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MC-18-2997 (2)Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: MC-10-18-2997 Permit Type: Mechanical - Residential Work C/assification: Addition/Alteration Permit Status: Approved Issue Date10/16/2018 Expiration: 04/01/2019 Location Address Parcel Number Project 77 NE 105 ST, Miami Shores, FL 1121360060150 <NONE> Contacts EZEQUIELZYLBERBERG Owner JESSICA SCHILLING Owner 77 NE 105 ST, MIAMI SHORES, FL 33138 77 NE 105 ST, MIAMI SHORES, FL 33138 Mobile:5617032510 SCHILLINGESI@GMAIL.COM Other:9546293012 JESSICA SCHILLING Applicant COOL FREEZE AC CORP Contractor 77 NE 105 ST, MIAMI SHORES, FL 33138 ERNESTO RODRIGUEZ Other: 9546293012 8430 NW 68 ST 1, MIAMI, FL 33166 Business: 3055919794 Description: NEW DUCTS, VENTILATION AND REPLACE AC. Valuation: $ 9,000.00 Inspection Requests: 1305-762-4949 TotalSq Feet: 230.00 Fees Amount Application Fee - Other $50.00 CCF $5.40 DBPR Fee $4.72 DCA Fee $3.15 Education Surcharge $1.80 Permit Fee $265.00 Scanning Fee $3.00 Technology Fee $7.88 Total: $340.95 Building Department Copy Payments Date Paid Amt Paid Total Fees $340.95 Credit Card 10/16/2018 $340.95 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 regulating construction and--6fiing. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / App ontractor / Agent Date October 16, 2018 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (30S) 79S-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING OCI 012018 FBC 201 Master Permit IN Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING 01 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 6 / � �OS- City: Miami Shores County: Miami Dade Zip: 7131 3e'. Folio/Parcel#: ((2- / 34 ()0 66 /-�-o Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: I %r OWNER: Name (Fee Simple Titleholder): _m/32� Phone#: Address: City: kf ! -Ar-v/ '`to State: Tenant/Lessee Name: Email h -33" / 3,F CONTRACTOR: Company Name: Ccd Cr .Ze-/?e- Phone#: Address: & Y 2- Qv-, '�-j City: \ /Pr l State: Zip: �r� Qualifier Name: (. - !' �2 Phone#: ��t7 `-I "t 0 L4?9 State Certification or Registration #: C KAg Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: _ Address: q City: State: Value of Work for this Permit: $ ! -0,00 - Square/Linear Footage of Work: Type of Work: ❑ Addition ® Alteration P New ❑ Repair/Replace r Descri tion of Work: �� ► I , Dw Zip: ❑ Demolition Specify color of color thru the: Submittal Fee $ Permit Fee $ ®O CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ � • —f (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 charge 1 Signature OWNER or AGE The fore oing instrument was acknowledged before me this �4day of lls;cp 1 .20 ls, by (4 Q VA JP(�� 1 Wi);C45 known to • me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: ' ;�: MY COMMISSION # GG Print: Seal: d. Signature 12= CONTRACTOR The foregoing instrument was acknowledged before me this 2—S day f P!/' 20 by i who is personally known to me or who has produced G D as identification and ho did take an oath. NOTARY PUBLIC; Print: Seal: MY COMMISSION # FF914890 EXPIRES September 01. 2019 A .. MY COMMISSION 044602 r'�^"•(� :„ o�g PI Examin r Zoning s';:�Q 't •'• Bonded Thru Notary Publiic Underw item Structural Review Clerk (Revised02/24/2014) •A,1 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): 2. Maximum Overcurrent Protection (Fuse/Breaker Size):: 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: (�Od �✓` ��i— Phone: State Certificate or Registration No. li( l 11 2 2— Certificate of Competency No. Signature 7,Date: (Qualifier's signature)[ (Revised02/24/2014) - - I STA�E'OFjL�t !C DEPARTMENT dbjvT),t0GU �'OF,iUSINESS:AND •eROFESSIONAL LAT.fO CAC1818272 �sti,Ed'07/16/2018 El AI CLASS R, NOITIONING CONTRACT_ OR: ='• , RODRIGL! �RNESTO - r-:, COOL FREEZEA/C.bORP�-r• t.Y ! ' Sift� LICENSED UNDtR CHAPTER4489,.�FLORIMSTATUTES • . �' p' EXPIRATION DATE:`AU6UST S1.1=6 - ' a ADk,, G`1I d tFl�JZjpq•DEPA�PROFRTNIENNTrydF13USiAESS AWpERTM REGULATION- ` CAC181&1?1 j" ' - ' - `... , CLASS A Aik, g dMONINGICO y ' _ ISSUES? 0/16/2018 RODRIGU.E�!gpj4tSTO. k -1 , _ NTRACMR i COOL FREZq%C CORD= i` =" - _ s'� f .� C � ,•l t l LICENSED UNDER C ' , - SlSnat EXPIRATION DATE AV&ST 3I " Local Busum=R . Miami -Dade Count}y�' State offlorid; �o -THISISNOTA8ILL- orida DO NOT Pqy 7188395 SUSINEUS NAME/LOCAnON COOL FREEZE A/C CORP 7750 NW 71 ST ST 126A MIAMI FL 33166 OWNER COOL FREEZE NC CARP C/0 ERNESTO RODRIGUEZ.PRES Worker(s) 3 RECEIPT NO. RENEwAi. EXPIRES 7469508 SEPTEMBER 30, 2019 Must be displayed at place of business Pursuant to County Code Chapter eq _ Art. 9 & 10 Wit• 74PE OF BUSINESS 196' "MECHANICAL CONTRACTOR PAYMENT RECEryED CACi8M 2 BY TAX COLLECTOR $75•00' 07/16/2018 This Local 80310ea Tex Rea• CREDITf.ARf1-18—Q54575 ponaiL or a co IMe o �I nd"mq" a� ato to bubo" &aloes: Tax Rscalp, is not a license or noaporemwt dca*80icati The RECEIPTNO.'ab"s htrvs an rs ess Holder nnat be dlsphryrod on ailwhici aaPh to the bwlnass, � vvitlt spry 9e►remiaen6 caamorcial For arore iaf 'nags ..sit vehicles- Mlawi-Dada Code Sec bl-2X 19D16M•mlamidad■cco, 011 CERTIFICATE OF LIA131LITY INSURANCE HOLDER, THIS CERTIFICATE j&j—S NOT IrlirwKw-ATION ONLY ANtj-60—NFERSNO RIGHTFUPO—NTHE-idERTWTC—ATE AFFIRMATIVELY OR NEGATIVELY At EXTEN[D OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE THE ISSUING I DOES NOT COUSTITUTE A CONTRACT BETWEEN NSURER(Sk, AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. im I 11��11111 h €faI � 11111111 V! ADDITIONAL IN lfaa WANED, sublOct to th* terms "d Conditions of the pol RR-0—GATION IS ,certificate does ell confer 1111111111�111, r icy, ce�a!n tho C01"1131cato holder In lieu of pch oildes may require an entfonemont. A stcbmant on this "*ndo'!!=2LS)' PRODUCER HOr"66116 COmmOmIal Insurance program PO Box S316 Binghamton, NY 13902 1AI NOURER(l) AFF"RG COVERAGE COOL FREEZEAJC CORP I : InHar 7052 NW 77 CT MIAMI FL 33166 iRaUAER COV THIS CERTIFICATE NUS' ER: SOS7131729891 REVISION NULtSEW. POLICY HAVE BEEN ISSUED YO THE INSURED NAMED ABOVEFORTHE RESPECT RM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH IS , CL U N, THE INSUPANCE AFFORDED By THE POLICIES DESCRIBED VXREIN AJM SUCH POLCIES, LrAITS SHOWN MAY HAVE BEEN REDUCED BY PAID T y P ro F TII TYPE OF IMMIRAWX MR WVD POUCykuuaER ''::: :!!!� Err I GE L UADAU'TY W TIAL iaD1Y'" Uws A X A X IN EACN OctXqVt:NcE 00C 131 AL Ae LIAMX ,NY N GLPIOD9179 DAMAGE TO Aj�j -M-- 0711112018 07111I2019 EMSES CLAWSAAAnf-, CCR X CCR r F3 3 E3 QAurwnces -- -fKjl-ONLO-00 S5,000 PERSON& a A-Ov jNApRy $1 003 000 AWREG T GE"t AWRMATE- LVIT APPUES P GrNERALAGWIrGATE $2,000,000 x PcLr-y MODV-'IS - CCWICP AGo S20000g9 CT OC. LOG Atrr(MCXE LIAC!UTy COWNED -hK;L,F LUR AWAUTO IE* wd-:hni AU O%"D L3ULEf3 80OXY IXARY ALffOS; BDDLYINMY tMEDAtn NON-Ov'WED at A--tdvt AUT PROPERTY DAMAGE {Per RE LI.A uAs OR EAChOQ'ApRrXpCCr- $ XCE33 UAS ZAWS-MADE AG ;trGATE DCO RETENTIOMS WORKERS CCUPMSATION Atha EVftOye"rLL4jMffY YM WC STATLJ- ar- AY P NROPRIETOKIPARTUMr)(Ccu T LIWIM -TpvrOFrCEMwV=RrxcLuOED-C NIA El EA04ACCZC3tT OISEAM - EA I Yes. d a *Ylw uJef nmwyEE CY Low PROFESSIONAL LIABILITY E.L. DISEASE - PCL OCCURRENCE AGGREGATE p Hosting, Venting and Air Conditioning S*rvicas pe" It CERTIFICATE 146L-D—ER CANCELLATION MIAMI SHORES BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED PCUCIES BE CANCELLED SHORES 10050 NE 2 AVE BEFORE THE EXPIRATION DATE THEREOF, NOTICE VVILL, a[! DELIVERED IN MA Mi SHORES t ACCC)"ANCE VM THE POLICY PROVISIONS [M11AMi SHORES MLLAGE FL 33138 AvrowzED REPRUYWATNE C 1988-2010 ACORD CORFO—P-A—T-1054F. All —lightsmsorvod. ACORD 25 (201(MS) Th2 ACORD nerne rnd 1090 =0 rovistamd mcrom of ACORD BID 013 20130603 1 1 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED ASA 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 SELOW, THIS CER11FICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMFO—WT—ART: If thecartif.;cataholder isanADDITIONAL INSURED, the policy 0-) rnust have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may reRuitG en endorsement- A slaten*nt an this certificate does not confer rights to the certificate holder in lieu of such andorsensenjfsj. FrartkCrurn IrmtranceAgemy, Inc. 100 South Wissouri Avenue FrankCrum L/CJF Cool Freeze AIC Corp 100 South Mssouri Avenue I.- Ki:VR510N NUMElt* TMS ISTO cmTify THAT THE POLIC ACS OFPIS URANM, t9STE0eMOW"AVE BEENISSUED TO TM rusum No'nvmt - DukMEDABOVE FOR THE POMY Pmoo MICATM. VERTA K. STAkJMAWRECUMAM-IT TrRU OR CONDtTM OF ANY CCINTRACT OROTHERDOCU'JENTv'MTJj RE93ECT To%vmicn rws cEnTmATE MAYS E ISSUED OR MAY THE INSURANCE AFFORDED BY THE POL"S CREED KE. REIN IS 3tMXCT TO ALL THE TERMS, E(CLUSIONS AND CON=ajS OF err POLICIES.1-IMITS SHMW L TYPE OF TOE OF MuR,04E SR 106[iliiFi--1 LW.7 3 nucnckvml Cov'— _ —E- E0ocCX" 0 A M A3- E -0 M 3 4 ID YN-L POVIONAL A A0V W-RV - A03X-aA -4 L047 Al.k* 3 PER -LCY ED PWUWT E]Lm 0 0 UK rQ- A 03 M-3 A7 E AwAVM clava"'D Ila ='wwj 90iMVrULR"r RAWAUT08 awy 19ccxyw, LRV PROPWTY OAMAGE EXCEWLWI - AGORM)LI-E OM A '03P1':RS 00PAVAISAMN AM —wLoyvm-LL4aLrry Y/N WNS OFFXMSKAMER MLLCODi MaaS Fv 063OMPTMOPOPOW MN3tek7W WA WC201800000 0110112019 x PM STATUM or,4. EL. EA Cs =1 i mocco Yiwo 000 E L C*S766.F0VC`f LK147 Effective OV212018, coveraW j3 for IOD% of the ernployces of FrartkCium leased to Cool Freeze ABC Corp (Client) for whom the client iSreportinghowsto FrankCrum. Coverage is not extended to statutory employees. S"OULDANY OF THE ABOVE OE' EMBED POLTIES BE CANCMIED BEFORE TIDE EXPIRATION DATE THEREOF, NOTICE WEL BE DELP&PX0 n AcCOsWAWt- virni THE MIAMI SHORES BUILDING DEPARTMENT. MUCY PROVISIONS 10050 NE 2 AVE MIAMI SHORES VILLAGE FL, 33138 AUTHORIZED RE; _MSENTATIVE ACORD 25 (2016M) The ACORD narne and logo are registered marks of ACORD 0 19 W-2016 ACORD CORPORATION. All tigtds reserved.