MC-18-1964`ywO12es L,�
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
�t""oRi"vA
Phone: (305)795-2204
Permit NO. 11 C-7-18-1964
Permit Type: Mechanical - Residential
aWork Classification: Addition/Alteration
Permit Status: APPROVED
issue ,oats. 7/2'7/2018 J Expiration: 01/23/2019
Project Address Parcel Number Applicant
29 NE 98 Street 1132060131120
Miami Shores, FL 33138- Block: Lot: GLENN DAIDONE
Owner Information Address Phone Cell
GLENN DAIDONE 54 NE 97 Street (305)788-2711
MIAMI SHORES FL 33138-2331
54 NE 97 Street
MIAMI SHORES FL 33138-2331
Contractor(s) Phone Cell Phone
ERV AIR CONDITIONING INC (305)975-5943
Tons:
4dditional Info: CHANGE OUT SPLIT SYSTEM AND ADDITIO
classification: Residential
Aooroved: In Review
Comments:
Date Denied:
Scanning: 3
Fees Due
Amount
CCF
$4.80
DBPR Fee
$4.20
DCA Fee
$2.80
Education Surcharge
$1.60
Permit Fee
$280.00
Scanning Fee
$9.00
Technology Fee
$6.40
Total:
$308.80
Valuation: $ 8,000.00
Total Sq Feet: 0
Date Approved:: In Review
Type of Work: CHANGE OUT SPLIT SYSTEM AND A
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC-7-18-68303
07/23/2018 Credit Card $ 50.00 $ 258.80
07/27/2018 Credit Card $ 258.80 $ 0.00
Available Inspections:
Inspection Type:
Final
Rough Duct
Review Mechanical
Underground �]E
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_4oqe in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -named c or o the yvo* sfaTdd
27, 2018
Authorized Signature: Owner / Applicant / Contract / Agent / Date-------.
Building Department Copy
July 27, 2018 1
Miami Shores VillageTu2
ii1.�iBuilding Department10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 t-4-L
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 201-1 Master Permit No. X? 2-18-2-7
1 /�
Sub Permit No. 1' C IS - � _L b T
a
❑ REVISION ❑ EXTENSION RENEWAL
❑ PLUMBING MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 5117 A&5 Z26
City: Miami Shores County: Miami Dade Zip: 5�/3�?
Folio/Parcel#:1132NP n 13112U Is the Building Historically Designated: Yes NO
Occupancy Type; Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): [�/ 41 �JO�Ib�X✓ Phone#:
Address: Z Ve(-4 /la!�
City: Ael04 411 State: L'�L Zip: % %
Tenant/Lessee Name: Phone#:i1J' U� 24`2�`1
Email: 4-Vb,4 & . (fon-9
CONTRACTOR: Company Name: l/Ri2C1�,t,1DlT/dam/��' j��vC. Phone#: 31W� 3
Address:
City: A'C!//--I'l7L��
r, State: Flo ✓'/d'a Zip:
C�'' / �� ✓ \
Qualifier Name: S ��L(./ /e t � / f<<( * Phone#: q 71
State Certification or Registration #: a,,de- /Cy S(pZZ Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Add
City:
Zip:
Value of Work for this Permit: $ RQMOO Square/Linear Footage of Work:
Type of Work: X Addition 9 Alteration !❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: ��� �� ��rG/� � Q�� ��all TL7e�24 i%ex.;
Specify color of color thru tile: j
Submittal Fee $ So ) Permit Fee $
Scanning Fee $ Radon Fee $
d" V V v CCF $—
DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
yeti W VMI M!1,fA
3"�a .>. inn: -a : e�T�l,'C $.•` � � rvw;'
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 2_S8 - (90
0-c1
(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
r
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. r-
"WARNING'TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS' TO YOUR PROPERTY. FF,YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT." t
Notice to Applicant: As a condition to the issuance of a building permit wiih an estimated value exceeding $1500,-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 charged. +.
Signatur
OWNER or AGENT
The foregoing instrument was acknowledged before me this
f Q�
1 S ' day of / , 20 t e , by
QI f UP PA-t C0W1f' I who is sonally kno n to
me or who has produced
identification and who did take an oath.
as
NOTARY PUBLIC:
Sign:
Print: Q
Seal: oMNuv�
t�oa'► auk ��
l�e►n � � t10fSSDpOJM
Z34WN 313SIa1111
sss***srsr**
APPROVED BY
Signature G
CONTRACTOR
The foregoing instrument was acknowledged before me this
V d of Svc 20 by
/G! 61 personally known to
me or who has produced L: QzoCiL as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
• 4�
Print:
"' �'' ANGEL PAEZ
Seal: t°4. Notary Public • State of Florida
ar' Commission G FF 977868
i `%<„ ,�d?•• My Comm. Expires Apr 3, 2020
•**rrs******rr***r*rr*1K,�r*sssr *ss**s*r*ss
Plans Examiner
Structural Review
Zoning
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):` /S
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
331�
Change disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑
UNIT BEING REPLACED
DATA
NEW UJYIT
MANUFACTURER
S
AHU or PKG. UNIT MODEL #
A911,6111
v6 A
CdND. UNIT MODEL #
AIX
A636
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:
State Certificate or Registration No66
of Competency No.
Signature Date:
(Qualifier's signature)
(Revised02/24/2014)
r ,'%
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
caner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this 1 1Z day of J 01 I 20-LK-.
By_�i(�i�/ �� /i e who is personally known to me or has produced
r— i c Q fir• e as identification.
Notary:
SEAL: r"19T
ANGEL PAEZ
Notary Public - State of Florida
Commission G'FF 977868
E 12, V Nlz_ C 0 Aj
�'a�e u ji, L i
C_ . . __ F � . .
i{nf...-c 4,
--- ---------
V-,%iuvii, U;zUst:S a.-.0 says -
That he or she will he the only nee working on the projert lo--.Ated Rt-,
. h - -I � - I. - I- I
Ok r--rod-uced identification
v.
ANGEL PAMEZ
Notary Public - Still of FW"W&
COMMISSion
I FF 977868
",ly COMM. Expires Apr 3, 2020
E
-AV
UC 1/Akt rl r1CKC
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
4 - STATE OF FLORIDA
` DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION`
CONSTRUCTION INDUSTRY LICENSING BOARD
CA61815622r_. y -_. '" • .I «. >' *r�tl: `Mom`` ? 4 #.
'The -CLASS B AIR-CONDITIONING CONTRACTOR'
Named below IS'CERTIF,IED: _., ""* ,�`�-- '`, ` •�" ,�'y,,
"lJnder the provlsion's of.:Chapter 489 FS
tik4
iExplra� n�1da'tre�;AUG`,31',2018 : - —'-
,��`!Y,_'iii X ❑ ❑
RUIZ,DEVILLA;-ERNESI'O� ,�. � „� Yak` .,� . � '��, � r•
ERVAIRCONDITIONINGpINC.J"" -•- '-� •~ '`�-
10840'SW 69,DRT
MIAMI---.'FL133173f = '" " , :,;"" `'v y _, "`` -n
if
ISSUED: 09/04/2016 DISPLAY AS REQUIRED BY LAW _ SEQ # L1609040001165
r.
000633
Local Business Tax Receipt
Miami -Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
6124929 .,LBT
BUSINESS NAME/LOCATION w $ RECEIPT NO. EXPIRES
ERV AIR CONDITIONING INC RENEWAL SEPTEMBER 30, 2018
10840 SW 69 DR 6387799 Must be displayed at place of business
MIAMI FL 33173 Pursuant to County Code
Chapter 8A - Art. 9 & 10
OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED
ERV AIR CONDITIONING INC 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR
r-.
Worker(s) 1 CAC1815622 c882.50::10/3172017
CREDITCARD=18-003950 - ~
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is note 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 NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276.
For more information, visit www.miamidade.govAaxcollector
07101/2013 22:38 3058881885
PAGE 01
�- CERTIFICATE OF LIABILITY INSURANCEDATE (MMrooirvvv)
_ (Mmmo
- - —_. i — 07 s
_..._�
TNI5 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
I
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the e'artificate holder is an ADDITIONAL INSURED, the policylies) must be cndorsed. If SUBROGATION IS WAIVED, subject to
i the terms and conditions or the policy, certain policies may require an endorsement. A statement on this certHicate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT _.. _. ... _ .
West Coast Insurance Consultants In PHONE FAX
LAIC-No-K, (305�88 1B80 _ i.tac,Npl__ i305)888-1885
P.O Box 520574 E-MAIL sapeltJ9Cmsn.corrl
Miami, FL 33152 INSURERLSJAFFOROING COVERAGE NAIC 2
Phone (305) 888-1880 Fax 305 888-1885 ---•—_ .....
........ .. ( ) . „_- ., INSURER A; GRANADA INSURANCE COMPANY
INSURED
INSURER 8
ERV AIR CONDITIONING INC INSURER C .
10840 S.W. 59 Drive INSURER D:
Miami, FL 33173-2008 305 INSURER E,:
F :
COVERAGES CERTIFICATE N -- REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELQW HAVE BEEN ISSUED TO
ICIETHE 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 A" THE TERMS, j
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _
INSR I 'ADDLSUBR� POLICY EFF I POLICY EXP—
LTR I _TYPE OF INSURANCE I vin�p _ POLICY NUMBERMNUDD/VYVY) (MM/DDIYYYY!} LIMITS
...—._..... _.. _._. -
GENERAL LIABILITY.
IABIL.... _.ITY EACH-XCURRFNCE S 2,000,000.00
COMMERCIAL GENERAL LIABILITY 1 OO,000.00
.. --DAMAGE TO RENTEG '
IV) _ _PREMISES LEe_xxurrence S —
( CLAIMS -MADE ( ) OCCUR 0185FL00031147 MED EXP (Any one person $ 5, W0.00
A Y Y 11 /07/2017 11 /07/2018 -- --- - ---- -'
- PERSONAL & ADV INJURY 5 1,000,000.00
GENERAL AGGREGAIR S 2,000,000.00
CEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS _COMPIOP AGO $ 2,000,000.00
I_ POLICY JECT LOC $
AUTOMOBILE LIABILITY MgIrvED SINGLE LIMIT
Ea acadent _
ANY AUTO BODILY INJURY Per person) $
ALL OWNED -7 SCHEDULED P BODILY INJURY i (Par xc�de
AUTOS AUTOS ( _ "_t S
i .. ..
-••-7 NON�OWNED PROPERTY DAMAGE
I ( MIRED AUTOS I I AUTOS I I l3,r BCCIOeni) ...... .. ..... S .. . .
��•-_I.._._.-_....__
.I UMBRELLA LIAO 1 OCCUR EA_CI-i_OCCURRENCE i
( I EXCESS LIAR U CLAIMS -MADE AGGREGATE SOR
—
i
AND EMPRKERgOYER3' LIABILITYY f N - ICOMPENSATION' I WC, Li r� FROTH
ANYPROPRIETOR/PARTNER/EXECUnvE E.L EACH ACCIDENT . $
OFFICER/MEMBER EXCLUDED? NIA — - - -- - -
(Mandatory in NH) E.L DISEASE - EA EMPLOYE f
n ee, descrl be under --_.._— .. ..._. ...__.._.. _. _......... _ .
DESCRIPTION OF OPERATIONS below - _ E.L. DISEASE •POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Sahadule, if more space Is required)
license no CAG1515622
Air Conditioning contractor
CERTIFICATE HOLDER
Miami Shores Village
10050 NE 2nd Avenue
Miami Shores, FL 33138
ACORD 25 (2010/06) QF
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELWERED IN
ACGQMPANGe WIT" Tne rOLICY PROVIaIONa_
AUTHORIZED REPRESENTATIV6
I
Z 1988-2010 ACORD CORPORATION_ All rights reserved.
The ACORD name and logo are regisWed marks of ACORD