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MCC-19-2341Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue mate: Location Address Parcel Number 9140 NE 8TH AVE 3H, Miami Shores, FL 33138 1132060440340 Contacts Permit No.: MCC-10-1,9-2341 Permit Type: Mechanical - Commercial Work classification: A/C Replacement Expiration: 08/ 19/2020 Susana Loor Owner BEST AIR SOLUTIONS Contractor 55 NW 85 ST, Miami, FL 33150 MARCELO GABRIEL ARNEDO 2622 NW 93 AVE 104A, DORAL, FL 33172 Business: 7862515463 Description: A/C REPLACEMENT EXACT CHANGE OUT 2 TONS Valuation: $ 3,200.00 Inspection Requests: REPLACING EXPIRED PERMIT MC-8-18-2188 305-762-4949 Total Sq Feet: 0.00 Fees Amount Payments Date Paid Amt Paid Application Fee - Other $50.00 Total Fees $112.00 Permit Fee $62.00 Check # 1017 02/21/2020 $112.00 Total: $112.00 Amount Due: $0.00 Building Department Copy 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 zoning. Futhermore, I authorize the above named contractor to do the work stated. 0M . 021- l / 2UZ.C:) Authorized Signature: Owner / Applicant / Contractor / Agent Date February 21, 2020 Page 2 of 2 - BUILDING PERMIT APPLICATION Miami Shores Village RECEIVED Building Department OCT 03 .019 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 2017-'� Master Permit No. occ 10 -19 - a 5 q 1 Sub Permit No. ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING [MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9/7 o X/e'e ..tl 3// City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ��� /Flood �l �� ! iiD �' Phone#: Address: 9/yd /JL Au�? City: /t4 c- M S`'" "& State: Zip: -3s 3� Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 8 F'sf 1"b 1--9 Phone#: 3:? �' 2-2 3 -16 P8 Address: 2�_5'r .✓cd /C)Z ,5'I/L_-? /041 City: !� > Q Qualifier Name: '4 , 1L O-A State Certification or Registration #: C-119 DESIGNER: Architect/Engineer: Zip: 3-71 ? L e do / Phone#: )'Pe" z6-1 - -5-16-3 Certificate of Competency #: ne#: Address: ✓ City: State: Zip: Value of Work for this Perm : $ 3 ZCX� 04 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ �N)ew [Repair/Replace Demolition Description of Work: /f Q n'1� C �.rQ,c>� �'�vG'� dal Specify color of color thru the: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ CCF $_ Radon Fee $ DBPR $ Training/Education Fee $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ I ( 2 • Go (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. Signature zj4��"A!�— OWNER or AGENT The foregoing instrument�w4acknowledged before me this day of Be.�' 20 /, by Sds'a�1 a lCit� /L who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign. Noce Pub1i S of FloridaC. .6azero Print: �fb►p tTo�v#i' ion GG 237447 a Seal: Signature NTRACTOR The foregoing instrument s acknowledged before me this a -) d &20 !2 by eU , who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign Print Seal as � APPROVED BY 1 "" Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ! _ Y 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: Phone: State Certificate or Registration No. Certificate of Competency No. Signature (Qualifier's signature) Date: (Revised02/24/2014) RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY Florida dpr STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE CLASS A AIR CONDITIONING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES ARNEIDO,K24441 MARCELO GABRIEL BEST AIR SOLUTIONS NW 93 AVENUE, SUITE 104A DORAL FL 33172 LICENSE NUMBER: CAC1818654 EXPIRATION DATE: AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com ❑' err` 'Dr, ❑� Do not alter this document in any form. ttiay.i �.' This is your license. It is unlawful for anyone other than the licensee to use this document. Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY [Z K-ri BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES BEST AIR SOLUTIONS RENEWAL SEPTEMBER 30, 2020 2555 NW 102ND AVE STE 104 6709704 DORAL, FL 33172 Must be displayed at place of business Pursuant to County Code Chapter BA - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED I & M CORPORATION 196 SPEC MECHANICAL BY TAX COLLECTOR C/O MARCELO G ARNEDO CONTRACTOR 011AIIFIFR 45.00 07l22/2019 Worker(s) 8 CAC1818654 0224-19-004524 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory lows and requirements which apply to the business. The RECEIPT N0, above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ba-276. M'` AMPRIDE For more information, visit ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `..,..� 02/20/2020 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 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: Mabel Felipe Acceptance Insurance Services 6887 SW 40 St PAICNNo El: (305)740-0515 ac No: (305)740-0518 E-MAIL ADDRESS: maaccebel@ P tanceinsservices.com INSURER(S)AFFORDING COVERAGE NAIC # Miami, FL 33155 INSURERA: Kinsale Insurance Company INSURED INSURER B INSURER C : National Union Fire Insurance Company I&M Corporation dba Best Air Solutions INSURER D : Retail First Insurance Company 2555 NW 102 Ave Suite 104 INSURER E : DORAL FL 33172 INSURER F : COVERAGES CERTIFICATE NUMBER: 1 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. INSRLTR TYPE OF INSURANCE AND UBR POLICY NUMBER MM DIDY/YYYY) (MMIDDNYYYI LIMITS GENERALLIABILITY EACH OCCURRENCE $ 1,000,000.00 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXIOCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000.00 MED EXP (Any one person) $ 5,000.00 A X Bkanket Additional Insured N N 0100076966-1 12/03/2019 12/03/2020 PERSONAL & ADV INJURY $ 1,000,000.00 X Blanket Waiver of Subrogation GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000.00 X POLICY X JE PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000.00 C X EXCESS LIAB CLAIMS -MADE N N EBU 066228244 12/03/2019 12/03/2020 AGGREGATE $ 3,000,000.00 DED I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? MN (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below /A N 0520-54636 08/17/2019 08/17/2020 WC STATU- OTH- X T RY LIMIT ER E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT I $ 1,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) HVAC Installation Service & Repair ��� �.AIYI.CLLA I IVIY MIAMI SHORES BUILDING DEPARTMENT 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 Ma,U cu ca tcu Iu/uo) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACOREP CERTIFICATE OF LIABILITY INSURANCE 16..� DATE(MM/DD/YYYY) 10/03/2019 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 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 - CONTANAME: Mabel Felipe " Acceptance Insurance Services 6887 SW 40 St PHONN Ex : (305)740-0515 a No): (305)740-0518 E-MAIL G P ADDRESS: Mabel@aGceptanceinsservices.com INSURER(S) AFFORDING COVERAGE NAIC # Miami, FL 33155 INSURER A: Kinsale Insurance Company INSURED INSURER 8 : INSURER C : AIG Specialty Insurance Company I&M Corporation dba Best Air Solutions INSURER D : Retail First Insurance Company 2555 NW 102 Ave Suite 104 INSURER E : INSURER F : DORAL FL 33172 COVERAGES CERTIFICATE NUMBER: 1 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. NR ILTR TYPE OF INSURANCE AN R SUER POLICY NUMBER MM/ POLICY EFF MM/DD POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR DAME O RENTED EMISES Ea occurrence $ 100,000.00 MED EXP (Any one person) $ 5,000.00 A X Bkanket Additional Insured N N 0100076966-0 12/03/2018 12/03/2019 PERSONAL & ADV INJURY $ 1,000,000.00 X Blanket Waiver of Subrogation GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000.00 X POLICY PRO LOC $ AUTOMOBILE LIABILITY OaBINEDSINGLE LIMIT Eaccident) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000.00 X AGGREGATE $ 3,000,000.00 C EXCESS LIAB CLAIMS -MADE N N EBU011656250 12/03/2018 12/03/2019 DED RETENTION $ $ WORKERS COMPENSATION X/ I WC STATU- I OTH- D AND EMPLOYERS' LIABILITY Y / N ANY OFFICER/MEMBER EXCLUDED' ECUTIVE � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A N 0520-54636 08/17/2019 08/17/2020 TORY LIMITSR . E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYEd $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT I $ 1,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) HVAC Installation Service & Repair MIAMI SHORES BUILDING DEPARTMENT 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 AUUKU ZO tZUIUIUD) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD