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PL-18-2424Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 790 NE 97 Street Miami Shores, FL 33138- Owner Information Address Permit Permit NO. PL-9-18- 424 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 9/12/2018 Expiration: 03/11/2019 Parcel Number Phone Applicant Cell ANN UENO 790 NE 97 Street MIAMI SHORES FL 33183- (312)305-0095 Valuation: Total Sq Feet: $ 395.00 0 Type of Work: INSTALL ELECTRIC TANKLESS WATER HEA Type of Piping: Additional Info: INSTALL ELECTRIC TANKLESS WATER HEA Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.00 $0.00 $0.00 $0.00 $150.00 $0.00 $0.00 $150.00 Pay Date Pay Type Invoice # PL-9-18-68849 09/12/2018 Credit Card Amt Paid Amt Due $ 150.00 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing 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 AFFIDAV/ : I ce ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo ng. F : more, I authorize the above -named contractor to do the work stated. September 12, 2018 ri % d Sign' T re: Owner / Applicant / Contractor / Agent Date Building Department Copy September 12, 2018 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number:INSP-312122 Permit Number: PL-9-18-2424 Scheduled Inspection Date: September 13, 2018 Inspector: Massanet, Maykel Owner: UENO, ANN Job Address: 790 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: USHAC Permit Type: Plumbing - Residential Inspection Type:�Final I Work Classification: Addition/Alteration Phone Number (312)305-0095 Parcel Number 1132060142190 Building Department Comments INSTALL ELECTRIC TANKLESS WATER HEATER TO REPLACE PL17-791 Infractio Passed Comments INSPECTOR COMMENTS False Passed C�J Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments September 12, 2018 For Inspections please call: (305)762-4949 Page 29 of 42 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION BUILDING ELECTRIC ❑ ROOFING QPLUMBING [MECHANICAL El PUBLIC WORKS JOB ADDRESS: 790 NE 97 STREET City; Miami Shores County: Master Permit No. 17L\B -292-4 Sub Permit No. ❑ REVISION ❑ EXTENSION •RENEWAL CHANGE OF ❑ CANCELLATION El SHOP CONTRACTOR DRAWINGS Miami Dade Zip: 9i!')2 Folio/Percel#:11-3206-014-2190 Is the Building HI§torically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): RICK &VNUENO Address:790 NE 97 STREET City: MIAMI SHORES Tenant/Lessee Name: NIA Email: State: FLORIDA NOX BFE: FFE: Phone1#: 312-305-009511 L Zip: 33138 Phoned: N/A CONTRACTOR: Company Name: USHAC Phone#: 954-581-8333 Address: 3721 SW 47 AVENUE SUITE 305 City:, DAVIE State: FLORIDA Zip: 33314 Qualifler Name: DERRICK OLESH Phone#: 954-581-8333 State Certification or Registration#: CFC1 428495 Certificate of Competency#: Phone#: N/A DESIGNER: Architect/Engineer: N/A Address: N/A City: State: Zip: Value of Work for this Permit: $ 395.00 Square/Unear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace Description of Work: INSTALL ELECTRIC TANKLESS WATER HEATER �o�LA tpL-I-1--19) ID Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ / GG CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revlsed02/24/2014) 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 .10 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 approved and a reinspectlon fee will be charged. Sign re t Signature )f OWNER or AGENT The foregoing instrument was acknowledged before me this day of < l--r(2'1 , 20 t , by N �► L L ] , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: moo_° 6'S"i�e =D: ��° _ A ° N � J"Y%6` co •• jai. tcl •F�O;`r r ssassasssssss sasssasssasass/f iiilxeZsssessssssssssssssssssssssssssssssss 074? ,%' Plans Examiner CONTRACTOR The foregoing instrument was acknowledged before me this day of i► , 20 A , by , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUB • Sign: APPROVED BY Print: Seal: Structural Review 4 ger- ••"""'"' A RAH MM KALMIB No/t�ary�PublicItteof�Fei rice, •'`F • QOmmisdon l W i%see 2C22 My Comm. Expires May 12 Zoning Clerk (Revised02/24/2014) et Goalie Plodder !LC PLUMBING • ELECTRICAL • HVAC �Nr . Tp 1.800.522.7115 August 30, 2018 State of Florida County of Broward Before me this day personally appeared Derrick Olesh who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 790 NE 97 Street, Miami Shores, FL 33138 /K Derrick Olesh Sworn to and subscribed before me this 30 day of August, 2018 by Derrick Olesh who is personally known to me. Avraham Kalmis, Notary AVRAHAM KALMIS ( aF Notary Public - State of Florida g u Commission # GG 176991 '\ •AlMy Comm. Expires May 12.2022 Bonded tro411 Nation. Malay Assn 3721 S.W 47th Ave. Suite #305 Davie, FL 33314 Office (954) 581-8333 Fax: (954)626-0483 Toll free: 1-800-522-7115 MECH# CAC056336 ELEC# EC13008155 PLUM# CFC1428495 RICK SCOTT, GOVERNOR •JONATHAN ZACHEM, SECRETARY STATE OF, FLORIDA DEPARTMENT OF BUSIN S .ANDAP z_OFESSIONAL REGULATION EREJN=IS':C CONSTRUE THE PLUMBI PROVI SING BOARD F 3 UNDER THE TA' UTES Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. DATE (MMIDDIYYYY) 8/30/2018 AC ® CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR 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 INSURED USHAOFS-01 USHAC of South Florida LLC DBA US Heating and Air Conditioning DBA USHAC 3721 SW 47th Ave #305 Davie FL 33314 NAME: CONTADepartment Certificate De artment PHONE 888-728-0817 Am No F"r). 511E . Certificates@bbimi.com INSURER(S) AFFORDING COVERAGE ►NSURERA:Ohio Security Insurance Co INSURER B :Ohio Casualty Insurance Co INSURER c :Mapfre Insurance Company of FL INSURER D : INSURER E : INSURER F : FA'( Not: 954-452-0450 lA(C. NA)C i 24082 24074 34932 COVERAGES CERTIFIGAICNUNICICK: IUwvwv" •---•-• .. 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. 14TSRR TYPE OF INSURANCE ADOL INSD SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYYl POLICY EXP (MM/DDIYYYYI LIMITS BKS55866863 10/11/2017 10/11/2018 EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERALUABILfY DAMAGE TO RENTED PREMISES (Ea occurrence) $300pp0 CLAIMS -MADE X OCCUR MED EXP (Any one person) $15,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S2,000,000 POLICY OTHER: X JECT LOC S C 5204070001372 10/11/2017 10/11/2018 COMBINED SINGLE LIMI I (Ea accident) 51,000,000 AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ X — ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS X AUTOS PROPERTYDAMAGE (Per accident) S X HIRED AUTOS — AUTOS $ X US055666863 10/11/2017 10/11/2018 EACH OCCURRENCE $2,000,000 B X UMBRELLA LAB OCCUR AGGREGATE $2,000,000 EXCESS UAB CLAIMS -MADE X RETENTION SO S WORKERS DED COMPENSATION PER STATUTE OT ER AND EMPLOYERS' LABILITY Y / N E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? N / A E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If describe under OF OPERATIONS below E.L. DISEASE •POLICY LIMIT S A D DESCRIPTION Leesed!Rented Equipment Crime BKS55688863 10/11/2017 10/11/2018 Limit: $25, 0000 DESCRIPTION HVAC, OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Rsmarke Schedule, may be attached I more space Is moulted) Plumbing and Electrical Contractor located at 3721 SW 47th Ave #305, Davie, FL 33314. CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT CONTRACTOR LIC# CFC1428495 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 (2014101) 01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A D CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDM'Y1') 8/1n018 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: Ifthecertificate holder is an ADDITIONAL INSURED, the policy(les) 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 praxiom Risk Management, LLC 123 West Bloomingdale Ave. #300 Brandon, FL 3351 www.praxiom-rm.com ACT CONTNAME: PHONE FAX None _Ern E+ t4 ADDREss: INSURER(S)AFFORDING COVERAGE NMC/ INSURERA: State National Insurance Company. Inc 12831 INSURED Congruity HR of North Carolina, LLC Congruity HR, LLC 508 Arbor Hill Road Kemersville NC 27284 INSURER B : ,NBURERe: ENSURER D : INSURER E: INSURER F : - _ r.rvlmnu LIIIMDCD• COVERAGES c•LK 1 ir iciR It numoC,c; as4wac40 •--- --- --. 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THEPOLICIESDESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIESAIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -LTR TYPE OF INSURANCE- Awln ma ' -POLICY NUMBER .._ POUCYF.FF (MM/DDIT'YYYI POLICYE�p JMMIDD/YYYY 1 - LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED ' PREMISES (Ea occurrence) S CLAIMS -MADE OCCUR MED EXP, (Any one person) S PERSONAL''S AOV INJURY 5 GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: - PROOUCTS - COMP/OP AGO 5 -- POLICY Jeer LOC OTHER: - S AUTOMOBILELIABILITY ) IEOMM�MSINGLE LMIT S ANY AUTO • BODILY INJURY (Par person) S OWNED r— SCHEDULED BOOS Y INJURY (Per sedderW S AUTOS ONLY HIRED AUTOS NON OWNED PROPERTY. DAMAGE,. Ip�Mp S AUTOS ONLY 1 AUTOS ONLY S UMBREU.AUAB EACH OCCURRENCE E EXCESS LUIB -- OCCUR AGGREGATE S DED I RETENTIONS CLAIMS -MACE S A - WORKERS COMPENSATION TGW900024902 7/30/2018 7/30/2019 i I Ik9Z 1 OTH- AND EMPLOYERS LIABILITY YIN E.L. EACH ACCIDENT $1,000.000 ANYPROPRIETOR/PARTNERIEXECUTIVE Q OFFICERMIEMBEREXCLUDED? N / A E.L. DISEASE • EA EMPLOYEE S 1;000 ono ttdatory in NH) D • DESCRIPTION Project PEO Main Work OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If mom spate is required) /Job#: Project/Job: - Client: USHAC of South Florida, LLC dba US Heating & Air Conditioning; USHAC PEO ClientID#: 1230 Location:. 3721 SW 47th Avenue Suite 305 Davie, FL 33314 Add Locations: None Comp is provided only those employee leased to but not subcontractors d USHAC of South Florida LLC dba US Heating & Air Conditioning; USHAC •. _. _ ................nu CERTIFICATE HOLDER MIAMIDEpT RC VILLAGE LIC#CFC14 45 10050 NE 2ND AVE MIAMI SHORES FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE David E. Carothers 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 43449245 1 PSO 12018-19 L,$HAC of South rL 11230) I Brittany 1 8/30/2018 10:02:59'AM 12071 I Page 1 of :This certificate cancels and supersedes ALL previously issued certificates. BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2018 THROUGH SEPTEMBER 30, 2019 DBA: USHAc Receipt #:182 -288 14 Business Name: Business Type: SPRNKL/CONTRACTOR yp (CERTIFIED PLUMBING CONTRACTOR Owner Name: DERRICK OLESH Business Location: 3721 SW 47 AVE STE 305 Business Opened:10/07/2017gCFC14284 3tate/County/Ce1't1Reg:CFC14284 95 DAVIE Exemption Code: Business Phone: 954 - 5 81- 8 3 3 3 Rooms Seats Employees 3 Machines Professionals Number of Machines: For Vending Business Only renum8 •ype: 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 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 WHEN VALIDATED 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. Thisreceipt does not indicate that the business is legal or that It is in compliance with State or local laws and regulations. Mailing Address: USHAC 3721 SW 47 AVE STE 305 DAVIE, FL 33314 2018 - 2019 Receipt #05A-17-00010230 Paid 08/09/2018 27.00 Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, FL 33138 Tel: (305)795-2204 • Fax; (305)756-8972 8/7/2018 To: Current Owner 790 NE 97 Street Miami Shores, FL 33138- Permit: PL-3-17-791 Address: 790 NE 97 Street Miami Shores FL33138- Dear Sir or Madam, Our records indicate that the above referenced permit has expired without obtaining the proper final inspection. In order to serve you better, we/need to keep our files up to date. As per section 105.4.1 of the Florida Building Code, "Every permit issued shall become invalid (expired) unless the work authorized by such permit is commenced within six months after its issuance, or if the work authorized by such permit is suspended or abandoned for a period of six months after the work is commenced, or completed without obtaining the final inspection of the work performed.." Please be advised that open permits will hinder your ability to obtain new permits, refinance or sell this property. Please contact the Building Department, within 15 days of receipt of this letter in order to take care of this matter. Sincerely, Ismael Naranjo (CBO) Building Director