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MC-17-2100Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit NO. MC-8-17-2100 m e t Permit Type:. Mechanical - Residential ' Work Classification: A/C Replacement Permit Status: APPROVED Parcel Number Issue Date:113012018 1 Expiration: 07/29/2018 Applicant 1569 NE 104 Street 1122320320160 Miami Shores, FL Block: Lot: ALAIN & CARLY GONZALEZ Owner Information Address Phone Cell ALAIN & CARLY GONZALEZ 1569 NE 104 Street (786)277-9756 MIAMI SHORES FL 33138- 1569 NE 104 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone SANTY'S AIR CONDITIONING & REFR 305-884-5333 Tons: Additional Info: REPLACING DUCT WORK Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Fees Due Amount CCF $4.20 DBPR Fee $3.41 DCA Fee $3.41 Education Surcharge $1.40 Permit Fee $227.50 Scanning Fee $3.00 Technology Fee $5.60 Total: $248.52 Date Approved:: In Review Type of Work: REPLACING DUCT WORK Valuation: $ 6,500.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC-8-17-64929 01/30/2018 Check #: 13953 $ 198.52 $ 50.00 08/18/2017 Check #: 13558 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 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 A7A�(I�: Itertiq that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction d zo in utherhiore, I authorize the above -named contractor to do the work stated. January 30, 2018 / Contractor / Agent 3uilding Department Copy January 30, 2018 1 BUILDING PERMIT APPLICATION Miami Shores Village Rr-- 1'.1� ' F Building Department AUG 18 2017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 g-Y. _ _ _ AIM Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBc 2014 sue"' Master Permit No. Zf -(e- l i - i 5�6PS Sub Permit No. 1 V 1 C 1�` 2-1/ w ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP ` CONTRACTOR DRAWINGS 10B ADDRESS: 1cS (c1Q QF I DL4 T-K City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): \�lt W� Z �� Z _ Phone#::; Address: a� `� (P City: 1 CLN(y-N► S hO rQ S State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: I'� IS -bA k 1 Address:3 City: �1 t Ctv -) ( State: 'L' Zip: Qualifier Name: ��'CL -C"] oa = a Ste, r Phone#: �_�� �, O- State Certification or Registration #: CAC O5,1305 Certificate of Competency M , DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ (OSOO ` CDC Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New [Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ 1 ` CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 1 '-9 U • 62, r Bondii'tg 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 absWe of such posted notice, the inspection will not be approved and a reinspection fee will be charged. I'�� Signature Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 02, day ofAQGQC 20 (a by is personally known to me or who has produced identification and who did take an oath. NOTARY PUB Sign: Print: r Seal: *************** APPROVED BY r009 "�,�^ Notary'Jahlir State of °iorida Sindi, v . o` MyCoinmiss;on -r 156750 940, Expires 09/03/2018 6, 1 2-L CONTRACTOR The foregoing instrument was acknowledged before me this 4T'0*- day of JCAnL)S7 , 20l) by ?41451ti 916= A� MGs who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: SANDRA:UGALota Pu IICe F da Sign: o ssion � DD 862331 Print: Seal: as ********************************* Examiner Zoning (Revised02/24/2014) Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER I ne L.:LA55 ti AIK L:UNUI 1 IUNINU UUN I KAL: I UK Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 �► DE ARMAS, PABLO SANTY'S A/C & REFRIGE ION INC 7531 N W MIAMI .FL'33166— LS U ISSUED: 09/22/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1609220002207 001013 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 1975813 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES SANTYS AIR CONDITIONING & REFRIGERATION INCRENEWAL SEPTEMBER 30, 2017 7531 NW 70 ST 1851147 Must be displayed at place of business MIAMI FL 33166 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SANTYS A/C & REFRIGERATION INC SEC. TYPE OF BUSINESS PAYMENT RECEIVED 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR CAC057305 $75.00 08/09/2016 Worker(s) 10 CHECK21-16-110243 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 NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Be-27& For more information, visits 'daille.goyftexcollecto /tex ACOR& CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/18/2017 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 have ADDITIONAL INSURED provisions or 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). SUNZ Insurance Solutions LLC ID: (Essential) c/o Essential HR, Inc. dba first Star HR 4455 LBJ Freeway, Suite 1080 Dallas, TX 75244 ONAPRODUCER NAME: Jennifer Hau er PHONE FAX E 972-404-0295 AIC No): E�1° ADDRESS: 'ennifer.hau er firststarhr.com INSURERS AFFORDING COVERAGE NAIL # INSURERA: SUNZ Insurance Company 34762 INSURED Essential HR Inc INSURER B : dba FirstStar HR INSURERC: INSURERD: 4455 LBJ Freeway Suite 1080 Dallas TX 75244 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 367236g1 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 A DL SUBR POLICY NUMBER POLICY EFF MIDD POLICY EXP MIDD LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO E PREMISES Ea occurrence 5 MED E XP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY C JECT LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG S S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMB Ea accident $ BODILY INJURY (Per person) S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ S UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR j DED I I RETENTIONS S A WORKERS AND EMPLOCOMPENSA YERSLIA T ON Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N I A WCPE00000184 04 10/1/2016 10/1/2017 STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1 000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT — S 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage provided for all leased employees but not subcontractors of: SANTY'S AIR CONDITIONING & REFRIGERATION, INC. 7531 NW 70 STREET Effective date: 10/1/2013 a,r=rc I WHIM I= nvLUCR GANGtLLA 1 IUN Miami Shores Village Building Department 10050 Northeast 2nd Avenue 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 Glen J Distefano 'I�yJK�/iJ•%����i)lQ�. ©1988-2015 ACORD CORPORATION- All rights resPrvpd ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 36723691 1 1 Master Essential HR dba First Star HR I MagaliA@hpadmin.com 1 7/18/2017 6:19:16 AM (PDT) I Page 1 of 1