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MC-13-570i y Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple A ��20i3 Permit No. btz I L/ U /0 Master Permit No. t t -- 1-7S & 0( City: In e'er 6�-c5 State: Zip: f Tenant&zsss°ee Name: Phone#: -� Email: '1-c �) k K' - a 1 JOB ADDRESS: _���r �V-rja fl�''� City: Miami Shores County: Miami Dade Folio/Parcel #.- Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: N Ey P SS Phone#: Address: _ (, (Jyhf WNW -refaiL- City: w –state: F Zip: Qualifier Name: /" �`% V C Pl►orie #:��i S r Z2 State Certification or Registration #: Contact Phone #: A slid - � �6 � � � � � 2 Ui Email Address: �A DESIGNER: Architect%Engineet: Phone#: .Value of Work for this Permit.' $ o Square/Linear Footage af;wark ": _ Type of Work: DAddress X41teration ONew ORepairMeplace Description of Work:,: Submittal Fee $ Permit Fee $ _ V ° CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ ' G -ea-' 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 v Signature Owner or Agent Contractor The foregoing instrument was acki wledg ed before me this t� day of ' 09.0 by o is personally known tom or who has produced As idena'ca"tweyd o i NOTARY PUBLIC: Print: ,tea 10-11 l kC My Commission Expires: - a7 --,o?6J� APPROVED BY ►ae`Voie s b Of MY Commfssfon EE 182608 Expires 04/2712018 (Revised 07 /10 /07)(Revised 06 /10=09)(Revised 3/15/09) The foregoing instru ent was acknowledged before me this-L9� day of ✓v` , 20 L, by hSYl who is personally known NOTARY Sign: �S►G� -COX Print: My Commission Expires: m f '� ' 0 em i f , `1 —ar— e>-a14 Plans Examiner Zoning Structural Review Clerk :cw A P EXPRESS AIR CONDITIONING & REFRIGERATION INC :ux AHMIED PIEDRA FIRES 6051 NW 198 TERR MIAMI FL 33015 � g U 41 I'rrilstill �lIII II III A loll 61 oil IN, 11'111141 i SEE OTHER SIDS — MIAMI- DE COU 2012 LOCAL BUSINESS TAX R t CEIPT 2013 TAX COLLECTOR MIAMI -OADE COUNTY - STATE OF FLORIDA ""T WS P AOE j 140 W. FLAGLER ST. EXPIRES SEPT. 30, 2013 1st FLOOR MUST BE DISPLAYED AT PLARF BUSINESS PAP) NIAIA FL PEST 9G4i. MIAMI, FL 331.30 PU T T r CODE !CHA , R 0A - ART 9 & 10 THIS 10 NOT AIMLL­DO NOT PAY RENEWAL BtIMAlIdE1L�A1t0�1 . 708390 -0 I Cx8Id7 A P EXPRESS AIR CONDITIONINS $ STATE# CA 68 REFRIGERATION' INC 6051 NW 198:TERR 33015 VNIN: DADE COb%W. o .:.: A P :EXPRESS AIR CONDWIT100. ;B Ste, NNW at 8911111111110 j WORMER /S 8A C: MECHANICAL CtNMACTOR 1 maw DO MW FOWAM :cw A P EXPRESS AIR CONDITIONING & REFRIGERATION INC :ux AHMIED PIEDRA FIRES 6051 NW 198 TERR MIAMI FL 33015 � g U 41 I'rrilstill �lIII II III A loll 61 oil IN, 11'111141 i SEE OTHER SIDS — From: 03/15/2013 09:04 #617 P.001/001 THIS CERTIFICATE IS CERTIFICATE OF LIABILITY INSURANCE 03/15/13 "li*6-ACA hiAftk& WbiWANM ONLY AND d&&iRS NO RIGdiTS UPON 1 tiE CERTIFICiM1TE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE BELOW COVERAGE AFFORDED BY THE POLICIES - THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING WSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE cwnmae HOLDER. IMPORTANT- ff Ow n"W8 FWM8r Is an ADDrnOMAL INOutmu- the WIWWS) must be WNUBIWGATIONIS MIAWED the tomw ancl =k2tl0nS Of the Polley, CWtdn wmoysw* Ir carlificate holder In Neu of Such P01101- AW reQUI(O an wXf*nwMft A 9WOMM 00 ewdftde do" not comer rWft to #w Accurate -t*j ff. PH - ONE 8300 West Flagler Suite 114 bOwuth. Miami, FL 33144 net Phone (305 CO-VOtAft .__.Fax (306)22"767 Amwica► BtWM bw Co -, co M A.P. Express Air Condftioning and RgIripration Inc 6051 NW 198 Terrace .FURER Hialeah. FL 33016- (788)252-7224 COVERAGES IMRM F: CERTIIFICATE NUMBER- REVIS THIS lSTOd&ffFY*kWf -tHk*OoQaES *6'FO4U—RAq'4C'*E-W-T-E*D-B-*&-OW'-K'AV--E--&- MCATED NOTWMWANONG ANY REQUAEMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT'ro WHICH THIS CERTIFICATE MAY 86 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEOTTO ALL THE TERMS. EXCLUSXW AND CONDITIONS OF LpSM SHOWN MAY HAVE BEEN REDUCED BY PAID CLAW. .... P-0 W, Y -M-) W _enpigCCxlCg __ S 1,000,000.00 - COWMW4AL GENER& LoAfLrry El El O=OR A El JOS109840 1 205/12l3 ;n -RR-99-.� GWL AGGREGATE LUT APKIES pEk 2M!L)0q.oq. t, O-P, l S 2,000,000.00 AUTOM0131LE LlABUTY E] ANYAUTO BODILYRCUW ❑ MWOMINED E] WHMwm (pw P-M) AUTOS WREDAUT0$ AMIGE7-.*'7 ..Pr 7' ,1JwAuHjAu4B Fl EXCESS U48 WORKERS COMPINSATUM AND EMPLOYERS` UASIUTY Yin: AWFY 0 WrMT EXC im L% KXM U ? :MIA WC-6M42 E EACHAOCIDENT 100.000.0o.. 01/0812013 01/08=14 (n NH) =11= EIS "10- 90:00- DBSCPPTIONOFOPEFtATUMILOCATRWIVEHIMM (Aftch ACORD i0i. Add MoWPAmwksododul%ff came q=GlSFOqUk*O City of Miami Shores Vfte 10060 NE 2 Ave Miami Shores, F133138 .30"23-7993 ACORD 25 (2010/05) OF CANC91-LATIM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TiWREOF, NOTICE WILL BE DELWAW IN ACCORDANCE VM THE POLICY PROVISIONS. AUTH OR RED p"R Lucia Estrella 0 INS-2010;WORI) CORPORATION. M rights r toad. The ACORD name and logo we registwW marks of ACORD