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MC-16-2480
Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 RPhone: (305)795-2204 Fi•OIDA Permit Permit No. C-9-16-24$0 Permit Type: Mechanical - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 9/12/2016 1 Expiration: 03/11/2017 Project Address Parcel Number Applicant 17 NE 105 Street 1121360060100 OLIVER &ANDREE STEPHANIE Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell OLIVER & ANDREE STEPHANIE 17 NE 105 Street --- - - -- MIAMI SHORES FL 33138- 17 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone EDUARDO GARCIA (305)456-2328 Tons: 1 Additional Info: AC AS PER PLANS A/C MINI SPLIT AND Classification: Residential Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Work: Scanning: 1 Fees Due Amount CCF $1.20 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.40 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 Valuation: $ 2,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC-9-16-61256 09/07/2016 Credit Card $ 50.00 $ 110.70 09/12/2016 Check #: 647 $ 110.70 $ 0.00 wvanaoie inspections: Inspection Type: Final Rough Duct Review Mechanical 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, 9e fo )going information is accurate and that all work will be done in compliance with all applicable laws regulating construction and ding. Futhermore, I tho ze the above -named contractor to do the work stated. September 12, 2016 Building De artment Copy September 12, 2016 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 ❑BUILDING ❑ ELECTRIC FBC 20 Master Permit No. Q_cIV- Q 11� Sub Permit No. - ❑ ROOFING 'N ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING 7 MECHANICAL ❑PUBLIC WORKCHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 17 NE 105 ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-2136-006-0100 Is the Building Historically Designated: Yes NO X Occupancy Type: - Load: - Construction Type: - Flood Zone: - BFE: - FIFE: - OWNER: Name (Fee Simple Titleholder): OLIVER SERVAT Address: 17 NE 105 ST City: MIAMI SHORES State: FL Tenant/Lessee Name: - Email: - CONTRACTOR: Company Name: ALEX A/C REPAIR Address: 1680 W 38 PL BAY A-1 City: HIALEAH State: Qualifier Name: MANUEL A SALAZAR State Certification or Registration #: CAC056759 DESIGNER: Architect/Engineer: - Address: - one#: 305-226-6664 zip: 33138 one#: - one#: 786-229-7465 FL Zip: 33012 Phone#: 786-470-7040 Certificate of Competency #: - Phone#: City: - State: - Zip: Value of Work for this Permit: $ 3,000.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace Description of work: INSTALLATION OF A NEW A/C AND VENTILATION Specify color of color thru the: Submittal Fee $ - Permit Fee $ - Scanning Fee $ - Radon Fee $ - Technology Fee $ - Training/Education Fee $ Structural Reviews $' - ❑ Demolition CCF $ - CO/CC $ - DBPR $ - Notary $ - Double Fee $ - Bond $ - TOTAL FEE NOW DUE $ - (Revi sed02/24/2014) 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 which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be einspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this day of ' 20 by e , who is nally kn n t me or who has produced - as identification and who did take an oath. II NOTARY PUBLIC: ee W. 0-, ICONTRACTOR The foregoing instrument was acknowledged before me this 29 day of SEPTEMBER 20 17 by MANUEL A SALAZAR who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: as II I Sign Sign: L2Z!�&� I_ ' MAHARAIK.GONZALEZ Print: P DRO VELASCO IPrint: = I�Seal: ?� °a Fo ;; EXPIRES:November2,2120 Banded Thru Seal: t;x�'P' •., PEDRO A. VELASCO ,•' Notary Public Underwriters r°. �`: Notary Public - State of Florida Commission `. GG077946 My Comm. Exoires Apr 25, 2021 l 11aInsaminer Bondedthrou ,,,onalkotaryAm. Zoning APPROVED BY Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 17 NE 105 ST City: Miami Shores Village County: Miami Dade zip Code: 33138 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑■ NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER CARRIER AHU or PKG. UNIT MODEL # 40MBQB18D-3 COND. UNIT MODEL# 38MAQB18R-3 KW HEAT - NOM TONS 1.5 AHU CU PKG- 1) M.C.A AHU CU PKG 20AMP AHU CU PKG- 2) M.O.P AHU CU PKG- AHU CU PKG- 3) VOLTS AHU CU PKG 208-230 PKG UNIT / / PKG UNIT EER/SEER 18.5 YES NO- REPLACING DUCTS YES NO YES YES NO- REPLACING THERMOSTAT YES NO YES YES NO- NEW 4"CONCRETE SLAB YES NO YES YES NO- NEW ROOF STAND YES NO No YES NO- NEW RETURN PLENUM BOX YES NO NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: ALEX AC REPAIR Phone: State Certificate or Registr No. CAC056759 Certificate of Competency No. Signature Date: 9/29/17 (Qualifier's signature) (Revised02/24/2014) 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. 1 V — ?, A O Owner's Name (Fee Simple Title Holder): Phone #: Owner's Address: /% &,f — /d 4j' 7" City: State L- Zip Code: 3 3 fob Address (Of where work is being done):_ City: Miami Shores Contractor's Company Name: Address: City: Qualifier's Name: 40- Architect/ Engineer of Record Name: Address: City: Describe Work: G � State: —Florida Zip Code: Phone #: State: Zip Code: 3 3 D /3 GrCtA. Lic. Number: 0,j�/YI QyOU '8y State: Phone #: Zip Code: 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 Shores harmless of all legal involvement. Signature Signature n or Agent Contractor or Architect The foregoing instru en — knowledged before me The foregoing instrument was aknowledged before me this L day of ,2011,by i Z C- — this day of 20 by Who i ers �y�nmeorvvh—ohas. uced who is personally known to me or who has produced as indentification. as indentification. Nota ublic: Sign: Seal: MAHARAI K. GO NZALEZ MY COMMISSION # GG 044602 -�` EXPIRES: November 2, 2020 Bonded Tluu Notary Public Underwriters Notary Public: Sign: Seal: 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 or Engineer A change of contractor, architect or engineer must be done under a permit number. There is a $75.00 charge for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized signatures. If the signature of the previous contractor cannot be obtained the owner must send a certified letter/return receipt notifying the previous contractor, architect or engineer the reason for the change. The owner must allow 10 business days for the contractor, architect or engineer to respond. A permit application must accompany the change of contractor form, with the information and signature of the new contractor. The new contractor must be registered with the Village or must submit the required documents to register with the Village. 1. Change of Contractor form completed, signed and notarized. 2. Permit application by new contractor. 3. Required fees. 4. Copy of original letter sent via certified mail along with the returned receipt. In addition to the requirements above the architect or engineer of record must authorized the new architect or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed. if .i Sindia Alvarez From: Sent: To: Cc: Subject: Good afternoon Mr. Cancio, Ismael Naranjo Friday, November 17, 2017 3:52 PM Jesus Cancio; Arlenis Silvera; Olivier Servat Sindia Alvarez; Yanady Prieto; Maharai Gonzalez RE: Change of mechanical contractor CEIVED N V 17 2017 Yes, the email will suffice. I was also informed by our electrical inspector that the electrical rough for the house has been approcved. Thank you. Ismael Naranjo, BO, CFM Building Director Miami Shores Village 10050 NE 2 Ave Miami Shores, FL 33138 Office: 305-795-2204 Fax: 305-756-8972 www.miamishoresvillage.com From: Jesus Cancio [mailto:jesuscancio@yahoo.com] Sent: Friday, November 17, 2017 12:43 PM To: Ismael Naranjo <Naranjol@msvfl.gov>; Arlenis Silvera <SilveraA@msvfl.gov>; Olivier Servat <oservat33@gmail.com> Subject: Fw: Change of mechanical contractor 1 Hello Ismael please verify that this email from Mr. Garcia will suffice as verification for the change of 4 contractor so we can call for ac rough inspection. Thank you, Jesus Cancio P.D.G. Construction 7105 SW 8 ST. SUITE 405 (305)226-6664 On Wednesday, November 15, 2017 6:14 PM, CAMACHO CONSTRUCTION <camacho_construction Photmail.com> wrote: ..7 From: ed-garcia@comcast.net <ed-ga rcia @comcast. net> Sent: Wednesday, November 8, 2017 11:50 AM Cc: Camacho construction Subject: Change of mechanical contractor Hello Mr. Naranjo, my name is Eduardo Garcia C.C.# 96M000080, I'm the qualifier / contractor for the mechanical permit at 17 NE 105 St. I do not have any objection to be removed as the Mechanical Contractor on the job at the mentioned address. Please do not hesitate to contact me at any time. My cell 786-346-5899. Regards, Eduardo Garcia RICK SCOTT. GOVERNOR ✓L ",- 1 1 "_1 \- KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The CLASS AAIR CONDITIONING CONTRACTOR 4 Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31 2018 SALAZAR MANUELA ALEX AC REPAIRS INC.::: 1680 W 38 PL BAY Al. HIALEAHIle 12 r ISSUED: 07/12/2016 I: t !' t I DISPLAY AS REQUIREDLBY LAW1 SEQ 4 1-1607120000592 004265 Local Business Tex Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 6679170 BUSINESS NAME/LOCATION RECEIPT NO. ALEX AC REPAIRS INC RENEWAL 1680 W 38 PL BAY A—i 6951561 HIALEAH FL 33012 EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS ALEX AC REPAIRS INC 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED CAC056759 BY TAX COLLECTOR Worker(s) 3$45.00:=08/07/20.1.7.=.._.-:rt,: CREDITCARD-17-052495 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 N0, above must be displayed on all commercial vehicles — Miami —Dade Code Sec lla-276. For more information, visit www.miamidade.gov/laxcallector A 01: � � � - CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYY) 9/29/2017 ' 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 A&D ALL -LINES INS ASSOC INC 5600 SW 135 Ave Ste 106 Miami, FL 33183 CNAOMNTCT :A PHONE 305 463-6781 FAx 305) 387-2918 A/ " AD AIL sama or a Bout .net INSURERS AFFORDING COVERAGE NAIC# INSURERA,LLOYDS OF LONDON INSURED ALEX A/C REPAIRS INC. 1680 WEST 38 PLACE bay al BAY A-1 HIALEAH, FL 33012 786-470-7040 ALEX INSURER B: FLORIDA CITRUS, BUSINESS i INDUSTRIES FUND INSURFR Q FUBA INSURER D. INSURFRF INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBFR: 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. ILTR TYPE OF INSURANCE INSR WVD P Y IJ M R MM/LDD//YYYY POLICY M D /YYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITYTL AmAL $ 100,000 MED EXP (Anyoneperson) $ 5 000 CLAIMS -MADE [:) OCCUR PERSONAL&ADVINJURY $ 1,000,000 A y CIBFL0044769 9/19/17 9/19/181 GENERAL AGGREGATE $ 2,000,000 GEN L AGGREGATE LIMITAPPLIES PER: —1 PRODUCTS - COMP/OPAGG $ 1,000,000 7P Y PRO- $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E n BODILY INJURY (Per person) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY r n DAMAGE $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED I I RETENTION WORKERS COMPENSATION X I WC STATU- I OTH- B AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 10640613 0 4 / 01 / 17 0 4 / 01 / 18 E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ r 000 If yes, describe under DESCRIPTION OF OPERATION bekrva E.[.DISEASE - P I Y LIMIT 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101,Addibonal Remarks Schedule, if more space is required) LICENSE NUMBER CAC056759 Miami shores village bldg dept lOOSO NE 2 AVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVER§4 IN Miami shores, fl. 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATI . All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department SEP072016 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 19v. Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 201`t BUILDING Master Permit No. RC. 1(6- -1 �g PERMIT APPLICATION Sub Permit No. I „C_1 `0 - �?�I ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING A4MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADD ESS:j 4 N E D S� City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO_ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): t�L/ �t✓r1L Srsnyi� %Phone#:130S- k/b - q 1 & f 1,Adiiress? Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �,a(� G7-4=r Cc ILA Phone#: / o o O O9 Address: % l 0 [� g S� City: // / '% F-L Zip: Qualifier Name: &-1)0'1q 2D0 C14-fe-c..1 A Phone#: State Certification or Registration #::?A OD /u IG 4 % 9 Certificate of Competency #: G (o M d o©eo V O DESIGNER: Architect/Engineer: Phone#: Address: City: State Value of Work for this -Permit: $. 2_Oob Square/Linear Footage of Work: _ Type_of.Work: W Addition ❑ Alteration ❑ New ❑ Repair/Replace Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $ 0 Permit Fee $ CCF $ ( 2.0 CO/CC $ Scanning Fee $ 3 - Q Radon Fee $ 2 4 DBPR Notary $ �U Technology Fee $ t - 6d Training/Education Fee $ n • L4 C) Double Fee $ Structural Reviews $ 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 wh' h,sju ors seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be app oved am xreinspection fee will be charged. igna ur�l Signature OWNER or AGENT 'he foregoing instrument was acknowledged before me this t !' day of -N t €+" 20 .'t �� by who is personally known to ne or who has produced .1.• far as identification and who did take an oath. NOTARY PUBLIC: Print: Seal CONTRACTOR The foregoing instrument was acknowledged before me this 41 day of CAA ,�,y� 20 1 :P by �rLA,2Lt Wa who is personally known to me or who has produced MTM as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: ^ 014m 4ilIFF071450 Seal: OQ'IRES:May 1, ft ftxbd ni^! N*y RabRa U,�dr+ ,itorr, MARTA ACOSTA W COMMISSION f FF 971450 OMRES' My 1. 2020 B=I9d Thu NotaryPL Mo Undewbm ********************** ** **************************************************************************** APPROVED BY ns Examiner Zoning Structural Review Clerk (Revised02/24/2014) Inspection History Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 MC-9-16-2480 Mechanical - Residential` Project: <NONE> Owner: OLIVER 81 ANDREE STEPHANIE SERVAT 1 A�`_ATTI I Phone: Job Address: 17 NE 105 Street Parcel: 1121360060100 Miami Shores, FL 33138- Block: Lot: Scheduled Insp # Inspection Type Inspection Status Inspector Date Completed 01/01/2999 INSP-266849 Underground NONE Default Inspector Not Complete 01/01/2999 INSP-266848 Final 01/01/2999 INSP-266847 Rough Duct 01/01/2999 INSP-266850 Review Mechanical NONE Default Inspector Not Complete NONE Default Inspector Not Complete NONE Default Inspector Not Complete Thursday, May 25, 2017 Page 1 of 1 O m „ rn �¢ C4 o W Lume ♦A Q Qf u >o o^ » S r � ]w n a Y fQb Q` EiC d I.LI X Si3 � � � o � � � a• N I uj( :LZ � � is tjj m a r F�Zea a Lu w =I L!!S] it m� 5 iz.� $gym �'x �wo , ca 9NI Aft It .� Y m v u- m �l: to lit sa g if X cog o � cz _ M N m Q ` O Q ena mow -3y U G 'Z3 o x m f�� W f�pp ib 10 Vi eL n7 a c•.mr R STATE OF FLORIDA ((�� B DEPARTMENT OF 8USINE58 AND CT42 PROFESSIONAL•, i�EGULATION su$s "°" T`� i�`�,tg awn E.4S CERTIFICATE OF �J TE c0 RA0086789 ; SSlI : _.0911st2015 0 80 RE©'AIR CON H?I�tG r.0W ACTOR GARCtA, EEWAR iQ DUARDO GA�RCW INDIVIDUAL '� (INDIVIDUAL MUST -BA: F; �i�'D�CAL 10ENONG REOI.IIRI-E.N7M' rojoR ' TO CONTRACTING 19ANYAREA) HAS REGISTER -CD artder tee Rso4iBlOns of Ch.489 FS. EQUARDO E.O?cAli�ndde AW 31, 2017 i.�50�EOt�tS87� iS wed iCtlr Ufb DR> fOrt9 of G 10Of bl --� _ QUALIFYINGTRADF(S) AC# 012 O 9 4 5 5 0001 GENI- MECHANICAL anew Haims �s PR ww�wewa�Y�.es Miami -Dade County - Building and neighborhood Compliance Office Page 1 of 1 Home Product Control I Contractors BuJding Officials I Contact us 1 Contractor License Information Contractor Number: 96M000080 Contractor name: EDUARDO GARCIA Address: 710 EAST 48 STREET City, St, Zip: HIALEAH FL 33013 Phone: (305) 456-2328 Other Phone: Fax: Email: D/B/A: Contractor Status: ACTIVE Class Category Category Description Expiration Date MECH 1 GEN'L MECHANICAL 09/30/2017 CONTRACTOR INQUIRY COMPLETE BCCO Contractor Inquiry and Complaint Search I BCCO Home Pao e I St-te License Search Menu a Home I About I Phone Directory I Privacy I Disclaimer © 2001 Miami -Dade County. All rights reserved. http://egvsys.metro-dade.com: 1608/WW WSERV/ggvt/BNZAW941.DIA?CNTR=96M00... 11 / 10/2016 ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/29/2016 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(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 CONTACT NAME: Pablo Conde A&A Underwriters Inc. A/c No Ext : (305) 220-7447 a,c No ; 305-220 4821 E-MAIL ADDRESS: pmc@aaunderwriters.com 8778 SW 8st INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Ascendant Commercial Insurance, Inc Miami FL 33174 INSURED INSURER B : BusinessFirst Insurance Company INSURER C : Eduardo Garcia INSURER D : 710 East 48th St INSURER E : Hialeah 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 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 SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1 F�7/ OCCUR GL-51859-0 04/02/2016 04/02/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 GEN'L X MED EXP (Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- JECT LOC OTHER: GENERAL AGGREGATE \ $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ A AUTOMOBILE x LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS NON -OWNED HIREDAUTOS AUTOS PIP / UM X Comp/Coll CA-41092-0 06/01/2016 06/01/2017 COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ 10,000 BODILY INJURY (Per accident) $ 20,000 PeOPERZDAMAGE $ 10,000 Medical Payments $ 5,000 UMBRELLA LIAB EXCESS LIAB Ld OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBER EXCLUDEDANY ? (Mandatory in NH) � If yes, describe under DESCRIPTION OF OPERATIONS below N / A 521-11366 04/18/2016 04/18/2017 X STATUTE ERH E.L. EACH ACCIDENT $ 1 ,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) ' **************** *Mechanical Contractor'--*---* Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores 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 FL 33138 ` /'r~--"-- (019SU-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD