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MC-18-1020Miami Shores Village 3�<r o 10050 N.E. 2nd Avenue NE y Miami Shores, FL 33138-0000 Phone: (305)795-2204 tonrvA Permit No, IBC-4-18-10 0 tPermit Type: Mechanical - Residential n' Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 4/2612018 1 Expiration: 10/23/2018 Project Address Parcel Number Applicant 133 NE 100 Street 1132060132050 Miami Shores, FL Block: Lot: ROBERT STOUT Owner Information Address Phone Cell ROBERT STOUT 133 NE 100 Street (954)789-4173 MIAMI SHORES FL 33138- 133 NE 100 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone B & R ENGINEERING CORPORATION (305)554-4294 s: Additional Info: MECHANICAL FOR INTERIOR RENOVATION Classification: Residential Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Work: Scanning: 1 Fees Due Amount CCF $3.00 DBPR Fee $2.63 DCA Fee $2.00 Education Surcharge $1.00 Permit Fee $175.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $190.63 Valuation: $ 5,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC-4-18-67204 04/26/2018 Credit Card $ 190.63 $ 0.00 AvanaDle Inspections: Inspection Type: Final Rough Duct Review Mechanical Underground 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, UMBI G, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: j� rtify th t all the 'going information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonmq. F therm a onze the above -named contractor to do the work stated. Authorized Siq Building De / Applicant / Contractor / Agent nt Copy April 26, 2018 April 26, 2018 1 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 JR 117 2018 IBY'44&a FBC 201-:�- Master Permit No. 6? - 205 Sub Permit No. �/�' le ^( 026 ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ON MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 133 /l/ E M D-�57726�1t--7- City: Miami Shores County: Miami Dade Zip: 33IJ� Folio/Parcel#: // _0Q10 —O/✓ -- 245d Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): �ZRO E2`T ��U7— Phone#: 9�64- Tel- WZ,✓ Address: �J �J it/� /40 5771.1-7.cT City: 101, }Ml -5D2E-,5 State: -,,-Ld121Z) ? zip: ?Ot30 Tenant/Lessee Name: Email CONTRACTOR: Company Name: /'l Phone#:'i5 Address: 1�✓Z?/ -5u/ /24 r77�EE'T City: Ah'IAA12 State: 7=74 Zip: 33/46 Qualifier Name: Phone#: State Certification or Registration #: G11/I6 ').6 W17'�Z Certificate of Competency #: DESIGNE . Architect gineer: A MAIZ f% Gi99rr/),O/�EL� Phone#: _ Address: Ale6 -q2 !!F,-172,!�ET' City: na State Value of Work for this Permit: $ 5,000 .00 Square/Linear Footage of Work: �� Zip: 3 /.3 Type of Work: ❑ Addition © Alteration ❑ New ❑ Repair/Replace ❑ Demolition 01 Description of Work: t-k--r�i�tN I -=L- 0e- ( [eft • `��GN 4V•-Pr"tl 0 n Specify color of color thru tile: Submittal Fee $ Permit Fee $ " v CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ 1�3 Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ Ir--TO J (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 r inspection fee will be charged. Signature Signature lllAd'or UENT Ur CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 10 14" day of r, 120 �g by d�:_ day of QP2/ 1 20 /13 by who i ersonally known to 2/GA2D0 ��1LiVAA/Da<7; who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: id Sign: Prin : Print: ,a������., DANETTE L. ROBINSON Seal: =o*�`Y P6a�� Notary Public - State of Florida Sea ' Notary Public State or Florida Commission # FF 190226 z y. MARINELY GARCIA =�N;FM Comm. Expires Jan 15, 2019 1 • • Ex Commission 12t2 /2 21 170475 y 0a�d� Expires t2/25/2021 , y%FOFaa� Assn. *************** ***#9'>k*** ******** ***************** APPROVED BY / �V A P'\ I\ � V N N moans Examiner Zoning Structural Review 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): /3J� .(/ Idd S772g��_,±:­ % 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: 0 // �i(/�/.t/F�/%,/�/� G�J�� Phone: State Certificate or Registrati�-< Certificate of Competency No. Signature Date: APeii &_ Qualifier's signature) (Revised02/24/2014) 4 RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGI CONSTRUCTION INDUSTRY LICENSING BOARD I CMCOSS674 I The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS, Expiration date: AUG 31, 2018 FERNANDEZ RODRIGUEZ, RICARDO E B & R ENGINEERING CORPORATION 13271 SW 124TH STREET,---- MIAMI FL 33186 ISSUED: OM9/2016 DISPLAY AS REQUIRED BY LAW KEN LAWSON, SECRETARY L1606290000836 001357 Local Business Tex Receipt Miami -Dade County, Mate of Florida THIS IS NOT A BILL - DO NOT PAY BUSINESS NAME/IOCATlON B & R ENGINEERING CORE 13271 SW 124 ST MIDI FL 33186 RECEIPT NO. EXPIRES RENEWAL. S E P EMBER 30, 2018 3436169 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED B & R ENGINEERING CORK 19E GENERAL MECHANICAL CONTRACTOR BY TAX COLLECTOR C10 RICARDO E FERNANDEZ RODRIGUELMC056674 $75.00 08/22/2017 Worker(s) 1 CHECK21-17--078284 This local Business Tax Receipt only confirms payment of the local St iness Tax. The Receipt is not a license, permit, or a certification of the holder's ualificatrons, to do business. Holder must comply with an governmental or nongovernmental regulatory laves requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sac 8e-276, 1=77FW F77Me ,Iola i !! #7M : i t B&REN-2 OP ID: M6 ACOR T CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/07/2018 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 endorsements . BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Suite#200 Miami Lakes, FL 33016-5869 Alfredo Andrial ONTAPRODUCER NAME: Alfredo And rial PH°NE 305-364-7800 ac No : 305-714-4401 FILEEDIA ADDSS: INSURER(S) AFFORDING COVERAGE NAIC A INSURER A: Commerce and Industry Ins Co 19410 INSURED B & R Engineering Corp. INSURER B:Brid efield Erri to ers Ins Co 10701 INSURERC:Wesco Insurance Co. 25011 Attn: Ricardo Fernandez 13271 SW 124th Street Miami, FL 33186 INSURER D:Security National Ins. Co. 19879 INSURER E : INSURER F : 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. INSR I LTR TYPE OF INSURANCE ADDLSUBR wvn POLICYNUMBER POLICY EFF MM/DD POLICYEXP MM DD LIMITS D X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE FxI OCCUR SES152901600 05103/2017 05/03/2018 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY PRCO- LOC OTHER: AUTOMOBILE LIABILITY Ee accidentCMINED SINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ C X ANY AUTO WPP117796204 05/03/2017 05/03/2018 BODILY INJURY (Per accident) $ ALLOWNED SCHEDULED AUTOS AUTOS X X NON -OWNED HIRED AUTOS AUTOS PROPERTY raccident) DAMAGE $ $ UMBRELLA LIAB Xd OCCUR EACH OCCURRENCE $ 5,000,00 A X EXCESS LIAB CLAIMS -MADE BE37083598 05/03/2017 05103/2018 AGGREGATE $ 5,000,00 DED I X I RETENTION $ 0 $ WORKERS COMPENSATION X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ SOO,OO B AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y /❑ 83052636 05/03/2017 05/03/2018 E.L. DISEASE - EA EMPLOYE $ 500,00 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A E.L. DISEASE - POLICY LIMIT $ rjQQ,QQ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Contractor License #:CMC056674 Miami Shore Village Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 MIAMISH 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 Brown and Brown of Florida, Inc. V 1VOO-LUT4 AL UKU l.vRrVIW I IVIr. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD P%11 I11911W ICJCIYGY.