MC-16-1244Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. MC-5-16-1244
Permit Type: Mechanical - Residential
:Per m " t
Work Classification: Addition/Alteration
Permit Status: APPROVED
Parcel Number
Issue Date:1212112016 1 Expiration: 06/1 /2017
Applicant
121 NE 96 Street 1132060132580
Miami Shores, FL Block: Lot: CK PROPERTY SOLUTIONS LLC
Owner Information Address Phone Cell
CK PROPERTY SOLUTIONS LLC 209 NE 95 Street (305)758-3133
MIAMI SHORES FL 33138-
209 NE 95 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
NORTH POLE AIR CONDITIONING INC (954)797-3639
Tons:
Additional Info: NEW SUPPLY/RETURN AIR DUCTS
Classification: Residential
Approved: In Review
Date Denied:
Scanning: 1
Fees Due
Amount
CC F
$3.00
DBPR Fee
$2.36
DCA Fee
$2.36
Education Surcharge
$1.00
Permit Fee
$157.50
Scanning Fee
$3.00
Technology Fee
$4.00
Total:
$173.22
Date Approved:: In Review
Type of Work:
Valuation: $ 4,500.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due I
Invoice # MC-5-16-59710
12/21/2016 Credit Card
05/09/2016 Credit Card
$ 123.22 $ 50.00
$ 50.00 $ 0.00
Avaname ins
Inspection Type:
Final
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.
December 21, 2016
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
December 21, 2016
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 ❑ ROOFING
RECEIVED,
M 09 2016
BY:
;Z irk
FBC 20 lu
Master Permit No —
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING dMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1 Z k WE vl (0 S-,r
City: Miami Shores County: Miami Dade Zip: 331 �g
Folio/Parcel#: / / 7 z c;P O 3 2 Is the Building Historically Designated: Yes NO X
Occupancy Type: des • Load: Construction Type: el-5Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple
Address: 4- V —1 1,,GV j
City: 4 v `� a, m iC )y �, d ie. C ] State: Zip: ? 3 1 3 6
Tenant/Lessee Name:
Email: V t \ 0
Pct.�+o H-ice 5
CONTRACTOR: Company Name: 1Qoyiit p0lf- h1c =nc Phone#: 1y0-zqS--Z14Z1I
Address: 1R3g9 Z(0 Ny
City: Hinitnl,-) State: FL. Zip:3301(0
Qualifier Name: Toil 1nI? A Q\)%N< Phone#: r1 pD10 - ZcjS -Zy Zy
State Certification or Registration #: C.K C. 1 a 15?J3q Certificate of Competency #: Q r 1J
DESIGNER: Architect/Engineer: `eF r �C4f'r'l1�l� Ji Phone#: - L4 _lam3 313Z-
r n I i
Address: f' 2 S- ([iy 1J l Z 0 City: (�er�v� W-c-1' 640 State: r—& Zip: 3 OLg
Value of Work for this Permit: $ Y J IS00 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration) ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: V�e,W SQm\sj 1 Rnetyrn !NJ 0"S
Specify color of jcolor
thru tile:
Submittal Fee $v "" Permit Fee $ J ` O CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $
Structural Reviews $
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 1
(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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature'' - �q)
Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 2:f'� , 20 Id-1 by
0o who is personally known to
me or who has pro ced Z- as
identification and who did take an oath.
NOTARY PUBLIC:
- 107v
yvGL
Sign:
Print: IgA.7"1 �.,. Z�
The foregoing instrument was acknowledged before me this
day of i 20 (�O by
jam c k-aQ l a-C who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
iiiiis
Seal _ Notary Public - State of Florida Seal: MY COMMISSION
etivan
My Comm. Expires Jan 13, 2017 EXPIRE8August 2$,2018
OF F�UCommission # F� 864892 {,071399-otw fbr'd+'N°M'1�r"'�°'•°°"r
�.t ifs'Ts,i'`._'QA'rteA."m�-...-.a.- ♦s...ok:aw,a�Wf.. r.G —
*s*rsr*sssssssssssrssssssr*s**r******r**fs*********s*ssssssss*ss**s***r***sss*ss*ts*****r*r**ss*sssrsrssrssrs
APPROVED BY `v Mans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
RICK SCOTT, GOVERNOR
LICENSE NUMBER
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
The CLASS B AIR CONDITIONING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
AGUIRRE, JAIME
NORTH POLE AIR CONDITIONING INC
8395 WEST 26 AVE
HIALEAH FL 33016
ISSUED: 08/14/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1408140001283
001084
Local Business Tax Receipt
Miami -Dade County, State of Florida
—THIS IS NOT A BILL — DO NOT PAY
7162167
BUSINESS NAME/LOCATION RECEIPT NO.
NORTH POLE AIR CONDITIONING, INC RENEWAL
8395 W 26 AVE 7"0134
HIALEAH FL 33016
LBT
EXPIRES
SEPTEMBER 30, 2016
Must be displayed at place of business
Pursuant to County Code
Chapter BA — Art. 9 & 10
OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED
NORTH POLE AIR CONDITIONING, INC C/4061/QWAdUNjWICAL CONTRACTOR BY TAX COLLECTOR
CAC1815339 $45.00 07/14/2015
Worker(s) 1 CHECK21-15-091763
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 8a-276.
For more information, visit www miamidade 9,ov/uixcollector
i— -1 ®
.CORD CERTIFICATE OF LIABILITY INSURANCE
(MM/DDNYYY)
7015/05/2016
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: Xamet Barreras
PHONE 786) 539-5989 ac , No): (305) 356 1235
o
Temax Insurance
ADDRIESS: xamet@temaxinsurance.com
7990 SW 117 ave #113
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA: CAPACITY INSURANCE COMPANY
32930
Miami FL 33183
INSURED
INSURER B :
INSURER C :
North Pole Air Condioning Inc
INSURER D :
8395 W 26 St
INSURER E :
INSURER F :
Hialeah FL 33016
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.
INPo
TR I
TYPE OF INSURANCE ADDLIS�U /BDR
0
POLICY NUMBER IIN
MM DI DY/YYYY
MM/DD EXP
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
�- CLAIMS -MADE 1 OCCUR
�
I
j
CLM010022876
09/27/2015
I
09/27/2016
EACH OCCURRENCE
s 1,000,000
DAMAGE TO RENTED
PREMISES fEa occurrence
$ 100,000
MED EXP (Any one person)
$ 5,000
PERSONAL BADVINJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
PRO-
X POLICY F_� JECT F7 LOC
�I OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMP/OP AGG
$ 2,000,000
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
1 AUTOS AUTOS
NON -OWNED
I� HIRED AUTOS AUTOS
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
s
UMBRELLA LIAB
EXCESS LIAB
OCCUR
I CLAIMS -MADE
I
i
EACH OCCURRENCE
$
I AGGREGATE
$
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes. describe under
DESCRIPTION OF OPERATIONS below
N / A
j
I PER STATUTE OTH
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE -POLICY LIMIT
$
I
I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Air Condioning Contractor
Lic # CAC 1815339
CERTIFICATE HOLDER 4,A1Yl+CLLA I IUN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Miami Shores Village. ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2 Ave
AUTHORIZED REPRESENTATIVE
Miami Shores FL 331386
(V ItRRS-ZU14 AGUKU GUK1'UKA I IUIV. All rlgnis reservea.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
S
s 04-16-2015
JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 03/2212015
PERSON: AGUIRRE
FEIN: 208059187
BUSINESS NAME AND ADDRESS:
NORTH POLE AIR CONDITIONING INC
8395 W 26 AVE
HIALEAH FL 33016
SCOPES OF BUSINESS OR TRADE:
1- HEATING, VENTILATION, AIR-COND
EXPIRATION DATE: 03/21/2017
JAIME
IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.0502), F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.0503), F.S., Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or
certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section.
QUESTIONS? (850) 413
DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
IMPORTANT
DIVISION OF WORKERS' COMPENSATION
O Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
CONSTRUCTION INDUSTRY
elects exemption from this chapter by filing a certificate of election
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
L under this Section may not recover benefits or compensation under thi
WORKERS' COMPENSATION LAW
D chapter.
EFFECTIVE: 03/22/2015 EXPIRATION DATE: 03/21/2017
Pursuant to Chapter 440.0502), F.S., Certificates of election to be
PERSON: JAIME AGUIRRE
H exempt.. apply only within the scope of the business or trade listed I
E the notice of election to be exempt
FEIN: 208OSS187
R
BUSINESS NAME AND ADDRESS:
E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt
NORTH POLE AIR CONDITIONING INC
and certificates of election to be exempt shall be subject to revocatic
8395 w 26 AVE
if, at any time after the filing of the notice or the issuance of the
HIALEAH, FL 33016
certificate, the person named on the notice or certificate no longer m
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at any time for failure of the
SCOPE OF BUSINESS OR TRADE:
person named on the certificate to meet the requirements of this
1- HEATING, VENTILATION, AIR-COND
section.
QUESTIONS? (850) 413-16
CUT HERE
Carry bottom portion on the job, keep upper portion for your records.
f
1
DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11
Notice to Owner — Workers' Com
Miami shores Village
Building Department
.10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation 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:
_Z Owirer
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day ofei�`iy_z�> 20_ff,;,,.
By /i DOGCG( c, i who is personally known to me or has produced
EL_ ` ) L— _ as idetification.
Notary: ( /;V w
SEAL:
�• , o's JIM t D. pc,p,�pLIN
• Notary Puhn, date
My Comm o Florida
Jdn'I 2n1.
NORTH POLE A IR CONDITIONING INC
8395 WEST 26 AVE HIALEAH FL 33016
MIAMI DADE(786)295-2424 BROWARD (954)354-9493
DECEMBER 21, 2016
State of Florida
County of Dade
Before me this day personally appeared Jaime Aguirre
Who being sworn deposes and says.
That he or she will be the only person working on the project located at:
121 N..EE.---99-6 Street Miami shores, Fl. 33138
_�
Jaime Aguirre
North Pole
Air Conditioning Inc.
8395 West 26 Ave
Hialeah, FL. 33016
Sworn (or affirmed) and subscribed before me this...... s.day of
R.IRFF
Q:o4NhSSIONc�'.
#FF 958833
9 .P t ndod
9�i��B� C STATE
/111111111111
Personal know.(. ..................
Or Produced Identification............
Type of identification ..................
or Stamp Name of Notary