MC-18-2158Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. MC-$-18-2158
Permit Type: Mechanical - Residential
erillitWork Classification: Addition/Alteration
Permit Status: APPROVED
Parcel Number
Issue Date 8/2712018 1 Expiration: 0212 /2019
Applicant
366 NE 99 Street 1132060135560
Miami Shores, FL 33138- Block: Lot: ITAY BEN ZVI
Owner Information Address Phone Cell
ITAY BEN ZVI F66
IL NE 99 Street (917)514-8517
366 NE 99 Street
FL
Contractor(s) Phone Cell Phone
KOOL HEAVEN LLC (786)256-0241
Tons:
Additional Info: RELOCATION OF EXISTING DUCTS. INSTA
Classification: Residential
Approved: In Review
Comments: Date Approved:: In Review
Date Denied: Type of Work:
Scanning: 1
Fees Due
Amount
CCF
$1.20
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total:
$160.45
Valuation: $ 1,200.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC-8-18-68536
08/27/2018 Credit Card $ 110.45 $ 50.00
08/14/2018 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Rough Duct
Review Mechanical
Underground �J�
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.* strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this per a sume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELE TRICA , PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT I cerV9 thy(
constructiQ4 and zonin Fµ{fiermore, I
//Authoriz;epart
ignature:Owner
Buildingm
August 27, 2 8
going information is accurate and that all work will be done in compliance with all applicable laws regulating
the ab ve-named contractor to do the work stated.
141fi6C-� A�i=� o August 27. 2018
Applicant / Contractor / Agent
COY
BUILDING
PERMIT APPLICATION
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 W
FB/C20� /
Master Permit No. R ; / 2 6`�
Sub Permit No. PC Kj> - 21 � F3
❑BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING XM
ECHANICAL
❑ REVISION ❑ EXTENSION RENEWAL
[]PUBLIC WORKS ❑ CHANGE OF
JOB ADDRESS: 1� 0 I -1 C011
CONTRACTOR
r? d,
❑ CANCELLATION ❑ SHOP
DRAWINGS
Folio/Parcel#:_
3zoO - 0 13 z1
Is the Building Historically Designated: Yes
NO
Occupancy Type:
Load: Construction Type:
Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): / rCA� J CY1Z� Phone#: q l� S W '5 r+
Address: `1V 4
City: �'(Or, S �1�� 2 r 1 State: f L Zip: } 0
Tenant/Lessee Name: Phone#:
Email:�eb�y V I VA06 1 CJi(1'1
CONTRACTOR: Company Name: A6j' / / /{� (�L�/�% ��L- Phone#:
Address: �^ 1" 0 3^ / S-
City: fJVGZj�� e- State: A Zip: 33 /J-q
Qualifier Name: G�/f i� 1i C� (� Phone#:�z q'/
State Certification or Registration #: t� ti�L f % (f Certificate of Competency #: T
DESIGNER: Architect/Engineer:
ne#:
Address: City: State
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Addition Alteration ❑ New �❑ Repair/Replace
Description of
C
Specify color of color thru the:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $.
(Revised02/24/2014)
0
Permit Fee $ b U t v4�) CCF $
Radon Fee $ 2 DBPR $ 2-
Training/Education Fee $
Zip:
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ � V
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 $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.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
�day of , 20 by
Q Yl Yis personallyknownto
me or who has produced I (egio as
identification and who did take an oath.
NOTARY PUBLIC:
MAHARAI K. GONZALEZ
Prin *'Pt: MY COMMISSION # GG 044602
:o EXPIRES: November 2, 2020
Seal: ,FOF F;o? Bonded Thru Notary Public Underwriters
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 , by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
s«««******ss*..****�**s*s*** *: « *�*s** .***.*,�ry�s*s*s****r*ss**s**s*.:**ssss*ss�****ss�s*s**.***�►s�.s**s
APPROVED BY f ns Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
�r RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY
FI r'da
pr
STATE OF FLORIDA
DEPARTMENT OF BUSINESS-,AKD OFESSIONAL REGULATION
CONSTRUCT O-'N,,I,NDUSTRl I NS;I,NG BOARD
THE CLASS B AIR CON, IT ONI�NGe-ONTRAC•T_0_.R`HEREIN/ IS -- RTIFIED UNDER THE
PROVIS .O.NS OFICH/aPITERr489-=FLOR17 } TABUTES
i 07 STRT.,.
MIA ` 1 FL 3:316
LWENSE�N, MBE' .
EXPIRATIONe® T, j,, J,GU T 31, 2020
Always verify licenses online at MyFloridaLicense.com
Do not alter this document in any form.
This is your license. It is unlawful for anyone other than the licensee to use this document.
■
Local Business Tax Fecei pt
Miami -Dade County, State of Florida
-THIS IS NOT A BILL -DON OT PAY
7181698
BUSINESS NAM E/LOCATION RECEIPT NO EXPIRES
KOOL HEAVEN LLC RENEWAL EXPIRES
2018
OPERATING IN DADE COUNTY 7462174
Must be displayed at place of business
Pursuant to County Code
Chapter 8A Art 9 8 10
OWNER SF TYPE OF BUSINESS
KOOL HEAVEN LLC 196 SPEC MECHANICAL PA YM ENT RECEIVED
ev TAX COLLECTOR
CONTRACTOR 90.00 12/04/2017
Worker(s) 1 CAC1819116 0233-18-000946
This Local Business Tax fecei pt only con ^rms payrnent of the Local Business Tax. The Receipt is not a I icense,
Perm t, Ora certi ^cation of the holder's qua] i "cations, to do business. Holder must comply with any governmental
or nongovernmental regulatory I aws and requirerrentswhich apply to the business.
'�1. The �PTNO.abovernustbedisplayed onall corwmtercialvehicles -Miami-Dade Code Sec8a-276.
MIAM For more information, visit w_w_MAMdade aov/t xc I _tor E*R' 1� � -
ACC>RV CERTIFICATE OF LIABILITY INSURANCE DATE
DD Srr) OB/13/
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(les) 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 NAME: Thomas A Reed
Westgate Contractors Insurance Services of Florida, LLC PHONE
Wc,x% utL. 277-2875 iuc. Not
3361 Fairlane Farms Road ADD..SS: treed nsurancee,Com
Wellington, FL 33414 INSURER(S)AFFORDING COVERAGE NAIC If
L099712 INSURER A: US Specialty Insurance Company (8+15 29599
INSURED Kooi Heaven, LLC INSURER a: Normandy Insurance—ompany C13012
'
4780 Pine Tree Drive #7 INSURER C :
Miami Beach, FL 33140 INSURER D
Attn: Angel Avedo CAC 1819116 INSURER E
COVERAGES f_FRTIFIrATF NI IMRFR- oCVICInu hll 1lURCo.
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
TYPE OF INSURANCE
I
POLICY NUMBER
POLICY EFF
M DIYYYY
POLICY EXP
MMfDDfYYYYI
LIMITS
A
GENERAL LIABILITY
Fx�kGE
%� COMMERCIAL GENERAL LIABILITY
.— CLAIMS -MADE OCCUR
f t—
'� X
I
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U18AC106297-00
07/21/2018
07/21/2019
EACH OCCURRENCE
$ 1.000000
dli€NTED
MIS
PREES_(Ea acurrencel
MED EXP (Any one person)
$ 100,000
$ 5,000
PERSONAL aADVINJURY
$ 1,000,000
^�
GENERAL AGGREGATE
$ 2,000,000
tGEN'L AGGREGATE LIMIT APPLIES PER:
ii POLICY F7 PRO F LOC
PRODUCTS -COMP/OP AGG
$ 2.000.000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOSAUTOS
NON -OWNED
HIRED AUTOS H AUTOS
I�
(
i
COMBINED SIN LE L1M1T I
Ea accident
BODILY INJURY (Per person)
_ ®—
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident
$
$
i
UMBRELLA LIAi
EXCESS LIAB
^
OCCUR
CLAIMS -MADE
I
1
EACH OCCURRENCE
$
AGGREGATE
_
$
DEO RETENTION $
Is
_
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I NLIM
ANY PROPRIETORIPARTNER/EXECUTNE
OFFICEIMEMBER EXCLUDED? N❑
(Mandatory In NH)
tt yes, describe under
I
N I A
F_ NHOO56890 107/21/2018
j
07/21/2019
I
X WC STATU• �OTRH-I
_
E L. EACH ACCIDENT
$ 1 90,000
E.L. DISEASE - EA EMPLOYEE
S 1,000.000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more apace Is required)
Certificate holder is an additional insured as it relates to the specifics of the GL policy. Angel's license in good standing CAC1819116
V GR11
Miami Shores Village
Building Department
10050 NE 2nd ave
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRAjpN DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANZE WITH THE POLICY PROVISIONS.
01988-2010 ACORD CORPORATION. All riahtx re_ arvwd
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD