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MC-05-22-1320, 1020 NE 92nd StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Permit No.: MC-05-22-1320 Permit Type: Mechanical - Residential Work ClossUkation: Alteration Permit status: Approved issue Date:05/24/2022 I Expiration: 11/28/2022 Parcel Number Project 1020 NE 92ND ST, Miami Shores, FL 33138 1132050130020 ONLINE PERMITS Contacts 1760 NE LLC Owner Boost Construction Applicant 1020 NE 92 ST David Pupo Business: 305-878-9326 MANNIX7705@HOTMAIL.COM 7841 NW 32 ST, DORAL, FL 33122 Business:3054847834 DPUPO@MODERN-STONES.COM Mobile: 3054847834 TEST AND BALANCE AIR CONDITIONING Contractor CORP AGUSTINE ALVAREZ 8355 NW FLAGLER ST, MIAMI, FL 33144 Business: 3052181798 Description: HOUSE RENOVATION 2 BATH AND KTICHEN Valuation: $ 4,000.00 Inspection Requests: 305-762-4949 Total Sq Feet: 2,475.00 Fees Amount Application Fee - Other $50.00 CCF $2.40 DBPR Fee $2.10 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $90.00 Scanning Fee $9.00 Technology Fee $3.50 Total: $159.80 Payments Date Paid Amt Paid Total Fees $159.80 Credit Card 05/24/2022 $159.80 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. Signature: Owner / Applicant / Contractor / Agent Date May 24, 2022 Page 2 of 2 Miami Shores Village Building Department �vAY 24 2h2Z 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No. G I 2S V PERMIT APPLICATION Sub Permit No. C - - 3 ?� ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING IECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /(/1,2--O A!0 F2 e��— City• Miami Shores County: Miami Dade Zip: Folio/Parcel#: � 13 `ZO�; ® 13 0 �� Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1p0 /L%L L L Phone#: Address: 1 D,�-b V E C� Z .S i` City: i State: Zip: 1 (� Tenant/Lessee Name: Phone#: 3 o S - S" L- 2- - C�1133 Email CONTRACTOR: Company Name: Address: ;�l�� /" �� S� 5Z1�/7 City: _ ✓ . State: Zip: ✓5/q7 c Qualifier Name: T/�^P �v Phone#: 3o s1-2-) 7/ State Certification or Registration #:Gol Certificate of Competency #: DESIGNER: Architect/Engineer: Address: hone#: City: State: Zip: Value of Work for this Permit: $ 1 9,6 00 Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace Description of Work: *I" `r 'Vk4 Lc E-1: LK Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF DBPR $ ❑ Demolition 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 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 wred occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not I apprand a reinspection fee will be charged. or AGENT The foregoing instrument was acknowledged before 7me this I` °°D day o(�f 1�/t , 20 7, by LLYCL P� who is personally known to me or who has produced identification and who did take an oath. NOTARY 8 — Signature l/ CONTRACTOR The foregoing instrument was acknowledged before me this day of A 20o?.a by Z &67..SSZi10 1q,wna is personally known to as nleorwho has produced identification and who did take an oath. NOTARY PUBLIC: Sign: ( RA F Sign: Print: Print: Seal: ��" ' DANIAPEREZ �9, ��: Seal: MY COMMISSION # HH 100967 EXPIRES: March 8, 2025 'goc d:?;' Bonded Thru Notary Public Underwriters APPROVED BY Plans Examiner Maria E Trinidad My Cpmmissia GG 2E3358 Expires o212712023 as Zoning (Revised02/24/2014) Structural Review Clerk ACOR" CERTIFICATE OF LIABILITY INSURANCE 05/18/DATE(M/2022 Y) `�- 022 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 endorsements . CONT PRODUCER NAMEACT Marcia C. Alvarez _- Pinnacle Insurance Group Inc. PHONE (305) 854-9898 ac No): (305) 854 9899 250 Catalonia Avenue ADDRESS: pinnacleins@comcast.net _ Suite 401-A _ INSURER(S) AFFORDING COVERAGE NAIC # MIAMI FL 33134 INSURER A: GRANADA INSURANCE COMPANY INSURED INSURER B : AMTRUST NORTH AMERICA Test and Balance Air Conditioning, Corp. INSURER C : 8355 W Flagler ST INSURER D : 164 INSURER E :---- Miami FL 33144 INSURER F RC\/1¢If'1A1 WIIMRFR• 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 LTRwyn TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY MWDD/ EFF MPOUCDY� LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 — CLAIMS -MADE X OCCUR $ 100,000 DAMAGETO RENTED PREMISES Ea occurrence MED EXP (Any one person) $ 5,000 A 0185FL00129292-1 08/23/2021 08/23/2022 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000_ PRODUCTS - COMP/OP AGG $ 2,000,000_ - $ POLICY PRO- LOC JECT — OTHER: AUTOMOBILE LIABILITY Ea aclid.ntED SINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ —_--- $ _ _...— PROPERTY DAMAGE Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAB CLAIMS -MADE $ DED RETENTION $ WORKERS COMPENSATION �/ X STATUTE ERH $ E.L. EACH ACCIDENT B AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOWPARTNER/EXECUTIVE ❑ (MandatoryOFFICERIMIn H) EXCLUDED? N (Mandatory In NH) If es describe under DESCRIPTION OF OPERATIONS below NIA AWC1180129 04/01/2022 04/01/2023 $ 1,000,000 $ 1,000,000 $ 1,000,000 E.L. DISEASE - EA EMPLOYE E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) L` C.4 It MULUCK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Building Department 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE ��LeZ' sr- �--r..r�. C � lam', 4'_�..•<r...`� Miami Shores FL REQUIRED = "/ \J-IJOO.LV I;) 11a.vRv --- ..y... --------- ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD