MC-18-51` SgOR£y
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. MC-1-18-51
Permit Type: Mechanical - Residential
Per I Worts Classiftation: New A/C System
Potmit Status: APPROVED
Parcel Number
Issue Date: 1/1912018 1 Expiration: 07/1812018
Applicant
420 NE 91 Street 1132060190070
PROPERTY HOUNDS LLC
Miami Shores, FL 33138- Block: Lot:
Owner Information
Address
Phone
PROPERTY HOUNDS LLC 420 NE 91 Street (954)520-2268
MIAMI SHORES FL 33138-
7021 NW 67 Court
PARKLAND FL 33067-
Contractor(s) Phone Cell Phone
A/C TECHNOLOGIES (954)815-0399 (954)344-0300
Additional Info: 3 AC UNIT AND DUCTWORK
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 3
Fees Due
Amount
CCF
$8.40
DBPR Fee
$7.35
DCA Fee
$4.90
Education Surcharge
$2.80
Permit Fee
$490.00
Scanning Fee
$9.00
Technology Fee
$11.20
Total:
$533.65
Date Approved:: In Review
Type of Work:
Cell
Valuation: $ 14,000.00
Total Sq Feet: 3995
Available Inspections:
Inspection Type:
Final
Rough Duct
Review Mechanical
Underqround
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC-1-18-66072
01/08/2018 Check #: 1231 $ 50.00 $ 483.65
01/19/2018 Check#: 1089 $ 483.65 $ 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.
January 19, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 19, 2018 1
l ® DATE (MMIDD/YYYY)
AIR" CERTIFICATE OF LIABILITY INSURANCE
04/10/2017
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 CONTACT
NAME: Javier CubaS
Atlantic Insurance Group PHONE FAX
(A/C, No, Ext): 954-974-8988 (A/C, No): 954-301-2788 _
2900 N. UniversityDr. E-MAIL
ADDRESS: Info@atlanbcinsurancegroup.net-
Coral Springs, FL 33065 INSURER(S) AFFORDING COVERAGE_ NAIL #
INSURER A: AmTrust North America
INSURED INSURER B : Normandy Insurance Company
A/C Technologies II. LLC
DBA A/C Technologies INSURER C
12298 Wiles Rd INSURER D :
Coral Springs, FL 33076 INSURER E :
INSURER F :
rr1VFRArFS CFRTIFICATF NIiMRFR- 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 I ADDL SUBRI
LTR TYPE OF INSURANCE IN R 1 POLICY NUMBER
f POLICY EFF POLICY EXP LIMITS
MMIDD/YYYY MMIDDIYYYY
GENERAL LIABILITY
EACH OCCURRENCE S 1,000,000
III
___
I
DAMAGE TO RENTED ( - -
X COMMERCIAL GENERAL LIABILITY
N
-OCCUR
PREMISES (Ea .occurrenceJ__f_S 100,000_ _.
CLAIMS -MADE %�
I MED EXP (Any one person) S 5,000
A WPP1545787-00
04/22/2017 04/22/2018
! PERSONAL & ADV INJURY_ $ 1,000,000
GENERAL AGGREGATE �I 5 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
(. PRODUCTS - COMP/OP AGG ]S 2�000 000
POLICY I JE I LOC
! $
AUTOMOBILE LIABILITY
j�F
COMBINED SINGLE LIMIT
(Eaaccident)___ _
I S
ANY AUTO i
BODILY INJURY (Per person)
$
ALL OWNED SCHEDULED
I
BODILY INJURY (Per accident)
$
AUTOS AUTOS
NON -OWNED
L— __ _ ___—_—___._____.�_—
PROPERTY DAMAGE
HIRED AUTOS AUTOS
II -(Per accident)___
UMBRELLA LIAB OCCUR IF
lF
EACH OCCURRENCE
_- -
5 _
EXCESS LIAR CLAIMS MADE
C_
!AGGREGATE I-
GAT
� 5
-
' DED RETENTION $
I - - _ - -�—- _- _
$
WORKERS COMPENSATION
j
I WC STATU- OTH-
I TORY LIMITS `- ER_i.—.
' AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETORIPARTNER;EXECUTIVE
B N❑ NIA! NHFL0067122017
04/22I2017104/22/2018
I E.L. EACH ACCIDENT $ QOQ Q0Q_
_. -, -_-.
OFFICE/MEMBER EXCLUDED?
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes describe under
E.L. DISEASE - POLICY LIMIT I S 1,000,000
F F
\
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule,
if more space is required)
License # CAC1817530
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village B��j pet SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
9 p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores Village, FL 33138
AUTHORIZED REPRESENTATIVE
/A 4n4G 9nin Af nDr1 /`r%DDl1D ATirIiJ All Anhf. -.-A
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
Miami Shores Village
BUILDING
PERMIT APPLICATION
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 RECEIVED
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 JAN 0 8 2017 +L1
FBC 20146
Master Permit No. RC-6-17-1597
❑BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING )QMECHANICAL ❑PUBLIC WORKS
Sub Permit No. fn C, 1 S 1
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 420 NE 91 ST
City: Miami Shores County: Miami Dade Zip: I
Folio/Parcel#: 11-3206-019-0070 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: WA C_� Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Property Hounds LLC Phone#
Address: 7021 NW 67 CT
City. Parkland
Tenant/Lessee Name:
Email:
CONTRACTOR:
Company Name:
]
Address: acloo—M
City: III S
Qualifier Name:
State Certification or Registration M
DESIGNER: Architect/Engineer:
State: FL Zip:
954-520-2268
33067
f-17 Zip:330%(0
Phone#: qjq. 34y • 0 360
of Competency #:
ne#:
Address: City: State:
Value of Work for this Permit:P409MO Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition [,Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Per Plans
Specify color of color thru tile:
Submittal Fee $ So '� Permit Fee $ J) CCF $ CO/CC $
Scanning Fee $ Radon Fee $ '__tO DBPR $ �' 3� Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
-114
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 charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of December 20 17 by
M iCnor t (zOlc-C f , wh ' personally know
me or who has produced s
identification and who did take an oath.
NOTARY PUBLIC:
Print: �,I G 1 KSW F- \
Seal: ,.%tw NATASHABOOKE
MY COMMISSION # GG 154422
", a`. EXPIRES- October 27, 2021
-' �Fdi F��°�� , Bonded nn NOWy Public Und *ft
###########rq
APPROVED BY
The foregoing instrument was acknowledged before me this
ao day of Decem er 20 17 by
�Q who ' ersonally kno 0
me or who has produced as
identification and who did
NOTARY P kL11SigPrint: t
Seal:
0atk MARSCAWM
Canmksim S O"
Exoi�rsseclar30.2�1
#######################################################
\ � Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk
STATE OF FLORIDA
'DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
2601 BLAIR STONE ROAD
TALLAHASSEE FL 32399-0783
LEVY, HEATHER F
A/C TECHNOLOGIES
12298 WILES ROAD
CORAL SPRINGS FL 33076
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque
restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order
to serve you better. For information about our services, please
log onto www.myfloridalicense.com. There you can find more
information about our divisions and the regulations that impact
you, subscribe to department newsletters and learn more about
the Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate
Fairly. We constantly strive to serve you better so that you can
serve your customers. Thank you for doing business in Florida,
and congratulations on your new license!
RICK SCOTT, GOVERNOR
17�
STf
DEI
PRI
CAC18175317
SINESS AND
,ULATION
508/07/2016
LEHEATH Ar
A/C
;0 k
1✓ IS 'E TIFI D —
.. Ir E under the= ravisfons f `fi. 9 ' R � o C 48 FS.
�,-Expiration elate '�AWG 31; 2018.r - `� _ � - - _-L160807000t861 _ r
DETACH HERE
KEN LAWSON, SECRETARY
STATE OF FLORIDA
'MENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION -INDUSTRY LICENSING BOARD
GAC1817530 it
The CLASS B AIR CONDITIONING CONTRACTOR
Named below IS'CERTIF,IED
Under the provisions of -Chapter 489 FS.�",-'
Expiration date: AUG 31, 2018
LEVY, HEATI
A/C TECHNC
122b&WILE:
CORAL SPR
ISSUED
ILOGIEyS
08/07/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1608070001861
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2017 THROUGH SEPTEMBER 30, 2018
Dme:A%C TECHNOLOGIES
Business Name:
Owner Name: HEATHER F LEVY
Business Location: 12298 WILES RD
CORAL SPRINGS
Business Phone: 954-344-0300
Receipt #:HEAT NG/AIRCONDITION
Business Type: (CLASS B AIR COND CO
Business Opened:o9/08/2010
State/County/Cert/Reg:CAC181753 0
Exemption Code:
Rooms Seats Employees Machines Professionals
15
For Vending Business Only
Number of Machines: Vandinn Tvnae
Tax Amount
Transfer Fee
N$F Fee
Penalty
Prior Years
Collection Cost
Total Paid
54.00
0.00
0.00
0.00
1 0.00
0.00
54.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
A/C TECHNOLOGIES
12298 WILES RD
CORAL SPRINGS, FL
33076
Receipt #1CP-16-00011531
Paid 07/12/2017 54.00
07/11/2017 Effective Date