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MC-08-23-2138Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 1240 NE 97TH ST, Miami Shores, FL 33138 Contacts Permit NO.: MC-08-23-2138 Permit Type: Mechanical - Residential Work Classification: Kitchen Hood Permit Status: Approved Issue Date:08/29/2023 Expiration:02/26/2024 Parcel Number 1132050090590 RON KURTZ Owner RBKACQ@GMAIL.COM R B Air Conditioned INC Contractor Ricardo Bendana 650 W Park or suite 203, miami, FL 33172 Business: 7862615252 info@hvacrescue.net Description: REPLACE EXISTNG KITCHEN HOOD Valuation: $ 350.00 Total Sq Feet: 232.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.30 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $10.00 Total: $123.90 Payments Date Paid Amt Paid Total Fees $123.90 Credit Card 08/29/2023 $123.90 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 certi� that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoni g. Futhgrmore, I authorize the above named contractor to do the work stated. / I g 21 2oZ3 Signature: Owner / / /Applicant/ Contractor / Agent August 29, 2023 Date Page 2 of 2 Miami Shores Village NT7~ 1 V� Building Department 3 2023 Icy N.E2nd Avenue, Miami Shores, Florida 3K38i Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 1 rf BC 20) CBUILDING Master Permit No—Qg--c2>C201 PERMIT APPLICATION Sub Permit No. M(,-b -93-;)43r _BUILDING ❑ PLUMBING JOB ADDRESS: ELECTRIC /MECHANICAL ROOFING CHANGE OF JCONTRACTOR I.I REVISION ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type:Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder) �� A)/ a0z �i�ne#: �/ [ Address: ,a 11n A.l� 4/�',(-i I _ City: /— ( ( (A/K4 —N Fill J State: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: R . e) • Al ( O It b/J/1 Ca XQ- Phone#: 7WP- a I -Sz 2 Addre Email: Qualifier Name: -P i rilAn �l1(lCA Phone#: State Certification or Registration #: afem t is- Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: _Zip: Value of Work for this Permit: $ JJ o Square/Linear Footage of Work: Type of Work: ❑Addition ❑ Alteration New 5A Repair/Replace ❑ Demolition Description of Work: �Cb�ac e o� ao .zy►}i)aq I \ram Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ DCA Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ P&Z Review $ Bond $ TOTAL FEE NOW DUE $ •RevsedE', 05,2e7 2, Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Z;p 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 fcrTz`c-. Is accurate and that all work will be done i, cc= a-ce with a! applicable laws regulating constructior 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 c1 dition to the issuance of a building permit with on estimated value exceeding $2500, the applicant must promise in good faith that o 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 sevenA) days after the building permit is issued. In the absence of such posted notice, the inspection will not belapp/ovej and a reinc4ictionfee will be charged. NER orAGENT Theforegoing A oregoing instrumentt was acknowledged before me this n� .GOB day of F QQ3V , 20 2�, by =a( e l) S V, C KC cho is personally known to met(r who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: Seal: 6 " " WENDY RUIZ YERAS MY COMMISSION N M68911 y'4.*dE)CPIRES: March 05, 2027 APPROVED BY Signature /� /,/�/ CONTRACTOR The foregoing insti umegnt was acknowledged before me this 2-� nday of F3,1&S4—, 20 2,7, by •,��_ CQ�Q Irol who is personally known to me`br who has produced as identification and who did ta/te an oath. NOTARYPUB Print: Seal: *R*4�r WENDY RUIZ1 ERASMY COMMISSION N HH368911 EXPIRI^S: March 05, 2027 Plans Examiner Zoning (Revised04/05/2022) Structural Review Clerk Ron DeSantis, Governor Melanie S. Griffin. Seuerary *00 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE CLASS A AIR CONDITIONING CONTRACTOR HEREIN 15 CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES SENDANA, RICARDO R 13 AIR CONDITIONED INC 65i7 W PARK DRIVE SUITE 203 M IAMI FL 33172 ti SE NUMBER: CAC057175 EXINRATION DATE: AUGUST 31, 2024 Always verify licenses online at MyFloridal-icense.com { " Igo not alter this document in any form. i This is your license. It is unlawful for anyone other than the licensee to use this document. Local Business moo Tax Receipt , L — x EXPIRE xl: r + p S } { h t c A 3s n � ACORl�® C40 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/28/2023 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE , (855) 222-5919 FAX A/C Noll: Next First Insurance Agency, Inc. PO Box 60787 Palo Alto, CA 94306 AMRILE S : support@nextinsurance.com INSURERS AFFORDING COVERAGE NAIL # INSURER A: State National Insurance Company, Inc. 12831 INSURED INSURER B : R.B AIR CONDITIONED INC -- License # CAC057175 650 W Park Dr Apt 203 Miami, FL 33172 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 570570592 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. INSR LTR TYPE OF INSURANCE D B POLICY NUMBER �POLICY EFF �POOLLIICp EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 CLAIMS -MADE � OCCUR PREMISES Ea occurrence) $100,000.00 MED EXP (Any one person) $15,000.00 PERSONAL & ADV INJURY $1,000,000.00 A NXTT37V3KC-00-GL 02/25/2023 02/25/2024 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000.00 X PRO JECT a LOC POLICY El PRODUCTS - COMP/OP AGG $2,000,000.00 $ OTHER: AUTOMOBILE LIABILITY CEOMBINED SINGLE LIMIT a accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? a N / A NXTHHDTT4W-00-WC 05/07/2023 05/07/2024 X PER OTH- TATUTE I I ER E.L. EACH ACCIDENT $1,000,000.00 E.L. DISEASE - EA EMPLOYEE $1,000,000.00 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1 000 000.00 Each Occurrence: $25,000.00 A Contractors Errors and Omissions NXTT37V3KC-00-GL 02/25/2023 02/25/2024 Aggregate: $50,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Proof of Insurance License #: CAC057175 GERTIFIGATE MO MIAMI SHORES VILLAGE 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 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD