MC-18-2997Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: MC-10-18-2997
Permit Type: Mechanical - Residential
Work C/assification: Addition/Alteration
Permit Status: Approved
Issue Date10/16/2018 Expiration: 04/01/2019
Location Address Parcel Number Project
77 NE 105 ST, Miami Shores, FL 1121360060150 <NONE>
Contacts
EZEQUIELZYLBERBERG Owner JESSICA SCHILLING Owner
77 NE 105 ST, MIAMI SHORES, FL 33138 77 NE 105 ST, MIAMI SHORES, FL 33138
Mobile:5617032510 SCHILLINGESI@GMAIL.COM Other:9546293012
JESSICA SCHILLING Applicant COOL FREEZE AC CORP Contractor
77 NE 105 ST, MIAMI SHORES, FL 33138 ERNESTO RODRIGUEZ
Other: 9546293012 8430 NW 68 ST 1, MIAMI, FL 33166
Business: 3055919794
Description: NEW DUCTS, VENTILATION AND REPLACE AC. Valuation: $ 9,000.00 Inspection Requests:
1305-762-4949
TotalSq Feet: 230.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$5.40
DBPR Fee
$4.72
DCA Fee
$3.15
Education Surcharge
$1.80
Permit Fee
$265.00
Scanning Fee
$3.00
Technology Fee
$7.88
Total:
$340.95
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$340.95
Credit Card
10/16/2018 $340.95
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--6fiing. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / App ontractor / Agent Date
October 16, 2018 Page 2 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (30S) 79S-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
OCI 012018
FBC 201
Master Permit IN
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING 01 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS: 6
/ �
�OS-
City: Miami Shores
County:
Miami Dade Zip: 7131
3e'.
Folio/Parcel#: ((2- / 34 ()0 66 /-�-o
Is the Building Historically Designated: Yes
NO
Occupancy Type: Load:
Construction Type:
Flood Zone: BFE:
FFE:
I
%r
OWNER: Name (Fee Simple Titleholder):
_m/32� Phone#:
Address:
City: kf ! -Ar-v/ '`to State:
Tenant/Lessee Name:
Email
h
-33" / 3,F
CONTRACTOR: Company Name: Ccd Cr .Ze-/?e- Phone#:
Address: & Y 2- Qv-, '�-j
City: \ /Pr l State: Zip: �r�
Qualifier Name: (. - !' �2 Phone#: ��t7 `-I "t 0 L4?9
State Certification or Registration #: C KAg Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: _
Address: q City: State:
Value of Work for this Permit: $ ! -0,00 - Square/Linear Footage of Work:
Type of Work: ❑ Addition ® Alteration P New ❑ Repair/Replace
r
Descri tion of Work: �� ► I , Dw
Zip:
❑ Demolition
Specify color of color thru the:
Submittal Fee $ Permit Fee $ ®O CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ � • —f
(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 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 charge
1
Signature
OWNER or AGE
The fore oing instrument was acknowledged before me this
�4day of lls;cp 1 .20 ls, by
(4 Q VA JP(��� 1 Wi);C45 known to
•
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
' ;�: MY COMMISSION # GG
Print:
Seal:
d.
Signature 12=
CONTRACTOR
The foregoing instrument was acknowledged before me this
2—S day f P!/' 20 by
i
who is personally known to
me or who has produced G D as
identification and ho did take an oath.
NOTARY PUBLIC;
Print:
Seal: MY COMMISSION # FF914890
EXPIRES September 01. 2019
A .. MY COMMISSION 044602
r'�^"•(�
:„ o�g
PI Examin r Zoning
s';:�Q 't •'• Bonded Thru Notary Publiic Underw item
Structural Review Clerk
(Revised02/24/2014)
•A,1
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):
City: Miami Shores Village County: Miami Dade Zip Code:
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
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
KW HEAT
NOM TONS
AHU
CU
PKG
1) M.C.A
AHU
CU
PKG
AHU
CU
PKG
2) M.O.P
AHU
CU
PKG
AHU
CU
PKG
3) VOLTS
AHU
CU
PKG
PKG UNIT /
/
PKG UNIT
EER/SEER
YES
NO
REPLACING DUCTS
YES
NO
YES
NO
REPLACING THERMOSTAT
YES
NO
YES
NO
NEW 4"CONCRETE SLAB
YES
NO
YES
NO
NEW ROOF STAND
YES
NO
YES
NO
NEW RETURN PLENUM BOX
YES
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: (�Od �✓` ��i— Phone:
State Certificate or Registration No. li( l 11 2 2— Certificate of Competency No.
Signature 7,Date:
(Qualifier's signature)[
(Revised02/24/2014)
- - I
STA�E'OFjL�t !C DEPARTMENT
dbjvT),t0GU
�'OF,iUSINESS:AND •eROFESSIONAL
LAT.fO
CAC1818272 �sti,Ed'07/16/2018
El AI CLASS R, NOITIONING CONTRACT_ OR: ='• ,
RODRIGL! �RNESTO -
r-:,
COOL FREEZEA/C.bORP�-r•
t.Y ! ' Sift�
LICENSED UNDtR CHAPTER4489,.�FLORIMSTATUTES
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EXPIRATION DATE:`AU6UST S1.1=6 - '
a ADk,, G`1I d tFl�JZjpq•DEPA�PROFRTNIENNTrydF13USiAESS AWpERTM
REGULATION- `
CAC181&1?1 j" ' - ' - `... ,
CLASS A Aik, g dMONINGICO y ' _ ISSUES? 0/16/2018
RODRIGU.E�!gpj4tSTO. k -1 , _ NTRACMR i
COOL FREZq%C CORD= i` =" -
_ s'�
f .� C � ,•l t l
LICENSED UNDER C ' , - SlSnat
EXPIRATION DATE AV&ST 3I "
Local Busum=R .
Miami -Dade Count}y�' State offlorid;
�o
-THISISNOTA8ILL- orida
DO NOT Pqy
7188395
SUSINEUS NAME/LOCAnON
COOL FREEZE A/C CORP
7750 NW 71 ST ST 126A
MIAMI FL 33166
OWNER
COOL FREEZE NC CARP
C/0 ERNESTO RODRIGUEZ.PRES
Worker(s) 3
RECEIPT NO.
RENEwAi. EXPIRES
7469508 SEPTEMBER 30, 2019
Must be displayed at place of business
Pursuant to County Code
Chapter eq _ Art. 9 & 10
Wit• 74PE OF BUSINESS
196' "MECHANICAL CONTRACTOR PAYMENT RECEryED
CACi8M 2 BY TAX COLLECTOR
$75•00' 07/16/2018
This Local 80310ea Tex Rea• CREDITf.ARf1-18—Q54575
ponaiL or a co IMe o �I nd"mq" a� ato to bubo" &aloes: Tax Rscalp, is not a license
or noaporemwt dca*80icati
The RECEIPTNO.'ab"s htrvs an rs ess Holder
nnat be dlsphryrod on ailwhici aaPh to the bwlnass, � vvitlt spry 9e►remiaen6
caamorcial
For arore iaf 'nags ..sit vehicles-
Mlawi-Dada Code Sec bl-2X
19D16M•mlamidad■cco,
011
CERTIFICATE OF LIA131LITY INSURANCE
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AFFIRMATIVELY OR NEGATIVELY At EXTEN[D OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE
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NSURER(Sk, AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER.
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PRODUCER
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PO Box S316
Binghamton, NY 13902 1AI
NOURER(l) AFF"RG COVERAGE
COOL FREEZEAJC CORP I : InHar
7052 NW 77 CT
MIAMI FL 33166
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CERTIFICATE 146L-D—ER CANCELLATION
MIAMI SHORES BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED PCUCIES BE CANCELLED
SHORES
10050 NE 2 AVE BEFORE THE EXPIRATION DATE THEREOF, NOTICE VVILL, a[! DELIVERED IN
MA
Mi SHORES
t ACCC)"ANCE VM THE POLICY PROVISIONS
[M11AMi SHORES MLLAGE FL 33138 AvrowzED REPRUYWATNE
C 1988-2010 ACORD CORFO—P-A—T-1054F. All —lightsmsorvod.
ACORD 25 (201(MS) Th2 ACORD nerne rnd 1090 =0 rovistamd mcrom of ACORD
BID 013 20130603 1 1
CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED ASA 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 SELOW,
THIS CER11FICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMFO—WT—ART: If thecartif.;cataholder isanADDITIONAL INSURED, the policy 0-) rnust have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS
WAIVED, subject to the terms and conditions of the policy, certain policies may reRuitG en endorsement- A slaten*nt an this certificate does not confer rights to the
certificate holder in lieu of such andorsensenjfsj.
FrartkCrurn IrmtranceAgemy, Inc.
100 South Wissouri Avenue
FrankCrum L/CJF Cool Freeze AIC Corp
100 South Mssouri Avenue
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VERTA K. STAkJMAWRECUMAM-IT TrRU OR CONDtTM OF ANY CCINTRACT OROTHERDOCU'JENTv'MTJj RE93ECT To%vmicn rws cEnTmATE MAYS E ISSUED OR MAY
THE INSURANCE AFFORDED BY THE POL"S CREED KE. REIN IS 3tMXCT TO ALL THE TERMS, E(CLUSIONS AND CON=ajS OF err POLICIES.1-IMITS SHMW
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S"OULDANY OF THE ABOVE OE' EMBED POLTIES BE CANCMIED BEFORE TIDE
EXPIRATION DATE THEREOF, NOTICE WEL BE DELP&PX0 n AcCOsWAWt- virni THE
MIAMI SHORES BUILDING DEPARTMENT. MUCY PROVISIONS
10050 NE 2 AVE
MIAMI SHORES VILLAGE FL, 33138 AUTHORIZED RE; _MSENTATIVE
ACORD 25 (2016M) The ACORD narne and logo are registered marks of ACORD 0 19 W-2016 ACORD CORPORATION. All tigtds reserved.