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MC-18-3719Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: MC-12-18-3719 Permit Type: Mechanical - Residential Work Classification: Pool Heater Permit Status: Approved Issue Date: 02/06/2019 I Expiration: 08/05/2019 Location Address Parcel Number 478 NE 92ND ST, Miami Shores, FL 33138 1132060140020 Contacts THOMAS ROGER & CHRISTINA WHITE Owner STRONG SERVICE USA LLC Contractor 478 NE 92 ST, MIAMI SHORES, FL 33138 ARILYS RUTKEVICH Mobile: 3054392855 Other: 3055461030 Business: 3052674960 Inspection Description: POOL WATER HEATER Valuation: $ 3,600.0on Requests: 0 Inspetti1305-762-4949 TotalSq Feet: 420.00 Fees Amount CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $108.00 Scanning Fee $12.00 Technology Fee $2.70 Total : $129.90 Building Department Copy Payments Date Paid Amt Paid Total Fees $129.90 Credit Card 02/06/2019 $129.90 Amount Due: $0.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulatir tr ction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Signature: Owner / Applicant / Contractor / Agent Date February 06, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION ❑ BUILDING ❑ PLUMBING JOB ADDRESS: YECHA ICNICAL `f- 0 f Folio/Parcel#: 11 ` � Z( `e Occupancy Type: Load OWNER: Name (Fee Simple Titleholder) Address Miami Shores Village 11F0 Department '0Fc �'`Fc Building p 1 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2011-1 Master Permit No.� Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS �Z Is the Building Historically Designated: Yes NO _ Construction Type: ,, 11 Flood Zone: BFE: FFE: Phone#: 3 o�CS Nfo /0 34 City: ti t44-1' State: Zip: --5 3 / 3 O Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Koq aeaujud USA I1 L Phone#: 3OS' 9%--�- gcli0 o Address: I'MW (y rid Aj Cit : State: zip: 3 3 � � 6 Y ; P� Qualifier Name: AP-4 S u f y"P-,U.1 CA Phone#: 3a - State Certification or Registration #: C-86 1$ I gG a Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: _ Add ress: City: State: Value of Work for this Permit: $ 3 1f/ d� ' b d Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Zip: ❑ Demolition Description of Work: UA-4, y— A "VL /L,(. r by LRO Specify color of color thru tile: Submittal Fee $ cetT-jPermit Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $_ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ 71 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. ---------� n Signature L� OWNER or AGENT The foregoing instrument was acknowledged before me this !/day of �6 +� """~' 20 19 by CA %; S4' 1-1C, k' , who i Cp'!I:on�aWnown to me or who has produced as identification and who did take an oath. NOTARY PU I If The foregoing instrAiment was acknovyledged beforethisthis / day of Z1O ✓ 20 ,a by who ' ersona nown to me or who has produced identification and NOTARY Q ke an oEN CARRERA MY COMMISSION # GG 159M gf EXPIRES: March 12, 2022 * °P BaWod TIn Notary Pubic lhideni NQM Sign: 41 Sign: Cv/ el Print: Print:s...,�,r 2.• .•!!g AYLEEN CARI2EFiA r <+ EN CARRERA Seal::;; MYCOMMISSION#GG159953 Seal: -•? ;�; MYCOMM,lS�' ^+fit GG15gg53 =� EXPIRES: March 12, 2022 2022 Banded Thm Notary Pubic W der nbm ' ` ��>;_. -- - Underwrpers as M- ************************************************************************************************************ RU A APPROVED BY Plans Examiner Zoning Nll-� �1 \X \ 1� \ Structural Review Clerk (Revised02/24/2014) f- 001398 Local Business Tax Receipt Miami-Dade County, State of Floriidar —THIS IS NOT A BILL — DO NOT PAY 7125388 BUSINESS NAME/LOCATION STRONG SERVICES USA LLC 13816 SW 142ND AVE STE 33 MIAMI FL 33186 OWNER STRONG SERVICES USA LLC C/O ISRAEL GOMEZ PRES Worker(s) 4 LBT RECEIPT NO. RENEWAEXPIRES 740267002670� SEPTEMBER 30, 2019 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 SEC. TYPE OF BUSINESS 196 GENERAL MECHANICAL CONTRACTOR By ME COLLECTOR CAC1817892 $75.00 07/02/2018 This Local Business Tax Receipt only confirms CREDITCARD-18-046890 Permit or a a. cmental reg of the holder's qualifications, to do business. Holder must cohm Receipt is not a license, or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles — Miami —Da a Code Sec 8a 2 6ental For more information, visit www miami --- dado..00yltaxco_llector ,aco CERTIFICATE OF LIABILITY INSURANCE DATE 12/12/2018Y) �.� I 12/12/2018 THIS CERTIFICATE IS ISSIiIED 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: Aline Jimenez J&A Insurance Services, I c A "N X : 786-518-2989 AIC No): 305-233-4289 12918 SW 133 Ct E-MAIL ainsuranceservices mail.com ADDRESS: I @9 Miami, FL 33186 INSURERS AFFORDING COVERAGE NAIC # INSURERA: Hallmark Specialty Insurance Company 26808 INSURED INSURER B : AmGuard Insurance Company 42390 Strong Services USA LLC INSURER C : 13816 SW 142 Rd Ave, su to # 33 INSURER D : INSURER E : Miami FL 33186 INSURER F COVERAGES CFRTIFICOTF NIIMRFR DI=11ICInAI KI"UDCD- THIS IS TO CERTIFY THAT TF E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAND NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE 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 INSURANC ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL Lh CLAIMS -MADE X� BILITY CCUR G09400088 03/20/2018 03/20/2019 EACH OCCURRENCE $ 1,000,000 DAMA ES S (Ea NT D currence PREMISoc $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES POLICY PRO- JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY STAU993622 04/13/2018 03/09/2019 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED XNO AUTOS ONLY AUTOS -OWNED ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIABHCLAIMS-MADE DED I I RETENTION $ $ WORKERSCOMPENSATION PER OTH- AND EMPLOYERS' LIABILITY I ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N El OFFICER/MEMBER EXCLUDED? N/A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS b low E.L. DISEASE - POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCA IONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) 9111 Air Conditioning Systems or Equipment 92478 Electrical work within Building CERTIFICATE HOLDER I CANCELLATION Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2 d Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD