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PL-17-791Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. P L-3-17-791 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 4/7/2017 Expiration: 10/04/2017 Parcel Number Applicant 790 NE 97 Street Miami Shores, FL 33138- 1132060142190 Block: Lot: ANN UENO Owner Information ANN UENO Address 790 NE 97 Street MIAMI SHORES FL 33183- Contractor(s) Phone US HEATING AND AIR CONDITIONING (954)626-0483 CeII Phone Type of Work: INSTALL ELECTRIC TANKLESS WATER HEA Type of Piping: Additional Info: INSTALL ELECTRIC TANKLESS WATER HEA Bond Return : Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $5.00 $150.00 $3.00 $0.80 $164.10 Scanning: 1 c\,‘%‘‘. Pay Date Pay Type Invoice # PL-3-17-63420 04/07/2017 Credit 03/22/2017 Credit Phone (312)305-0095 Valuation: Total Sq Feet: Amt Paid Amt Due Card $ 114.10 $ 50.00 Card $ 50.00 t0.00 CeII $ 395.00 0 Available Inspections: Inspection Type: Top Out Final Review Plumbing 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 AFFIDA construction and z rti that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating authorize the above -named contractor to do the work stated. April 07, 2017 Authored Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy April 07, 2017 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 Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL .IVE'D MA'S 2017 ❑■ PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 790 NE 97 STREET si-h FBC 2011 Master Permit No. PL ti r1 C ` ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores Folio/Parcel#:11-3206-014-2190 County: AMiairii+D�ad, Zip: i141I"s thuding Historically Designated: Yes Occupancy Type: Load: NO X Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): RICK & ANN UENO Address:790 NE 97 STREET Phone#: 312-305-0095 City: MIAMI SHORES state: FLORIDA Zip: 33138 Tenant/Lessee Name: NIA Phone#: N/A Email: CONTRACTOR: Company Name: US HEATING & AIR CONDITIONING INCH, p)`o e#: 954-581-8333 Address: 3721 SW 47 AVENUE SUITE 305 r City: DAVIE state: FLORIDA \Jr% Qualifier Name: GLENN BUTTS Zip: 33314 Phone#: 954-581-8333 State Certification or Registration #: CFCO57167 Certificate of Competency #: DESIGNER: Architect/Engineer: N/A Phone#: N/A A Address:iN/A Value of Work for this Permit: $ 395.00 City: Square/Linear Footage of Work: State: Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace Description of Work: INSTALL ELECTRIC TANKLESS WATER HEATER n Demolition Specify color of color thru'tile: • Submittal Fee $� Permit Fee $ f O 0 CCF $ ' CO G CO/CC $ Scanning Fee $ _ Radon Fee $ - DBPR $ Z• 7 S Notary $ 5 Technology Fee $ l 750 Training/Education Fee $ ' Z CD Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) N/A Bonding Company's Address City State 4,, ,.yf. - ,f t - . Mortgage Lender's Name (if applicable) N�A ,,;..� �,. _ • ,,,dx, 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 $2500, Ythe applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to•the person whose property is subject to attachment Also, a certified copy of the recorded notice of commencement must be posted at'the job site, for the first inspection which occurs seven (7) days after the building permit is i ed. In the absence of E ch posted notice, the inspection•will not be approved and `a' reinspection fee•will be charged.•`•d'-ak,°' OWNER or AGENT The foregoing instrument was acknowledged before me this. V 22.r4nday .�of t,M,Ctrck , 20 J� , by 1v V Alin llur `� t, tn.Q , who is personally known to me or who has produced IriV`QY (1 C`QYiS'e. as identification and who did take an oath., NOTARY HQBLIC: Sign: Print: Seal: YANADY PRIETO MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 Bonded Thru Notary Pubic Underwriters *******'ice41' *** ' ************ APPROVED BY Signature CONTRACTOR The'foregoing instrument was acknowledged before me this • 14 day of 001 ,20 11 ,by eIr in tAt , who is personally known to _me or who has produced. as identification and who did take an oath. NOTAR PUBLIC: Sign Print: Seal: 1(a V} vvis �� AVRAHAM KALMIS MY COMMISSION t FF 122440 EXPIRES: May 12, 2018 %ea n(30O� Bonded 1hru Budget Notary Serrius ************************************************************************ Plans Examiner "` '' :Zoning `- Structural Review Clerk (Revised02/24/2014) RJCK SCOTT, GOVERNOR STATE OF FLORIDA PMTMFNT OF, BUSINESS AND PROFESSIQNALR,EGU CONSTRUCTIO-INDUSTRY LICENSING BOARD Tile LVMBJ Q O BRAG$ f_iip %t%n date'" AII6 31;'2 ISSUED: otrp,$ 91,6. KEN LAWSON, SECRETARY DISPLAY AS REQUIRED BY LAW SEQ # L1607050001096 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 OBA: Business Name: US HEATING & AIR CONDITIONING INC Receipt#:pL aiNG/LWN SPRNKL/CONTRACTOR Business Type: (PLUMBING/CONTRACTOR) Owner Name: GLENN C BUTTS Business Opened:lo/31/2oos Business Location: 3721 SW 47 AVE #305 State/County/Cert/Reg:CFCo57167 DAVIE Exemption Code: Business Phone: 954-581-8333 Rooms Seats Employees 10 Machines Professionals For Vending Business Only Number of Machines: Vending Type: t 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: US HEATING & AIR CONDITIONING INC 3721 SW 47 AVE #305 DAVIE, FL 33314 2016 - 2017 Receipt #1CP-15-00018676 Paid 08/11/2016 27.00 NY kY_ AcoRD® CERTIFICATE OF LIABILITY INSURANCE L.—/ DATE(MM/DD/YYYY) 3/14/2017 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 CONTACT NAME: Bonnie Krigsman Ext 313 PHONE FAX riC Nn Frt) 888-728-0817 (A/C. No): 954-452 0450 AIL ADDRESS: bkrigsman@bbimi.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Ohio Security Insurance Co 3491 INSURED USHAC-1 USHAC of South Florida LLC DBA US Heating and Air Conditioning 3721 SW 47th Ave #305 Davie FL 33314 INSURER B :Ohio Casualty Insurance Co 24074 INSURER C :Normandy Insurance Co 13012 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1952801279 • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAbE 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/DD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY BKS55666863 10/11/2016 10/11/2017 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 8 ADV INJURY $1,000,000 GEN'L AGGREGATE X LIMIT APPLIES EC PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE X . _ — LIABILITY ANY AUTO AUTOS OWNED HIRED AUTOS — •SUTOSULED NON -OWNED AUTOS BAS55666663 10/11/2016 10/11/2017 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE US055666863 10/11/2016 10/11/2017 EACH OCCURRENCE $1,000,000 AGGREGATE $ DED X RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N / A NHFL0043062016 10/11/2016 10/11/2017 X POTH- STAER TUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 t DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) HVAC, Plumbing and Electrcial Contractor located at 3721 SW 47th Ave #305, Davie, FL 33314. Uninsured Motorist $20,000. PIP $10,000 w/ $0 Deductible. Comprehensive / Collision Deductible $500/$500. Certificate Holder is included as an Additional Insured on the policy with respect to General Liability, only as required by written contract. Waiver of Subrogation Applies. General Liability policy is primary and non contributory. CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE 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