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MC-8-18-2251, 478 NE 92nd StMiami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit NO. MC-8-18-2251 Permit Type: Mechanical - Residential Per it Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 8/23/2018 1 Expiration: 02/19/2019 Project Address Parcel Number Applicant 478 NE 92 Street 1132060140020 Miami Shores, FL Block: Lot: THOMAS ROGER & CHRISTINA Owner Information Address Phone Cell THOMAS ROGER & CHRISTINA WHITE 478 NE 92 Street (305)546-1030 (305)439-2855 MIAMI SHORES FL 33138- 478 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone PRIME AIR SERVICES CORP (786)308-1422 Tons:2 Additional Info: 2 NEW AC UNITS 2 TONS Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Fees Due Amount CCF $5 40 DBPR Fee $4 46 DCA Fee $2.98 Education Surcharge $1.80 Permit Fee $297.50 Scanning Fee $3.00 Technology Fee $7.20 Total: $322.34 Date Approved:: In Review Type of Work: Valuation: $ 8,500.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC-8-18-68647 08/23/2018 Credit Card S 272.34 $ 50.00 08/22/2018 Credit Card S 50.00 $ 0.00 n rlvaname mspecuons: Inspection Type: Final Rough Duct Review Mechanical Underground 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 zo n Futhermo I authorize the above-nam ontractor to d7the work stated. ,c-3 August 23, 2018 Authorize Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy August 23, 2018 1 Miami Shores Village BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑PLUMBING ErIVIECHANICAL JOB ADDRESS: 4:1 Y 0e Building Department AUG RR 20/8 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �� Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 b FBC 20(1 Master Permit No. C�z �� ' S� Sub Permit No.� ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 3 3 i Folio/Parcel#: I, 'Lzo (_ ©I 1 oo L 0 Is the Building Historically Designated: Yes NO Occupancy Type: _ Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): I'I e �r "1 \ �— Phone# _��-� `I Address: -I � � u )L' -1 Z S �� , City: i Ctv Tenant/Less/nee Name: Email: is Ct C, ( State: Phone#: p: ' s ( `3 CONTRACTOR: Company Name: i �L� �- !� c •` Sc / L)- CU 1 Phone#: � y U �� L I �? Address: �`� I Zo ct,/ I b AI)L! City: aUX^<_ j1�� v Qualifier Name �IJo i+l) (c,^ State Certification or Registration #: DESIGNER: Architect/Engineer: _ State: C tx (-- 16 5 `6ts Zip: q one#: Certificate of Competency #: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ S1`O Square/Linear Footage of Work: Type of Work: ZrAddition ❑ Alteration ❑ New ii 1 ()❑ Repair/Replace ❑ Demolition Description of Work: Z vUwJ U.V,\ 1 Specify color of color thru tile: Submittal Fee $ -� Permit Fee $ � Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ (Revised02/24/2014) CCF S DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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 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 app oved.and a reinspection fee will be charged. OWNER or AGENT The foregoing instru ent was acknowledged beforev this day of UA— 20 by wirul,` who isnally�to t_ me or who ha roduced as identification and who did take an oath. NOTARY Print: Signature / CONTRACTOR The fo`rreg ing instrument was acknowledged before me this day of a �j �, 20 by �i ' �^- =...,N �11i , who s ersonally known toy me or who has identification and who did take an oath. ARY PU Sign:_ Print: as P" LORETTA COMES Seal: r°c►�;;_ee� LORETTACOMES Seal: °;,�Y yfte" MY COMMISSION # FF 954664 W COMMISSION # FF 954664 * * *Mw-* EXPIRES: March 21,2020EXPIRES: March 21,2020 �4Bonded ThruBudget Notary Servioes ' BondedThruBudgetNotaryServia C' APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 .. .. .. ... . .. MULlUe Lv owner — vvvukeub Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of County of Miami -Dade , j The foregoing was acknowledge before me this 6--' Y day of !� tJ�T 20' . .l By who is personally known to me or has produced as identification. Notary: * * MY COMMISSION # FF 954664 SEAL: EXPIRES: March 21, 2020 Bonded Thru Budget Notary Sakes Prime Air Services corp. 30120 sw 156 ave Homestead Florida 33033 8/15/18 State of Florida Miami Dade county Before me this day appeared Bernardo Pla who, being duly sworn deposes and says: That he will be the only person working on the project located at: 478 ne 92 st Miami Shores Contractor Sworn to (or Affirmed) and subscribed before me this/pay of / 2,( %1 BY ��(r\.r� � J Personally known Or produced identification Type of identification produced o1Par °oeo LORETTA COMES MY COMMISSION 9 FF 954664 * * EXPIRES: March 21, 2020 Bonded Thru Budget Notary Services 'ORD® 3 i. • ; INSURANCE D• D LIABILITY08/22/18 PRODUCER Express Insurance Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 12001 SW 128 CT *210 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33186 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305) 388-5650 Fax (305) 388-4640 .........__ ........- ......... - ......... ...... INSURERS AFFORDING COVERAGE ..... NAIC # INSURED PRIME AIR SERVICE CORP ........... ......... (NSURER A GRANADA INSURANCE -- -- ...... 30120 SW 156 AV INSURER B: -- Homestead FL 33033 INSURER C: — — - - ------------- — -- ---- — -- --- --- -- INSURER G: (786) 299-7231 — — --- ------ - iNSURER E: COVERAGES ...................................................... ....... ...... ..... INSURER F - ....._... —_ HE POLICIES OF INSURANCE LISTED 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 OE MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ....... ........ ....... ...- ...._........._ CLAIMS. INSR ARD L LTR INSRD TYPE OF INSURANCE -I POLICY NUMBER - ....... ......... POLICY EFFECTIVE POLICY EXPIRATION i DATEjMMrDDNY�_ DATE- n kMQDfvY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 1.000,000 C COMMERCIAL GENERAL. LIABILITY 0185FL00073302 DAMAGE F TO RENTED 0$f04(1$ 08r"04i19 PREMISF� Ea o u once ..... .. ) -t— I 100.000 ❑❑ CLAIMS MADE CJ OCCUR MEG EXP (Any one person) D p00 A C 500 deductible E r PERSONAL & ADv` INJURY 1 ,OpO OOO -- -. GENERAL AGGREGATE .... 2,000.000 .._- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO 2,000.000 ❑ POLICY ❑ PROJECT ❑ LOC _....__.._..._....------.._..........----------__._._...... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) f� ALL OWNED AUTOS _....................._................................................................ ............................. .... ....................... .................. I I SCHEDULED AUTOS EliPer,cersc; BODILY INJURY HIRED AUTOS i......................................................... BODILY INJURY ............................................ NON OWNED AUTOS (Per accident) €€❑ PROPERTY D ^h•tAGE El LIABILITY L_ ❑ ANY AUTO IL ! (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG ............... _ .... EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE OCCUR ❑ CLAIMS MADE AGGREGA.,E ..................................................................................... DEDUCTIBLE RETENTION S ............... WORKERS COMPENSAT€ON AND ❑ IBC STA,TU- ❑ ^TH- EMPLOYERS' LIABILITY TGRY LIMITS ER ANY PROPRIETOR / PARTNER I EXECUTIVE E.L. EACH ACCIDENT OFFICER ' MEMBER EXCLUDED)E.L. DISEASE- EA EMPLOYEE if yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LItv9IT ..... ..._- l OTHER . _._.... _...... . .. ...._ ..... - DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Prime Air Service. Bernardo Pla LIC# CAC1815929 Air Conditioner CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Miami Shores Village 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO Building DepartmentTHE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES, 10050 NE 2nd Ave Miami Shores; FL 33138 AUTHORIZED REPRESENTATIVE Patricia Duque - ----..._-------------- ...--- ---- — - - ....._.._............ ACORD 25 (2001/08) QF -._.................................... _................. - -- .... ----................... ......... _............. _....---- ... ----...................... _.......... .......: Oc ACORD CORPORATION 1988