The URL can be used to link to this page

MC-18-2346ORES V,l` Miami Shores Village g iall 10050 NE 2 Ave Miami Shores FL 33138 y-. 305-795-2204 so F OERION Location Address Yerrrltl7VV.. IY14.0-10-6J-*V rW1111 s I- —r.ruc,:+............ - L permit Type: Mechanical - Residential _( Work Classification: Addition/Alteration Issue Date: Parcel Number Permit Status: Approved Expiration: 04/15/2019 Project 122 NE 105 ST, Miami Shores, FL 33138-2033 1121360130680 <NONE> Contacts ROY AND MARGARET MEVERS Owner ROY AND MARGARET MEVERS Applicant 122 NE 105 ST, MIAMI SHORES, FL 331382033 122 NE 105 ST, MIAMI SHORES, FL 331382033 Other:3057560156 Other:3057560156 WILLIAMS AND SON AIR CONDITIONING Contractor CARLOS A CASTILLO 11315 SW 47 ST, MIAMI, FL 33165 Business: 7865876971 Description: A/C AND DUCT WORK FOR THE ADDITION OF A Valuation: $ 14,300.00 Inspection Requests: NEW MASTER BEDROOM, MASTER BATHROOM BEDROOM#4, 305-762-4949 CLOSET STUDY AREAS AND A/C RETURNS Total Sq Feet: 548.00 Fees Amount CCF $9.00 DBPR Fee $7.51 DCA Fee $5.01 Education Surcharge $3.00 Permit Fee $500.50 Scanning Fee $3.00 Technology Fee $12.00 Total: $540.02 Building Department Copy Payments Date Paid Amt Paid Total Fees $540.02 Check # 206 10/15/2018 $540.02 Amount Due: $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 regt4tpting construction and zoning. Futhermore, I authori e)he above named contractor to do the work stated. Signature: Owner / Applicant / G ✓, / Agent Date October 15, 2018 Page 2 of 4 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 ppFBC 201� BUILDING Master Permit Nozo-1( & _ ' PERMIT APPLICATION Sub Permit No. MC(U —23 qG ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING Q MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 122 NE 105TH STREET City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2136-013-0680 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee simple Titleholder): Roy Mevers and Margaret Hood Mevers Phone#:305 812-6522 Address:122 NE 105th Street City: Miami Shores state: Florida Zip: 33138 Tenant/Lessee Name: N/A Phone#: N/A Email: royatsea@gmail.com CONTRACTOR: Company Name: Williams and Son Air Conditioning Corp Phone#: 305 587-6971 Address: 11315 SW 47 Street City: Miami State: Florida Zip: 33165 Qualifier Name: Carlos A Castillo Phone#: 786 587-6971 State Certification or Registration #: CAC1816926 DESIGNER: Architect/Engineer: Marl( A. Campbell Architect Certificate of Competency #: N/A e#: 305 754-2318 Address:373 NE 92nd Street city: Miami Shores State: FL Zip: 33138 Value of Work for this Permit: $ 14,300.00 Square/Linear Footage of work: 1017 and 548 sgff Type of Work: ❑� Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: A/C and duct work for the addition of a New Master Bedroom, Master Bathroom Bedroom #4, Closet, study areas and A/C returns. Specify color of color thru tile: Submittal Fee $ Permit Fee $ !�;03 ' CCF $ CO/CC $ Scanning Fee $ Radon Fee $ . n t DBPR $ l Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 5 `4 d ` O 2�— (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 f such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature / Signatu OWNER or AGENT The foregoing instrument was acknowledged before me this day of ! Lr t%� f 20 "1 1 by '( M PIV4 S , who is personally known to me or who has produced i' c. 0 L/ as identification and w NOTARY -PUBLIC: Sign:_ Print: --CHASE CAMPBELL MY COMMISSION # FF 200055 EXPIRES: February 17, 2019 Bonded Thru Notary Public Underwriters E tr L The foregoing instrument was acknowledged before me this 6 I� day of d Yt f , 20 J I by Carlos Castillo who is personally known to me or who has produced FL -7Q as identification and who did take an oath. NOTARY PUBLIC: .% Print: Seal: Seal: AJV `rl;z WENDY NMIANDA MY COMMISSIOMOM029 " March 11, 2021 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 009593 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6896048 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES WILLIAMS AND SON AIR CONDITIONING CORP RENEWAL SEPTEMBER 30, 2018 11315 SW 47 ST 7171663 Must be displayed at place of business MIAMI FL 33165 Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS WILLIAMS AND SON AIR CONDITIONING 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED CAC1816926 - BY TAX COLLECTOR Worker(s) 1 $75.00 07/08/2017 CREDITCARD-17-045293 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or 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.govttaxcollector �. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CAC 1816926 ISSUED: 09/15/2016 CERTIFIED AIR COND CONTR CASTILLO, CARLOS A WILLIAMS AND SON AIR CONDITIONING IS CERTIFIED under the provisions of Ch.489 FS. Expiration date AUG 31. 2018 L1609150002079 ` "345SW OM ST a; Opp;9Y2t- 8E%, ¢ Air- R25 M039116MGs.6i� "`"` ^mw«.orp M , ,mwa +dsM eOweldtiMs edwMw to Mv>taOrnlr>.M w�rsA y w. ACUR I CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) r05/29/18 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 terns 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 CONTACTNAME: ,,,.. Lucia Estrella Accurate Underwriters 8300 West Flagler Suite 114 PHONE (305)226-8727c No): (305)226-8767 M RIE A's ' luc(aestrella@bellsouth.net INSURERS AFFORDING COVERAGE NAIC # Miami, FL 33144 INSURER A: Granada insurance Company Phone (305) 226-8727 Fax (305) 226-8767 INSURED INSURER B : Progressive Insurance Company INSURER C : William & Son Air Conditioning Corp INSURER D : 11315 SW 47 St INSURER E: Miami, FL 33165- 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 LTR TYPE OF INSURANCE ADD I SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD LIMITS A GENERAL LIABILITY ❑d COMMERCIAL GENERAL LIABILITY ❑ CLAIMS -MADE R OCCUR 0185FL00066268-3 01/16/2018 01/16/2019 EACH OCCURRENCE S 1,000,000.00 DAMAGE TO RENTED PREMISES Ea occurrence)$ 100,000.00 IVIED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER 0 POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ B AUTOMOBILE LIABILITY ❑ ANY AUTO ALL SCHEDBODILY ❑ AUTOS OWNED AUTOSULED ❑NON -OWNED ❑ HIRED AUTOS AUTOS ❑ ❑ 03076031-3 05/08/2017 05/08/2018 COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ 10,000.00 INJURY (Per accident) $ 20,000.00 PROPERTY DAMAGE Per accident $ 10,000.00 $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A ❑ WC STATU- ❑ OTH- 1ER 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) CAC1816926 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 25 (2010105) OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TUERMF, NOTICE WILL BE DELIVERED IN AUTHORIZED REP 7E�Sl Lucia Estrella The PORATION. All rights reserved. are registered marks of ACORD IW"E. JIMMY PATRONIS CHIEF FINANICAL 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: 11/1/2017 PERSON: CASTILLO FEIN: 452983558 BUSINESS NAME AND ADDRESS: EXPIRATION DATE: 11 /1 /2019 CARLOS WILLIAMS AND SON AIR CONDITIONING CORP. 11315 SW 47TH ST MIAMI FL 33165 SCOPE OF BUSINESS OR TRADE: Heating, Ventilation, Air - Conditioning and Refrigeration Systems Installation, Service and Repair, Shop, Yard & Drivers A 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 440.05(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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 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: tl Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 1 u day of ,20 �6 . By R L"— t who is personally known to me or has produced d L. as identification. CHASE CAMPBELL Notary: MY COMMISSION # FF 200055 C (, L LA" E'13 EXPIRES: February 17, 2019 SEAL: v�°P`• Bonded Thru Notary Puift Underwriters a�„•••` Air Conditioning Corp Date: June 5, 2018 State of Florida County of Miami -Dade CAC 1816926 Carlos: 786-587-6971 Williams: 786-251-8653 Residential — Commercial — Industrial Before me this day personally appeared Carlos Castillo who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 122 NE 105th Street, Mini shores, FL 33138 Signature Sworn to (or affirme ) and subscribed before me this 6 k day of J � Ml 20, by S _d Personally know OR Produced Identification Typ qmff� A029021 Print, Type or Stamp Name of Notary