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MC-18-1964 (2)`ywO12es L,� Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 �t""oRi"vA Phone: (305)795-2204 Permit NO. 11 C-7-18-1964 Permit Type: Mechanical - Residential aWork Classification: Addition/Alteration Permit Status: APPROVED issue ,oats. 7/2'7/2018 J Expiration: 01/23/2019 Project Address Parcel Number Applicant 29 NE 98 Street 1132060131120 Miami Shores, FL 33138- Block: Lot: GLENN DAIDONE Owner Information Address Phone Cell GLENN DAIDONE 54 NE 97 Street (305)788-2711 MIAMI SHORES FL 33138-2331 54 NE 97 Street MIAMI SHORES FL 33138-2331 Contractor(s) Phone Cell Phone ERV AIR CONDITIONING INC (305)975-5943 Tons: 4dditional Info: CHANGE OUT SPLIT SYSTEM AND ADDITIO classification: Residential Aooroved: In Review Comments: Date Denied: Scanning: 3 Fees Due Amount CCF $4.80 DBPR Fee $4.20 DCA Fee $2.80 Education Surcharge $1.60 Permit Fee $280.00 Scanning Fee $9.00 Technology Fee $6.40 Total: $308.80 Valuation: $ 8,000.00 Total Sq Feet: 0 Date Approved:: In Review Type of Work: CHANGE OUT SPLIT SYSTEM AND A Pay Date Pay Type Amt Paid Amt Due Invoice # MC-7-18-68303 07/23/2018 Credit Card $ 50.00 $ 258.80 07/27/2018 Credit Card $ 258.80 $ 0.00 Available Inspections: Inspection Type: Final Rough Duct Review Mechanical Underground �]E 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_4oqe in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named c or o the yvo* sfaTdd 27, 2018 Authorized Signature: Owner / Applicant / Contract / Agent / Date-------. Building Department Copy July 27, 2018 1 Miami Shores VillageTu2 ii1.�iBuilding Department10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 t-4-L BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC ❑ ROOFING FBC 201-1 Master Permit No. X? 2-18-2-7 1 /� Sub Permit No. 1' C IS - � _L b T a ❑ REVISION ❑ EXTENSION RENEWAL ❑ PLUMBING MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5117 A&5 Z26 City: Miami Shores County: Miami Dade Zip: 5�/3�? Folio/Parcel#:1132NP n 13112U Is the Building Historically Designated: Yes NO Occupancy Type; Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): [�/ 41 �JO�Ib�X✓ Phone#: Address: Z Ve(-4 /la!� City: Ael04 411 State: L'�L Zip: % % Tenant/Lessee Name: Phone#:i1J' U� 24`2�`1 Email: 4-Vb,4 & . (fon-9 CONTRACTOR: Company Name: l/Ri2C1�,t,1DlT/dam/��' j��vC. Phone#: 31W� 3 Address: City: A'C!//--I'l7L�� r, State: Flo ✓'/d'a Zip: C�'' / �� ✓ \ Qualifier Name: S ��L(./ /e t � / f<<( * Phone#: q 71 State Certification or Registration #: a,,de- /Cy S(pZZ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Add City: Zip: Value of Work for this Permit: $ RQMOO Square/Linear Footage of Work: Type of Work: X Addition 9 Alteration !❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ��� �� ��rG/� � Q�� ��all TL7e�24 i%ex.; Specify color of color thru tile: j Submittal Fee $ So ) Permit Fee $ Scanning Fee $ Radon Fee $ d" V V v CCF $— DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ yeti W VMI M!1,fA 3"�a .>. inn: -a : e�T�l,'C $.•` � � rvw;' Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 2_S8 - (90 0-c1 (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 r 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. r- "WARNING'TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS' TO YOUR PROPERTY. FF,YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." t Notice to Applicant: As a condition to the issuance of a building permit wiih 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. +. Signatur OWNER or AGENT The foregoing instrument was acknowledged before me this f Q� 1 S ' day of / , 20 t e , by QI f UP PA-t C0W1f' I who is sonally kno n to me or who has produced identification and who did take an oath. as NOTARY PUBLIC: Sign: Print: Q Seal: oMNuv� t�oa'► auk �� l�e►n � � t10fSSDpOJM Z34WN 313SIa1111 sss***srsr** APPROVED BY Signature G CONTRACTOR The foregoing instrument was acknowledged before me this V d of Svc 20 by /G! 61 personally known to me or who has produced L: QzoCiL as identification and who did take an oath. NOTARY PUBLIC: Sign: • 4� Print: "' �'' ANGEL PAEZ Seal: t°4. Notary Public • State of Florida ar' Commission G FF 977868 i `%<„ ,�d?•• My Comm. Expires Apr 3, 2020 •**rrs******rr***r*rr*1K,�r*sssr *ss**s*r*ss Plans Examiner Structural Review 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):` /S 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 331� Change disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UJYIT MANUFACTURER S AHU or PKG. UNIT MODEL # A911,6111 v6 A CdND. UNIT MODEL # AIX A636 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: State Certificate or Registration No66 of Competency No. Signature Date: (Qualifier's signature) (Revised02/24/2014) r ,'% 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: caner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 1 1Z day of J 01 I 20-LK-. By_�i(�i�/ �� /i e who is personally known to me or has produced r— i c Q fir• e as identification. Notary: SEAL: r"19T ANGEL PAEZ Notary Public - State of Florida Commission G'FF 977868 E 12, V Nlz_ C 0 Aj �'a�e u ji, L i C_ . . __ F � . . i{nf...-c 4, --- --------- V-,%iuvii, U;zUst:S a.-.0 says - That he or she will he the only nee working on the projert lo--.Ated Rt-, . h - -I � - I. - I- ­ I Ok r--rod-uced identification v. ANGEL PAMEZ Notary Public - Still of FW"W& COMMISSion I FF 977868 ",ly COMM. Expires Apr 3, 2020 E -AV UC 1/Akt rl r1CKC RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY 4 - STATE OF FLORIDA ` DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION` CONSTRUCTION INDUSTRY LICENSING BOARD CA61815622r_. y -_. '" • .I «. >' *r�tl: `Mom`` ? 4 #. 'The -CLASS B AIR-CONDITIONING CONTRACTOR' Named below IS'CERTIF,IED: _., ""* ,�`�-- '`, ` •�" ,�'y,, "lJnder the provlsion's of.:Chapter 489 FS tik4 iExplra� n�1da'tre�;AUG`,31',2018 : - —'- ,��`!Y,_'iii X ❑ ❑ RUIZ,DEVILLA;-ERNESI'O� ,�. � „� Yak` .,� . � '��, � r• ERVAIRCONDITIONINGpINC.J"" -•- '-� •~ '`�- 10840'SW 69,DRT MIAMI---.'FL133173f = '" " , :,;"" `'v y _, "`` -n if ISSUED: 09/04/2016 DISPLAY AS REQUIRED BY LAW _ SEQ # L1609040001165 r. 000633 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6124929 .­,LBT BUSINESS NAME/LOCATION w $ RECEIPT NO. EXPIRES ERV AIR CONDITIONING INC RENEWAL SEPTEMBER 30, 2018 10840 SW 69 DR 6387799 Must be displayed at place of business MIAMI FL 33173 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED ERV AIR CONDITIONING INC 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR r-. Worker(s) 1 CAC1815622 c882.50::10/3172017 CREDITCARD=18-003950 - ~ This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is note license, permit or a 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.govAaxcollector 07101/2013 22:38 3058881885 PAGE 01 �- CERTIFICATE OF LIABILITY INSURANCEDATE (MMrooirvvv) _ (Mmmo - - —_. i — 07 s _..._� TNI5 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 I REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the e'artificate holder is an ADDITIONAL INSURED, the policylies) must be cndorsed. If SUBROGATION IS WAIVED, subject to i the terms and conditions or the policy, certain policies may require an endorsement. A statement on this certHicate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT _.. _. ... _ . West Coast Insurance Consultants In PHONE FAX LAIC-No-K, (305�88 1B80 _ i.tac,Npl__ i305)888-1885 P.O Box 520574 E-MAIL sapeltJ9Cmsn.corrl Miami, FL 33152 INSURERLSJAFFOROING COVERAGE NAIC 2 Phone (305) 888-1880 Fax 305 888-1885 ---•—_ ..... ........ .. ( ) . „_- ., INSURER A; GRANADA INSURANCE COMPANY INSURED INSURER 8 ERV AIR CONDITIONING INC INSURER C . 10840 S.W. 59 Drive INSURER D: Miami, FL 33173-2008 305 INSURER E,: F : COVERAGES CERTIFICATE N -- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELQW HAVE BEEN ISSUED TO ICIETHE 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 A" THE TERMS, j EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR I 'ADDLSUBR� POLICY EFF I POLICY EXP— LTR I _TYPE OF INSURANCE I vin�p _ POLICY NUMBERMNUDD/VYVY) (MM/DDIYYYY!} LIMITS ...—._..... _.. _._. - GENERAL LIABILITY. IABIL.... _.ITY EACH-XCURRFNCE S 2,000,000.00 COMMERCIAL GENERAL LIABILITY 1 OO,000.00 .. --DAMAGE TO RENTEG ' IV) _ _PREMISES LEe_xxurrence S — ( CLAIMS -MADE ( ) OCCUR 0185FL00031147 MED EXP (Any one person $ 5, W0.00 A Y Y 11 /07/2017 11 /07/2018 -- --- - ---- -' - PERSONAL & ADV INJURY 5 1,000,000.00 GENERAL AGGREGAIR S 2,000,000.00 CEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS _COMPIOP AGO $ 2,000,000.00 I_ POLICY JECT LOC $ AUTOMOBILE LIABILITY MgIrvED SINGLE LIMIT Ea acadent _ ANY AUTO BODILY INJURY Per person) $ ALL OWNED -7 SCHEDULED P BODILY INJURY i (Par xc�de AUTOS AUTOS ( _ "_t S i .. .. -••-7 NON�OWNED PROPERTY DAMAGE I ( MIRED AUTOS I I AUTOS I I l3,r BCCIOeni) ...... .. ..... S .. . . ��•-_I.._._.-_....__ .I UMBRELLA LIAO 1 OCCUR EA_CI-i_OCCURRENCE i ( I EXCESS LIAR U CLAIMS -MADE AGGREGATE SOR — i AND EMPRKERgOYER3' LIABILITYY f N - ICOMPENSATION' I WC, Li r� FROTH ANYPROPRIETOR/PARTNER/EXECUnvE E.L EACH ACCIDENT . $ OFFICER/MEMBER EXCLUDED? NIA — - - -- - - (Mandatory in NH) E.L DISEASE - EA EMPLOYE f n ee, descrl be under --_.._— .. ..._. ...__.._.. _. _......... _ . DESCRIPTION OF OPERATIONS below - _ E.L. DISEASE •POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Sahadule, if more space Is required) license no CAG1515622 Air Conditioning contractor CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 ACORD 25 (2010/06) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELWERED IN ACGQMPANGe WIT" Tne rOLICY PROVIaIONa_ AUTHORIZED REPRESENTATIV6 I Z 1988-2010 ACORD CORPORATION_ All rights reserved. The ACORD name and logo are regisWed marks of ACORD