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MC-17-726y� Miami Shores Village �eti'O"S 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 FCORLDp' Permit NO. MC-3-17-726 Permit Type: Mechanical - Residential en o Work Classification: A/C Replacement Permit Status: APPROVED issue Date: 4/17/2017 1 Expiration: 10/14/2017 Project Address Parcel Number Applicant 43 NW 110 Street 1121360030610 Miami Shores, FL 33168-4318 Block: Lot: INTER MALL INC INTER MALL INC Address 8260 SW 2 Street MIAMI FL 33144- 8260 SW 2 Street MIAMI FL 33144- Contractor(s) Phone Cell Phone COOL TOUCH INC (786)543-2166 Tons: Info: AIR CONDITIONING CHANGE OUT AND DUC ion: Residential In Review ments: Denied: ning: 1 Fees Due Amount CCF $3.00 DBPR Fee $2.63 DCA Fee $2.63 Education Surcharge $1.00 Permit Fee $175.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $191.26 Phone Cell (786)231-7789 Valuation: $ 5,000.00 Total Sq Feet: 0 Date Approved:: In Review Type of Work: AIR CONDITIONING CHANGE OUT A Pay Date Pay Type Amt Paid Amt Due Invoice # MC-3-17-63349 04/17/2017 Credit Card $ 191.26 $ 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 perm assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECT IC LUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDA IT: ``that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo m . eigre, I authorize the above -named contractor to do the work stated. Building April 17, 2017 / Applicant / Contractor / Agent nt Copy April 17, 2017 1 Miami Shores Village Building Department Ma xs 2017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Telr(30S) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC ern 4 BUILDING Master Permit No.-k 17 ) PERMIT APPLICATION Sub Permit No. 1 c L1- 4�y ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL ❑PLUMBING [g MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 7 3 "J l/D City: Miami Shores County: Miami Dade Zip: :3 S Folio/Parcel#: 2-/36 -003 "0 616 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): L ider 9—& 1 a G Phone#: -?-,4 2 3/ 9212 Address: R2 C a S tJ 'Z 3 /- City: mFCCoq ? State: i�L zip: 3 3/YY Tenant/Lessee Name: Pho Email: CONTRACTOR: Company Name: (, (o0/ t6 U C 6 �YI C. Phone#: Address: 7 59- W 39 PL City: AcJl-la 4 State: F4 Zip: 3 3 d/ Z Qualifier Name: DS it Cr. I do F-U e 4 a Phone#: State Certification or Registration #: 'C'4 C / 8/ <0- 6 3.5 Certificate of Competency #: 8 b 5 4.3 2/ DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ �� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Pl k- ea Lt d/ 410 v11 n I C,6 a bg, 6 ,7� (T> Ltc.1 d L)C.11-- ✓ Q2J� 7 ✓ S t' Y a ;^F,4A.M nND 8+09a!Ww awia.ly �v.� ��--•_ _ _._ ._. , f i,.. fit.. .r Tj .a,a�.rc•.,ti�Ih� 5i.i�t +.,1 r•, ! 4• I i •i1°'1 ^ -';1 r r 11 't, (tiYh, ° I f}' 1'�GY iT •a �ja t '{ + *� ti Specify color,oif color,thru tiled J"�' irA j� a :v JR 3ry�,;jA ui �( aUw. .. 4.nx.tit � 'C a>;�... n:+`�.«w w aw+iw~raeY`".,�,,:r. :iw�;i. �%•� Submittal Fee $ "°° ' ' `"Permit tree' CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Structural Reviews $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (� (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 I 7)41 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 0 +-"- day of t:f�foruGZri-( , 20 1 by '2J5 day of Te br 0 ' vF 20 1 r3- by V�)GnnW Cre S� , who is personally known to AtIol/Q'O 44 who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign A Print: Seal: JACOUEIJIIE :.= MY COMMISSION t FF 916635 # EXPIRES: September 9, 2019 i 8otd,d Tlw MoUY FV* lhdNwiw as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print: Seal: 11ImAr .MOpUMROORWEZ MY COON t FF 9166X EXPIRES: September 9.2019 *********************************************** * * ******** APPROVED BY Pans Examiner Structural Review as **************** Zoning 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): 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): rlir 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 6 d 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means Contractor's Company Name: 40 . '?11v• Phone: State Certificate or Registration No d(! Certificate of Competency No. Signature � - Date: (Qualifier's signature) (Revised02/24/2014) 7 , Miami Shores, village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.9972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY'OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER f&rn and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ■��rrrr�rrrr�,■ a ��r��r�r��.■.�� a �� a ��s��u ��r�� BUSINESS NAME: BUSINESS ADDRESS: /J��® G(J ��l �G CITY__,O/STATE ZIP.�D�Z BUSINESS PHONE:67 FAX NUMBER (_ ) CELL PHONE (____j QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: loll 000880 Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 6482327 BUSINESS NAME/LOCATION RECEIPT NO. COOL TOUCH INC RENEWAL 1635 W 44 PL 303 6751862 HIALEAH FL 33012 }" LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter BA — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS. PAYMENT RECEIVED COOL TOUCH INC 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR CAC1816035 $56.25 01/12/2017 Worker(s) 1 FPPU 10-17-005019 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 holders 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 ga-276. For more information, visit w :+ miamidade gov_haxcollector ® CORD � CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/03/2017 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(los) 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 EAP Insurance Group 15165 NW 77TH AVE CONTA NAME: T EAP Insurance Group PHONE • 305-820-5511 n/c No: 786-279-2426 ADDRESS: E-MAIL custserv@eapinsurance.com INSURE S AFFORDING COVERAGE NAIC N SUITE 2012 INSURERA: WESTERN WORLD INSURANCE COMPA MIAMI LAKES FL 33014 INSURED INSURER B : INFINITY INSURERC: COOL TOUCH INC INSURERD: 1635 W 44 PL UNIT 303 INSURER E : INSURERF: HIALEAH FL 33012 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 LTR TYPE OF INSURANCE D L B POLICY NUMBER MM/DDYIYYYY POLICY LIMITS A GENERAL LIABILITY t/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR NPP1421079 10/28/2015 10/25/2016 EACH OCCURRENCE $ 1 000 000 PREMISES Ea occurrence $100 000 MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $ 1 00O 000 GENERAL AGGREGATE $ 2 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 1 000 000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED n SCHEDULED AUTOS AUTOS AUTOSNON-OWNED AUTOS 509-80000-6191-001 06/02/2016 06/02/2017 BI E.Macc.dwSINGLE LIMIT BODILY INJURY (Per person) $ 25 000 BODILY INJURY (Per accident) $ 5O 000 PROPERTYDA AGEHIRED paracadent $ 25OOO UMBRELLA LIAB EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED I I 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 WC STATU- OTH- I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) "THIS CERTIFICATE IS SUBJECT TO ALL TERMS, CONDITIONS, EXCLUSIONS AND ENDORS MENTS OF THE POLICY" 61W /8/ A0 w Miami Jf10reS VIIIagE Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 L7_V lR1a111111111IF_\l011L 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 j' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD JEFF ATWATER OWE CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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: 1/3/2017 EXPIRATION DATE: 1/3/2019 PERSON: FUEGO OSVALDO FEIN: 263256329 BUSINESS NAME AND ADDRESS: COOL TOUCH INC 1635 WEST 44TH PLACE APT 303 HIALEAH FL 33012 SCOPES OF BUSINESS OR TRADE: HEATING, VENTILATION, AIR-COND 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 440.05(12), 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 440.05(13), 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 Cool Touch Air, Inc. Date: March 16, 2017 State of Florida County of Miami -Dade Before me this day personally appeared Osvaldo Fuego who, being duly sworn, deposes and says: That he or she will be the only person working in the project located at: Sworn to (or affirmed) and subscribed before me this fay of 2017, by Personally known �( Or Produced Identification Type of Identification Produced MAD[$ GARCIA Commission # FF 171106 My Commission Expires October 30, 2018 r Stamp Name Miami Shores Village Building Department 10050 N.E:2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795,2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption 77, 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 thestock of the corporations 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. A Signature: Owner State of Florida. County of Miami -Dade The foregoing was.acknowledge before me this '41day of Pa rW , 20 9 By:[)0nnt-t Cr'eSprp ----who is personally known to or has produced as identification. Not ZP* -0 JACCAJM Ft=K11JFZ �r W COMMISSION t FF 916636 SEAL: I:. EXPIRES: September 9, 2019 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 FUEGO, OSVALDO COOLTOUCHINC 1635 W 44TH PL, APT 303 HIALEAH FL 33012 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 q1F-,-,_-STATE-.0 DEPART PROFEc --CAC1816035 -CERTIFIED-Ai -FUEGO OSVA, "COOLTOUCM<I DETACH HERE --DEPARTMENT O.F:BUSIN - _ - CONSTRUCTION (850) 487-1395 - E - F_ 4BUSINESS AND . A EGULATION - t * "06/01:/2016 e,-p o `isrons oLCh 489•F•S _ L16W10001488 KEN LAWSON, SECRETARY ILATION Tht ,CLASS-B AIR' CONDITIONING CONTRACT Named°below.�ERTIFIED- Un r foie rovlsiorls-ofCtlapter,489 rS , --E�c�irati6n�d�ie i4UG'31•;�201.8":� ` 0 C 11 IRRIIFn• nR/n1/9nis i RFOUIRED BY LAW~ SEQ # L1606010001488