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MCC-18-3053Miami 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 RECEIVED NOV 2 8 2018 FBC 20 BUILDING Master Permit No. CC (g .VSus PERMIT APPLICATION Sub Permit No. M C r ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: giVtiLy wv\ivr q _ (Apo* c-- c t-aVE7 City: Miami Shores County: Miami Dade Zip: Follo/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: Ian � C OWNER: Name (Fee Simple Titleholder): �'N 1 ( 1/� U6 ` 1 i Phone#: Address: II 300 N l% 74 A ���ww 3 1/ City: �� % N`�L 1 S � ��' State: ��L� Zip: � 1 b Tenant/Lessee Name: Phone#: Email: J y 'SA' -al 16') U, CONTRACTOR: Company Name: ' !� (AC//'.!27 /5 Phone#: 97 S9 Pi j Address: //l! o k/. cs G Al 6 ci Pe--. _ 17 City: ,�i!/'/ ‹ State: Zip: 33,Z� Qualifier Name: � •cL A • ))2 /,'�I A,.O Phone#: 9 Syg State Certification or Registration #: 5'7 O `/ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition/0Alteration �►� New ❑ Repair/Replace ❑ Demolition Description of Work: 4-Al A - ix/ f k/t k2?_ ..PA. or' 4 O /1t.6-14,4 /!api-i'o- ..... Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO/CC $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) 2 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 commencemen must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the abse i�; j of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrumentmwas acknowledged before me this 2 $�`'` day of IQ V ait ;/L ,20 , by SI SAN N11,1A" , who is personally known to _Lex who has produced as identification and who did take an oath. NOTARY PUB Sign: Print: St JAO �900249916 a Expires November 12, 2022 •.:ftt°' 6cadednaltoyFilInsranoe8003&F' 7019 s#,.....,411111ll0nsll lR$+es:*-wrslrxa###': APPROVED BY Signature CONTRACTOR The foregoing instrument was acknowledged before me this a -/ day of NO deervoJ & , 20 /1 se , by V.00 AO..'Uv'pelt/WO, who is personally known to me or who has produced. 'D L • as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: (me Seal: Plans Examiner OfU "P40,,MARJORIE SAAD-VENTURA ��µr� �State of Florida -Notary Public *= Commission # GG 149806 +' ' My Commission Expires �,m moo October 09, 2021 s###ss## Zoning (Revised02/24/2014) Structural Review Clerk ?Fi Signature Miami Shores Village 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. MC 18-3053 Owner's Name (Fee Simple Title Holder): BARRY UNIVERSITY Owner's Address: 1130 NE 2ND AVENUE Phone #: 305-899-3000 City: MIAMI SHORES State : FL Zip Code: 33161 Job Address (Of where work is.being done): 1130 NE 2ND AVENUE City: Miami Shores State: Florida Zip Code: 33161 Contractor's Company Name: PRECISION REFRIGERATION AC Phone #: 954 484 5711 Address: 4764 NE 12TH AVE City: OAKLAND PARK State: FL Zip Code: 33334 Qualifier's Name : James Blackford Lic. Number: CC 618 1545 Architect/ Engineer of Record Name: Address: City: State: Zip Code: Phone #: Describe Work: CHANGE OF CONTRACTOR hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shor harmless of all le al involv ment. 1130Dik,DA `of Signature tt44k7 Owner or Agent The foregoing instrument was aknowledged before me thisialday of NOU4ngifL,20(Yby ,U41u 4SfIVRIP`/ Who is personally known to me or who has produced as indentification. Nota Sign: \J a 4 A Commission a GG 249916 A:3 Expires November 1Z 2022 Bonds•J Tree* Insurance 800435.7019` Contractor or A(Mtect The foregoing instrument was aknowledged before me this 13TH day of NOVEMBER , 20 by JAMES BLACKFORD who is personally known to me or who has produced personally known as indentification. NotaP^ublic: Sign: C r Seal: • ZENOAYAH 11 MY COMMISSION K FF .r EXPIRES Ranson 17. 2020 ,1.Ct•:efl:fj+aa ilaraleNntwySurvinerar SS • Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Permit NO.: MCC-10-18-3053 Permit Type: Mechanical - Commercial Work Classification: Alteration PermitStatus: Approved Issue Date: 10/23/2018 Expiration: 04/01/2019 Parcel Number Project 11300 NE 2 AVE Landon Student, Miami Shores, FL 33138-0000 1121360010160-26 <NONE> Contacts t BARRY UNIVERSITY INC BARRY UNIVERSITY 11300 NE 2 AVE, MIAMI SHORES, FL 331616628 Owner PRECISION REFRIGERATION & AC REPAIR OF SOUTH FLORIDA LLC JAMES BLACKFORD 4764 NE 12 AVE, OAKLAND PARK, FL 33334 Contractor BARRY UNIVERSITY INC BARRY UNIVERSITY 11300 NE 2 AVE, MIAMI SHORES, FL 331616628 Applicant Description: INSTALL A NEW WALK COOL/FREEZER WITH FLOOR. Fees Amount Application Fee - Other CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fe'e Technology Fee Total: $50.00 $31.20 $22.96 $15.31 $10.40 $1,480.63 $3.00 $38.27 $1,651.77 1, Valuation: $ 51,021.00 Total Sq Feet: 3,556.00 Inspection Requests: 305-762-4949 Payments Total Fees Check # 9293 Amount Due: Date Paid 10/23/2018 Amt Paid $1,651.77 $1,651.77 $0.00 Building Department Copy 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: regulating,cort uctioi zoning �uthermore, I authorize the above named contractor to do the work stated. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws �Oc12qP, •orized Signature: Owner / / Applicant / Contractor % Agent Date October 23, 2018 Page 2 of 2 c3( \/ BUILDING 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 PERMIT APPLICATION OBUILDING El ELECTRIC El ROOFING 0 PLUMBING MECHANICAL El PUBLIC WORKS r\DOP¼J 0-g JOB ADDRESS: 1 i3o 2 City: Miami Shores Folio/Parcel#: Occupancy Type: Load: Construction Type: A County: RECEIVED T 08 ij18 0 BY. FBC 20 Master Permit No. 6.- 61g- 5145" Sub Permit No. Pi ao. 19 - 3:f53 0 REVISION 0 EXTENSION 0 RENEWAL El CHANGE OF CONTRACTOR 1/g OWNER: Name (Fee Simple Titleholder Address: / / 3 00 0 CANCELLATION Ej SHOP DRAWINGS I 0 i/v 1. 5)7eS Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: Phone AQ 9 3oo City: M Qvv Shoce s State: Zip: 33 ) I Tenant/Lessee Name: Phone#: Email: affy 2 1-1'Di OtA CONTRACTOR: Company Name: P C I 5 0 V1. -e f.'a-tPhone#: 451/ e_ C.- State: j C Addre City: Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: El Addition Description of or tit-9 ( S--) 02-1 e31) 17 Alteration SZNew in SVed a zip: Certificate of Competency #: Phone#: City: State: Zip - Square/Linear Footage of Work: ET] Repair/Replace ri Demolition a_A c ye L:c.\/Fr-e--ez.01 Specify colorcolor thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Permit Fee $ Radon Fee $ DBPR 5 Training/Education Fee $ 391 IOF $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 1,, C-S) ;-9 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 atl 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 low 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 a reinspection fee will be charged. 1 Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 51_1__ day of SPPS/Ag61....- , 20 , by day of 5e/h kyi let', 20 by who is personally known to o is personally known to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY P identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Print: Print: Seal 1400 Pf4k, Notary Public State of Florida Jeffry J Yao My Commission FF 168481 Expires 11/12/2018 APPROVED BY PtarP Examiner (Revised02/24/2014) ** Structural Review ***** ***** •**••********* ***** *•************* Zoning Clerk RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINE A OFESSIONAL REGULATION THE CLASS B AIR CON PROVIS B PRECISION G BOARD RTIFIED UNDER THE UTES EXPIRATION -T 31, 2020 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. DBA:PRECISION REFRIGERATION AND AC Business Name: REPAIR OF SOUTH FLORIDA LLC Owner Name: JAMES CHARLES BLACKFORD Business Location: 4764 NE 12TH AVE OAKLAND PARK Business Phone: 9544845711 Rooms Tax Amount Number of Machines: 54.00 Transfer Fee Employees BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. VALID OCTOBERI9 2018 Lauderdale,0. Ft. THROUGH SEPTEMBER 30, 2019 954-831-4000 Receipt#:HEATING/AIIRCONDITION Business Type: Business Opened:01/1s/2014 State/County/Cart 9e9:CAC1814 713 Exemption Dodo: Machines i r4 Professionals NSFFFee ,_e For Vending Business only a �t 4,Vending_7ype: Penalty° '+.a 1.Frior ,Yeas `.,CWiei ion Cost, 0.00� 0.00: CONTRACTR Total Paid 54,.00 464 THIS RECEIPT MUST^BE: POSTED;CONSI?ICUOUSLY [IV YOUR PL d BUSINES__' THIS BECOMES A TAX RECEIPT WHEN VALIDATED This taxj.s levied for thespiivilege#ofdoing business within Broward,Countyy and is•` non-regulatory;in nature. You rmust meet'"all;Courity and/or Municipaiity_pianning andFzoni requirements: ThiS Business,Tax,FRec iipt must to transferred1when the bush ess is sold ;bu iness name has ganged 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. 4 ..- Mailing Address: PRECISION REFRIGERATION AND AC REP. 3636 NW 83RD WAY COOPER CITY, FL 33024 dig {X'`3'.•1J --Y--— •r r zsx • Gu,...�.. ✓?L �„>ac��:4�`vi !', ..a rID.44�•_._�5.,,. t...., ut dT.n_-'��.�..l.. .: LY ... Receipt #20C-17-00001085 Paid 08/01/2018 54.00 ,` ® A Ro CERTIFICATE OF LIABILITY INSURANCE9/27/2018 DATE (MMIDDIYYYY) 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(les) 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 Certificate Department PHONE ,�). 888 728-0817 F(A/C fio); 954-452-0450 EMAIL Certificates@bbimi.com ApnRFSS• °C INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A:StarStOne Specialty Ins. Co. 44776 INSURED PRECREF-01 Precision Refrigeration & AC Repair of South Florida, LLC 4764 NE 12th Ave Oakland Park FL 33334 INSURER B :Depositors Ins Company 42587 INSURER C : INSURER D INSURER E : INSURER F : CERTIFICATE NUMBER. 111(1851823 • • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP WLIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYY� B x COMMERCIAL GENERAL LIABILITY ACPGLD03037051435 3/8/2018 3/8/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS -MADE X OCCUR PREMISES (EaENTED occurrence) $100,000 MED EXP (Any one person) $5,000 PERSONAL 8. ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JECT PRO LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINdED SINGLE LIMIT $ (Ea acciANY AUTO BODILY INJURY (Per person) $ A O D CERTIFICATE HOLDER 1 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 Insurance Services Page 1 of 1 ACCORE, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 10/03/2018 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. IMPORTAtertificate holder Is on ADDITIONAL INSURED, th o es) must be ernlorsed. SUBROGATION IS WAIVED, uhJect to (*Mile:eta holder in Neu of such endorsamentfe). the terms and conditions of the policy. certaIrt policies may require an enders merit A statement on certificate does not confer rights to the cER Automatic Data Processing insurance Agency, inc. 1 Adp Boulevard Roseland, NJ 07060 suR CERTIFICATE OF LIABILITY INSURANCE PRE SION REFRIGERATION & AC REPAIR ORA:PRECISION REFRIGERATION & AC REPAIR OF SOUTH FLORI 4764 NE 12TH AVE Oakland Park. EL 33334 COVERAGES CERTIFICATE NUMBER: 995825 i REVISION NUMBER: IS TO CERTIFY THAT THE POLICIES oF INSURANCE LISTED BELOW HAVE NELN ISSuE3 TO THE tIvSURED NAMED ABOve FOR THE POLICY PERi00 INDICATED NOTWITHSTANDING ANY REOU1REMEN r, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY GE ISSUED OR MAY PIERIAN, 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 L TR -PIXTViCT LOREN& NUREJN **FORMING WWI/ATTE k Tuchnotorry 'um* Cermenk, ER S R , RER D.: ITO NIRC * 4237 ANY AUTO ALI. OWNED AUTOS WORKERS ANSE RS' rrY A clizamoriVeve ITUTTAIERE IkkanArelary NI /00 firCRI'PItt tFERiknons bE$61., 8011...DIA.E0 AUrn$ soNowstED WIGS ETEHX»$ IN DESCRIPI1ON 0* opERATRwsitOCATIC*111 max Cortractot Lin. CACl/114713 CERTIFICATE HOLDER ACO Miami Shores Village Bldg Dept 10050 NE 2nd Ave Miami, FL 3313$ A marks Scludubc, m F, L S EACH TN1 1,.9 Pi r4LMStEssegs/osscsi s awe (WM.) $ AD INJURY NERAI AOGR ' r $ C AGO$ "A OM 8 IL !UM' RN' NAIRN INN ck• it I NACT, 0 U *NC* E.AcHAcoDENT 0112312111 01/2 019 UGEAS e • ea FivaoYE DISEASE • POUCH UT CANCELLA w s ON 1,000,000 ,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLJCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE Willi THE POLICY PROVISIONS, AtoNDRIZEDREmsENTATNE ,N• kt 1988.2014 ACORD CORPORTION AU rights reserved. The ACORD name and logo are registered marks of ACORD hups://adpia.adp.com/ISExternaliapp/index.html?clientid=2824498&requestFro --run 1013/2018