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MC-18-2459Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Permit NO.. MC-9-18-24S9 Permit IVR Number: 622549 ` Permit Type: Mechanical - Residential Work Classification: A/C Replacement Permit Status: Approved issue Date:09/28/2018 1 Expiration: 03/18/2019 Parcel Number Project 338 NW 111 TER, Miami Shores, FL 33168 1121360010560 <NONE> Contacts CITI MORTGAGE INC Owner CITI MORTGAGE INC Applicant 1000 TECHNOLOGY DR MS 314, OFALLON , MD 63368 1000 TECHNOLOGY DR MS 314, OFALLON , MD 63368 XTREME COOL SERVICES Contractor LUIS CARVAJAL 13876 SW 56 ST 276, MIAMI, FL 33175 Business: 3053824500 Description: AC REPLACEMENT 3.5 TON Valuation: Inspection Requests: uests: 305-762-4949 0Total Scl Feet: Fees Amount CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $127.58 Scanning Fee $9.00 Technology Fee $3.20 Total: $146.98 Building Department Copy Payments Amt Paid Total Fees $146.98 Credit Card $96.98 Check # 2992 $50.00 Amount Due: $0.00 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. Authorized Signature: Owner / Applicant / Contractor / Agent Date October 04, 2018 Page 2 of 4 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Ave, Miami Shores, Florida 33138 Tel: 305-795-2204 Fax: 305-756-8972 Inspection Number: INSP-000426-2018 Scheduled Inspection Date: October 09, 2018 Inspector: Perez, Jan Pierre Owner: CITI MORTGAGE INC Address: 338 NW 111 TER Miami Shores, FL 33168 Project: <NONE> Contractor: XTREME COOL SERVICES LUIS CARVAJAL Building Department Comments AC REPLACEMENT 3.5 TON Checklist Item Passed Comments General Comments False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Permit Number: MC-9-18-2459 Permit Type: Mechanical -Residential Inspection Type: Mechanical Final Work Classification: A/C Replacement Phone Number: Parcel Number: 1121360010560 Phone Number: 3053824500 , L-,-) � (�' ( n' October 05, 2018 For Inspections please call: 305-762-4949 Page 2 of 30 Miami Shores Village �r `r - I,',) Building Department SEP 18 018 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 BUILDING Master Permit No. 1`� n►aA —24scl PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ROOFING REVISION ❑ EXTENSION ORENEWAL ❑PLUMBING [)g MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: � % g %� � 4J l � I ��'r•• � 2 City: Miami Shores County: Miami Dade Zip: '22 , J b6l?r Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �'.4-1, mc., v-4 e_ Phone#: q 7 7- Z q0 ' 39q 7 Address: / 0 G (7 City: 0 l" I Iy // VI State: S'�o fit, Zip: (V Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: XTI-115*4E eO P k SE'd J r elm Phone#:: b.S 3S2 Sg6zo Address: /0074. S&A .-4o Si City: �J i A LA - State: 1 Zip: Qualifier Name: LU 1 S C ALy Q."1 _%S Phone#: _"'50.5" 501 1$61 State Certification or Registration #: 0—A C_ \I&l % S5(, Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State Value of Work for this Permit: $x (�4-S Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ lew ❑ Repair Description of Work: Specify color of color thru tile: Submittal Fee $ Sb 1 Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ Zip: ❑ Demolition - 230-1 CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whiciyoccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not I approv d and�a rejpspectign fee will be charged. Signatu ot AG The foregoing instrument was acknowledged before me this day of 20 � by 0 Z , who is 6Eally know to me or who has produced iden NOT Sign Print Seale as Signature _ J// CONTRACTOR The foregoing instrument was acknowledged before me this % 2 day of SepTem 4r . 20 a , by *Ly/5 &gr!WA-1 .ti. , who is personally known to me or who has produced Q L as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ,,••�;�� :r., MARIA M. PATTERSON Seal: Notary Public - State of Florida Commission # GG 120907 rc#: My Comm. Expires Aug 25, 2021 I'w:;�•' Bonded through National Notary Assn. APPROVED BY I la ns Examiner Structural Review Zoning Clerk (Revised02/24/2014) M1 RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY Florida pr,l STATE OF FLORIDA DEPARTMENT OF BUSINESS�A-NDr.P OFESSIONAL REGULATION CONSTRUCTsI� 1INDU,STRY= �ICENSING BOARD THE CLASS AAIR CONDITLON'ING`.-C,ONTRAC OR=HERE IS CERTIFIED UNDER THE PROMIS 4,S Off-H T.ER.489-FL=ORIDA S — UTES CQQL SER+[I.C_E�CORPORA 11�3$'7'6�S:W�5;6ST 27�i= LI'C�ENS INUNtBERCAC-�181SS36 EXPIRATIONRD TE: AUG.UST 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. A`CORQ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2018W) 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 Peoples Insurance Agency Of Florida CONTACT ALEJANDRO MARTINEZ NAME: A/c°NNo Ext • (754) 200-4886 FAX No): (754) 200-4896 E-MAIL globalgreen7557@gmail.com 1808 N UNIVERSITY DR INSURERS AFFORDING COVERAGE NAIC # PEMBROKE PINES, FL 33024 INSURER A: FEDERATED NATIONAL 10790 Phone (754) 200-4886 Fax (954) 505-3896 INSURED INSURER B : INSURER C : X-TREME COOL SERVICES CORP INSURER D : 13876 SW 56th #276 INSURER E : MIAMI FL 33175 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 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 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 ADD INSR UBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD LIMITS A COMMERCIAL GENERAL LIABILITY ❑ CLAIMS -MADE❑ OCCUR Y Y GL-0000024697-03 10/18/2017 10/18/2018 EACH OCCURRENCE $ 1,000,000.00 PREM SESOEa occuence $ 100,000.00 MED EXP (Any one person $ ,000 ❑ PERSONAL 8 ADV INJURY $ ,000,00 1 000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO JECT ❑ LOC ❑ OTHER GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 _ $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AALL UTOS OWNED ❑ SCHEDULED AUTOS NON -OWNED ❑ HIRED AUTOS ❑ AUTOS ❑ ❑ COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ PROPERTY DAMAGE Per accident $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA A ❑ STAT T ❑ EERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) A/C REPAIR, INSTALLATION AND SERVICE CFRTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shore Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 ALEJANDRO MARTINEZ @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) CIF The ACORD name and logo are registered marks of ACORD Xtreme Cool Services Corp 13876 SW 56 St. Suite #276 Miami Florida 33175 Date: September 12, 2018 State of Florida County of Miami -Dade Before me this day personally appeared UI 5rl/A J#4 who, being duly sworn, deposes and says: That he will be the only person working at the project located at: A/ Contrpctor Signature Sworn to (or affirmed) and subscribed before me this 12 day of �;E T,emhf,J .20 11 BAU I s 11 -_ Personally know Or produced identification Type of identification produced OL 4rla Pa71_1w0 n Print, Type or Stamp Name of Notary MARIA M. PATTERSON • ��`� Notary Public - State of Florida ` • ' • Commission t GG 120907 " mot: My Comm. Expires Aug 25, 2021 Bonded through National Notary Assn. 010228 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6076996 BUSINESS NAMEMOCATION RECEIPT NO. EXPIRES XTREME COOL SERVICES CORPORATION RENEWAL SEPTEMBER 30, 2018 13780 SW 56 ST 214 6339337 Must be displayed at place of business MIAMI FL 33175 Pursuant to County Code Chapter BA - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS XTREME COOL SERVICES CORPORATION196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED CAC1815536 BY TAX COLLECTOR Worker(s) 1 $75.00 07/11/2017 CHECK21-17-056405 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 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.miainidade.govftaxcollector per. JIMMY PATRONIS CHIEF FiNANICAL OFFICER STA T F O i=i_c:tRI1J%a DEPARTMENT OF FINANCIAL SERVICES rjiliiSi0W OF iT (;R iFRS* t,.Oi-Oi ENSA T iO€V y CErc iF€ ^.A. T i- OF ELECTION ION TO SE EXEM.P € FRO44 FLORMA WORKERS' C,OlMvMENSA'710N LAW * * is OWS T RUC. T ION Dj1)US T €KY Ei(=-PPP T iON This Ccfl.iila;S that uit; ti'iCIiViCjtial listedbelow has cicCtcd to be cncRlpt iPGiii Florida Workers''Compensation. laxJ. EFFECTIVE DATE: 9/231201 7 PERSON: CARVAJAL 19N: 680635399 BUSINESS NAME AND ADDRESS: XTREMvIE COOL SERVICES CORPORATION 13876 SW 56 ST SUITE # 276 , MIAMI Fi.. 3317.; SCOPF- OF BUSMESS OR TRADE: Heating, Ventilation, Air- Condilioning and Refrigeration Svstems Installation. Service and Repair, Shop. Yard & Drivers EXPic ATiON DATE: 9/23120 i 9 LUIS JR IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing 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... appi; only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13). F.S., Natices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at anv time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DVVC-252 CERTIFICATE OF ELECTION TO of EXEMPT REVISED 08-13 QUEST IONS? (850A 13-1609