC_CORtf
�.,.-- CERTIFICATE OF LIABILITY INSURANCE.
DATE (MM/DD/YYYY)
9iti1,7.
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 'MIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE ACONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
' IMPORTANT:. if the certificate holder is an ADDITIONAL INSUREDS the poncy(ies)"mtust be^endorsect If S%JBROGAAIVIS IS WAIVED; subject tb,.
the teams and Conditidns,of the poticq; certainpolicies mays requite an endorsement A statement on this certificate does not contort lights to the
certificate holder in lieu :ofsuch endorsement(s)
PRODUCER
Atkaratis insurance •
'15441 SW 137 Ave.
CONTACT Ralph Ceballos
q'HONE
): (3051969 8776 ; FAX . NI; (305) 969-8744
AIL
DDRRESS' atlantiSinrsuranoega'ttxtet
Miami, .FL 33177
Phone (305)'989 8776 Fax (305)9694744
INSURES) AFFORDING COVERAGE
NAIL #I
wsw eRA: IN ALUIDU&INSURANCE
71NSURED
'MDR'PLLJ'M81NG 2 FIRE' LLD tlba'MDR'F RE
13000S. Tryon St.,'Stl+te'F 240
Charlotte, NC 28278 (305) 484-8509
titilsuRER+B :
-INSURER C :
INSURER D:
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
REVISIONNUNIBER"
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE (LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWfTHSTANDINGAN(YREQUIREMENT, TERM.ORCOND lONOFANYCONTRACTOROTIHERDOCIUMENTWITHRESPECTTOWHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN) IS SUBJ€CT, TO"AL L THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY (HAVE BEEN RE0tJCEDBY PAID CLAIMS.
INSR
TYPEOFC INSURANCE__
ADDLSURR
mot
*ND
_,� POLACY NUMBER
POLICY EFF
, POLICYEXP'
UNITS
A
GENERAL LIABILITYEACW
❑ COMMERCIAL GENERAL LIABILITY
AN
Y
NN724442
)
1I3/17/2016
}
10J17/2017
1
OCCURRENCE
$ 1'„000 000 00
DAMAGE TO' RENTED•
PREMISES (Ea occurrence)
$ 100,000.00
MED EXP (Any one person
$ 5,000.00
• ❑ :CLAIMS -MADE ❑ OCCUR
PDRSONAL & ADV INJURY
$ 1,000,000.00
> 5
GENE AL AGGREGATE
s 2;000,000.00'
GENII AGGREGATE' LIMIT APPNIES•PER:
JPOLCCY ❑ JECT 3LOCPAITOMORIDELIABIUTY
-PRODUCTS- COMPOP AGG�
:;$ 2,000,000.00
$
t❑ ANY ALTO
COMBIMaED:SINGLE,LIMIT
$
?BC'iDILYIINDl11RY'IQPeripersoe)
'.$
BODILY NJJURY-(Peractident)
$
ALL'flWNED ❑ 'SCHEDULED
AUTOS = AUTOS
NON -OWNED
HIRED AUTOS ❑ AUTOS
Imo; 4,� P
LL❑JJ L f❑
PROPERTY DAMAGE
(Per accident)
$
UMBRELLA LAM OCCUR
�
EACIHtOCCW NCE
$
i . FYrFSS LIAR D. CLAIMS -MADE
AGGREGATE
$
❑ DEO ❑ RETENTIONS
$'
WORKERS COMPENSATION -
EMPLOYERS'ANfl EMPLOYERS' LIABIA.IfIf Y / It
ANY PROPREETORIPARTNffR/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
;
fRl A
WC.STATU- OTH-
❑ TORYu.IMItS" ❑ ER'
E.L. EACH ACCIDENT
$,
E.L. DISEASE-EAEMPLOYE
E.L. DISEASE - POLICY LIMIT
$
`XIESDIIIIPIICIN OF OPERATIONS (LOCATIONS i' VEHICLES Pasch &CORD 1o1, Adihional;Remads'Scheduler tf,nore rpao,isrequLed)
'.STATEOF FLORIDA PLUMBING' CONRACTOR.
STATE OF FLORIDAMEC-IANICAL CONRACTOR.
STATE'OF FLORIDACLASS'H-•FIRE'PRGTECTIONCONTRACTOR.
TE MIOI.DER
CANCEIttLATICNi
11MAMI SHORES VILLAGE"
Building Department'
10050 NE 2nd Avenue
Miami Shores, FL 33138
I
SHOULDANY OF THE ABOVE DESCRIBED'POLICIES.BE CANCELLED BEFORE
THE EXPI ATtON DATE THEREOF, NOTICE W LL. BE DELIVERED IN,
' ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
-RALPH CEBALLOS
ACC 25 12134810S) CIF
®1988-2010 ACORD CORPORATION. ATI rights reserved.
The ACORD name -and Aogo are registered marks of ACORD
1 ®
Ac ?R/ CERTIFICATE OF LIABILITY INSURANCE
!hi....-----..
DATE (MM/DD/YYYV)
09/01/2017
THIS CERTIFICATE IS ISSUED AS. A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES- NOTc.AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENDOR. ALTER' THE, COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE' DOES NOT CONSTITUTE A CONTRACT. BE KEEN ;THE ISSUING:- INSURER(S), AUTHORIZED,
REPRESENTATIVE OR'FRODUCER,, AND THE CERTIFICATE HOLDER
I ORTAWT: ti the certificate holder is an ADOI:TIONAL INSURED, the ploiicy{pes); must be: endarrsed. Iff SUBROGATION IS "WAIVED,, subject to
the -terms and cone itions of the po1f certain:policies may require are;endDcsement. A statement on this certificate does not confer rights to the
certificate holder im lieu'>of such endorsement(s).
PRODUCER
Absolute Choice Insurance
9415 St*iisei i11'1ve 594e 151
Miami 33/73
CONTACT
NAME: Carlos A Melich
Y 1< PHONEFAX
(305) 275-'1777 Iplc, No): (305)275-1711
tiEDER MI 4UteCIAOi0D.CGTNA
ADcrRess: NY
BISURER S) AFFORDING COVERAGE I
D
NAIC #
'INSURER A: ASSOOIATE' INDUSTRIES INSURANCE COMPAt
INSURED
-MDR 'Pluthbirig i, Fire; LLlCidba:MDR ,Fire
13000'S. Tryen'•St.
Suite F-240
Charlotte, NC 28278
;INSLIRER,B:
WISMnERC:
rNEIBRele'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,ANi1! REQUIREMENT, TER%i OR COIND1fl ION OF ANY CONTRACT O1T OTHER DOCUMENT WI(F t RESPECT TO WH$c141` THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED(BY THE POLICIES DESCRIBED HEREIN'.BS,: SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH. POLICIES: LIMITS SHOWNMAY (HAVE BEEN REDUCED<BY PAID CLAIMS,
INSR
LTR
TYPE OF INSURANCE
ADDLSUBR
INSD.-WVD.
POI'JCYNUMBrW
POLICY,EF1~
(MM/OD/YYYYI
POLICY EiP
(MMIDD/YYTY)
LIMITS',
COMMERCIAL GENERAL LIABIUTY.
-
{
EACH OCCURRENCE
$
DAMAGE TO D
PREMISES (EaENTEoccu occurrence)
$
CLAIMS -MADE
OCCUR
N ED EXP 1Any one person)
$
IPERSONAL & A:OV11NLMURY
S
GENERAL AGGREGATE
S
GEWL
AGGREGATEUIMIT
POLICY
`OTHER-
APPUES,PER:
CT (
,)
LOC
PRODUCTS - COMP/OP AGG '
$
$
AIiTeMOBLE%mown,
_
ANY AUTO
ALL OWNED
AUTOS
,
'
SCHEDULED
AUTOS
i NON -OWNED
AUTOS
:
t
:
COMBINED' SINGLE'UMNr
(Ea.accident)
S
BODILY.INJURY:(Per person)
'S
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per, accident),
y $
$
U&$URELLA LJAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
:
EACH OCCURRENCE
$.
AGGREGATE
$
$'
DED
RETENIIIOB
A
WORKERS COMPENSATION
AND E .OYERS' LIABILITY
ANY TOOR'/PARTNEERR/EXECUTIVE
AN
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONSbeNow_____
N
N/A
Y
AWC1056524
01/08/2017
01/08/Z01$
PERT
STATUTE
OTH-
ERY:CN
E.LEACHACCIDENT
$, 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ .500,000
j
1
DEBCRIPTIDN'OF oFERATIONSA1 oCAT10Ns rVEEH1Ot €S i(Attaoh ACORO KUL Add itiorsdilbmualus Schedule, if move spacers required)
STATE OF FLORIDA PtUMB1NG'CONRACT'OR.
iSTATE,OF FLORIDA MECHANICALCONRACTOR.
STATE OF 'FLORIDA CLASS/WARE/PROTECTION CONTRACTOR.
ELICA1 RK
Miami Shores Village - BuiidingDepartment
10050 NE 2nd Avenue
Miami Shores, FL 33138
SAD ANY OF THE ABOVE DESCRIBED POLICIES -LIE CA LED BEFORE
`
THE EXPIRATION DATE THEREOF,NOTICE WALL BE DELIVERED, IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
n
D 1988-2014 ACORD CORPID7tA1t .Ail r)igftts reserved.
ACORD 25X2014f0 j
The ACORD name and,logo are registered matks of-ACORD
Miami Shores ViHage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Permit N.
Owner's Name (Fee Simple Title Ho de
ir:4A
Owner's Address: '7;210 Ailp,,,,
City: �"rn,Hd►G
Job Address (Of where work is being done):
City: Miami Shores
State :
Phone #:
135 YE 980' sd-
&I?- s"9X- ‘3‘,/
Zip Code: 33�./,
State: Florida Zip Code: 3 5/ f
Contractor's Company Name: Arx,,g, Ekc7f ,I C
Address: 10 p 7dl'1 (�Q,
City: Nor 1 tail PAN " Iss,€, - J
Qualifier's Name :
Architect/ Engineer of Record Name:
Address:
City:
Describe Work:
Phone #:
Zip Code: ib/
Lic. Number:
Phone #:
State: Zip Code:
.4vAc. cL4- cola Li/4
hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to c • • plete the contract. I hold the Building Official and the
ores harmless of all legal involvement.
Signature
•caner o
The foregoing instrument was aknowledged before me
this30 day of4,203 6y p' hk-'✓
Who is personally known to me or who has produced
Notary Pu .Ir��'►'►
Sign: l _AgW
iw.„1w Tr NIP
: I John Joseph
Signature
indentification.
Seal:
Commission # GG023014
Expires August 21, 2020
y
', ' Bonded thru Aaron Notary
•ter
o ?" or or Architect
The foregoixinstrument was aknowleded before me
this ;2 da of Alibi 4 , 20t bys% W e/ 15
who
personally know
Notary Pu
Sig Wm`�=I6VA\`
Seal: ,
o me or who has produced
as indentification.
,i,
John Joseph
Commission 1 GG023014
Expires: August 21, 2020
Bonded thru Aaron Notary