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MC-19-723Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Hate: 04/10/2019 Location Address Parcel Number 148 NW 96 ST, Miami Shores, FL 33150 1131010240290 Contacts PermitNO.: MC-04-19-723 Permit Type: Mechanical - Residential WorkCiassifcation: Alteration Permit Status Approved Expiration: 10/07/2019 JOSE CABANILLAS RODRIGUEZ Owner 600 NE 36 ST APT 1917, MIAMI, FL 33187 Home: 7867478191 CABASCASITA@GMAIL.COM QUALITY COOLING SYSTEM Contractor ROGER W PARRIS 14629 SW 104 ST UNIT 300, MIAMI, FL 33186 Business: 3052559439 Other:3059701935 Description: KITCHEN TO BE REMODELING INTERIOR NEW Valuation: $ 3,000.00 Inspection Requests: TILEUP FIRST AND SECOND FLOOR, VANITY IN BATH TO BE 305-1 2-4949 REPLACED AND SINK CEILING TO BE REPLACED (SEE FLOOR Total Sq Feet: 928.00 PLAN Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $55.00 Scanning Fee $3.00 Technology Fee $2.63 Total: $117.03 Building Department Copy Payments Date Paid Amt Paid Total Fees $117.03 Credit Card 04/10/2019 $117.03 Amount Due: $0.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws 712b7 onstr7 zo ' g. Futhermore, I authorize the above named contractor to do the work stated. Authorized Si(nature: Owner / Applicant / Contractor / Agent Date April 10, 2019 Page 2 of 2 I Miami Shores Village 9�1P>11� Building Department °��® 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2011 BUILDING Master Permit No. VC ` 4-1 10-3 C% PERMIT APPLICATION Sub Permit No.M C _ — N-19--123 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS:__NO %/�/_ & City: Miami Shores County: Miami Dade Zip• 3 � Folio/Parcel#: ��" �) -v�}. - oRn Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): \'�1� l Ai Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: 0 CONTRACTOR: Company Name: Address: /4loAW S ne#: City: �$,�p State: � Zir�3),I r" Tqr Qualifier Name- r S Phone#: _�3'1I) State Certification or Registration #: 12 Ae d Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit. $ 3 I GO 0 Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work:Zge 11 To Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ CCF $_ DBPR $ CO/CC $ - Notary $ 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 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 on estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Za eo�-� OWNER or AGENT A--C—ONTAAMOR The foregoing instrument was acknowledged 3 before me this The foregoing instrument was acknowledged before me this day of l�c(pQ,c t 120 1 1 by !�_ day of f 20 by l�Sr�- l'�A�.+t u-L` who is personally known to who is personall knout to me or who has produced - f-y2-L`1/4-1rZ3 as D3gor who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBUC: aLiSign:Sgs� / � Print ��_°g�yo a! Print rz P`,:: �� MIA M. RODRIGUEZ Seal: = Q oQ�sss J 2 Seal: # * MY COMMISSION I FF 96 n CC U �° • vs# : o EXPIRES: Apra 19, 2020 .- ^ �� r' , o ` `. '+rF� n.�''e Bonded Thru 8udpet Notary SenlCet 1 iir �' N3li3d @�\�\�\~4\ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY d R da r STATE OF FLORIDA DEPARTMENT OF BUSINE$-SAN--PVAQFESSIONAL REGULATION THE CLASS B,AIR * NVICTMAYWIL A - Always verify licenses online at Do not alter this document in any form. UNDER THE This is your licenseAt it unlawful for anyone other than the licensee to use this document. Loca I x ftceipt Miami-DadeR no i Client#: 1531283 fiK�Z�1�L\,.C«ZeZe7 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10/01/2018 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 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER McGriff Insurance Services 9200 S. Dadeland Blvd, Ste 314 NA jTA T Alisa Josephs PHONE 305 670-0083 Fax 8668028668 A/C No Ext : AIC No E-MAIL ADDRESS: ajosephs@mcgriffinsurance.com Miami, FL 33156 305 670-0083 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : arse^can Builders Imurance Company 11240 INSURED Quality Cooling Systems Inc. 14629 SW 104 ST. #300 INSURER B : Florida Citrus Business &Industry Fund WCSIF INSURER C :INSURER Miami, FL 33186 D INSURER E : 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 CONTRACTOR 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 ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY GLP018000504 10/02/2018 10/02/2019 EACH OCCURRENCE $1 000,000 CLAIMS -MADE 51OCCUR PREMISES EaEONxun-once $1001 000 X MED EXP (Any one person) s5,000 PD Ded:250 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JP CT LOC GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OPAGG $2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO OWNED F SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F—Y] N / A 106578312018 6/01 /2018 06/01/201 PER I OTH- E.L. EACH ACCIDENT $1 00O 000 E.L. DISEASE - EA EMPLOYEE $1 00O 000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 _ _ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ** Workers Comp Information ** Proprietors/Partners/Executive Officers/Members Excluded: ROGER PARRIS-PRES, ELECOFC Aphzal Ramjohn, Officer Maggie Parris, Officer (See Attached Descriptions) Village of Miami Shores 10050 NE 2nd Ave. Miami Shores, FL 33138 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 ACORD 25 (2016/03) 1 of 2 #S21089300/M21089070 9)1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ALJO DESCRIPTIONS (Continued from Page 1) Waiver of Subrogation - BRIDGEWATER TOWERS COA FL Waiver of Subrogation- One Miami East/West & Master Condominium Associat FL Miscellaneous Coverage - Worker's Compensation - Pol.# 106578312018 Form Information Form: WC000308 Form Description: PARTNERS, OFFICERS AND OTHERS EXCLUSION ENDORSEMEN Form: WC090403A Form Description: FLORIDA TERRORISM RISK INSURANCE PROGRAM Form: WC000414 Form Description: NOTIFICATION OF CHANGE IN OWNERSHIP Form: WC000419 Form Description: PREMIUM DUE DATE ENDORSEMENT Form: WC090303 Form Description: FLORIDA EMPLOYERS LIABILITY COVERAGE ENDORSEMENT Form: WC090401 Form Description: FLORIDA CONTRACTING CLASSIFICATION PREMIUM Form: WC090606 Form Description: FLORIDA EMPLOYMENT AND WAGE INFORMATION RELEASE Form: WC000421 C Form Description: CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORIS Form: WC000422A Form Description: TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION A Form: WC990006A Form Description: CHANGE IN INFORMATION PAGE ** Supplemental Name ** First Supplemental Name applies to all policies - Quality Cooling Systems, Inc. LIC#: CAC042713 SAGITTA 25.3 (2016/03) 2 of 2 #S21089300/M21089070