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MC-14-728
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 Permit Type: MECHANICAL APR 10 2014 FBC 20 00 Permit No. o-) cj 0 m -72,S Master Permit No. --7 JOB ADDRESS: cR011 Up, 4 Avcnue Rl City: Miami Shores County: Miami Dade Zip: i 5A Folio/Parcel#: 11 'A26U 01"} 1-At C> Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 30- 3f ph A J01 l f 0bfXnnC4 Rn. Phone#: Address: _ City: (Wayn t State: I L Zip: 53 l 3a Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: li l C'CI�Pt� Coe)i Y1(] Phone#: � 3 -10 �J Address: N Lk) CLjn1jz!!21. City: w1awf, State: '- Zip: 33018 Qualifier Name: _ L -U 115 1PCP-R-Z Phone#: State Certification or Registration #: (JJS-� 161 'l-0 1 �3- Certificate of Competency #: Contact Phone#: Email Address: jif&())kftdl i 1\J0C. C DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ �.�u > ' Square/Linear Foot ge of Work: 151 Type of Work: ❑Address `P(Uteration ❑New ❑Repair/Replace ❑Demolition Description of Work: 4 -13040 WOrn - -ReM ,e- HCl ` 4)XAAX S aCG �b exLsshrLLi i mnkexq , nnoci- niomt and efe-o zto.A "S--W-ms Submittal Fee Permit Fee $ I CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ l S A � �� <:Z47 Inspection Worksheet — Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-210725 Permit Number: MC -4-14-728 Scheduled Inspection Date: September 15, 2014 Permit Type: Mechanical - Residential Inspector: Rodriguez, Jorge Inspection Type: Final Owner: OBERMEYER, JOSEPH & JULIE Work Classification: Addition/Alteration Job Address: 9909 NE 4 Avenue Road Miami Shores, FL Phone Number Parcel Number 1132060171310 Project: <NONE> Contractor: DEDICATED COOLING LLC Phone: (786)346-4571 Building Department Comments REMODEL MASTER BATHROOM Infractio Passed Comments INSPECTOR COMMENTS False (0 q [ t� 1 September 12, 2014 For Inspections please call: (305)762-4949 Page 3 of 26 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 12, 2014 For Inspections please call: (305)762-4949 Page 3 of 26 L 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 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 L J Owner or Agent The foregmg instrument was acknowledged before me this day of AA0WJa, 20 a, by jpW a , Feta > who is p sonally kn- a njo me or who has produced NOTARY Sign: Print: As identification and who did take an oath. Signature Contractor 15 The foregoing instrument was acknowledged before me this day of , 20j4, by W) i S , who is sonally kno to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: n. i4 FEINBERG Print: t=�� y p iC - 8 e0 Of 8My Commission Expires:tiLL Ay Comm. Expires Apr 8, 2016 My Commission ExpiresAY PuCommission #EE 158541°t;uLOISTEPPER * * W COMMISSION # FF 045244 EXPIRES: September 9, 2017 APPROVED BY \�A Plans Examiner Zoning Structural Review Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. OF QUALIFIER'S STATE LIC CARD LOCAL BUSINESS TAX RECEIPT OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: BUSINESS ADDRESS: OR04 NV3 Imo` I cune- CITY M.I QMJ STATE ZIP CODE 1 BUSINESS PHONE: FAX NUMBER ( ) CELL PHONE () I QUALIFIER'S NAME: Luis QUALIFIER'S LIC NUMBER: cAc i rS 0cb f=�_ E-MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV I RV 3126109 MLDV OP ID: SK 111. . -"" CERTIFICATE OF Li BILITY INSURANCE D 1 041031/2014 4ta314 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION OLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN , EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTI 'REPRESENTATIVE UTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WANED, 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 Ileu of such endorsement(s). PRODUCER Clawson & Company Inc CONTACT NAME: ShirleyKoons aC°NN Ftl:954-389-6930 Arc No 954-389-x452 2731 Executive Park brave, #8 Weston, FL 33331 MAIL ADDRESS: PRODUCER CU TOMERI s:DEDIC4 INSU AFFORDING COVERAGE MAIC 9 INSURED Dedicated Cooling LLC INSURER A. -American Empire Ins.Co. LUIS Perez INSURER 6: 8964 NW 174th Lane INSURER C : Hialeah, FL 33018 INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW JAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITII IN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFO IDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HA IE BEEN REDUCED BY PAID CLAIMS, INT R TYPE OF INSURANCEim KM SOON ma POLICY NUMBE MMID POLICY FXP LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,0Cq A X COMMERCIAL GENERAL Limu.rrY 14CGO177266 0210812014 02/08/2016 PREMI Ea ' $ 100,00 MED EXP (Any one person) $ 1,00 CLAIMS -MADE a OCCUR PERSONAL &ADV INJURY $ 1,000,0 GENERAL AGGREGATE $ 2,000,00 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS -COMPJOPAGG $ 1,000,00 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea ncr4dad) BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per acdderd) $ SCHEDULED AUTOS PROPERTY DAMAGE $ (PER ACCIDENT) HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIABHo CCUREACH OCCURRENCE $ EXCESS LIARLAIuM:4 ADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU- OTH- ER ESV Y❑ OFFlCER�M�R E.L.EACH ACCIDENT $ OIN E�UDEWD7 N r A (Mandatory in NH) H yee, describe under E.L. DISEASE - EA EMPLOYE$ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHICLES (Attach ACORD 101, Additional Wm /C Contractor Wm Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF MIAMI SHORES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shares, FL 33138 AUTHORIZED REPRESENTATIVE v �>,aa zUUV AVVKV GURPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * f CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law, EFFECTIVE DATE: 2/6/2014 EXPIRATION DATE: 2/6/2016 PERSON: PEREZ LUIS M FEIN: 453417866 BUSINESS NAME AND ADDRESS: DEDICATED COOLING LLC DEDICATED COOLING 8964 NW 174TH LANE HIALEAH FL 33018 SCOPES OF BUSINESS OR TRADE: HEATING, VENTILATION, AIR-COND Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a cenffkate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of eleotfon to be exempt... apply only within the scope of ft. business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt end cerlifkates of election to be exempt shall be subject to revocation II, at any time after the filing of the notice or the Issuance of the cerifricate, the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate. The department shall revoke a DFS-F2-DtMC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (860)413-1609 Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOT A BILL - 00 NOT PAY 6939145 BUSINESS NAMMOCATION DEDICATED COOLING LLC 8964 NW 174 LN MIAMI, FL 33018 RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2014 7214950 Must be displayed at place Of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED DEDICATED COOLING LLC 196 SPEC MECHANICAL BY TAX COLLECTOR CONTRACTOR 75.00 07/02/2013 Worker(s) 1 CAC1817017 CREDITCARD-13-000978 This Local Business Tax Receipt only confirms payment of the Local Business Tax, The Receipt Is not a license, permit, ors certification of;thefioldees qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0, above must be displayed on all commercial vehicles- Miami -Dade Coda Sec ea -276. M®WPI Far more information, visit www.miamidade.amrkaxcollector ocal Bu intessTz ftneip t'Jlarnl=Dade'Co nty,Stf€ of Florida IS IS,NITT A BILL ©LJ0 f SPAY' 6939145• BUSINESS NANIE/LOC/\TIOIV - RECEIPT NO. DEDICATED COOING LLC $964 NW,1741NRENEWAL. SEPTI 72149$0 Must be jvI 1;12 33018 OWNER SEC.MYPE OF BUSINESS C)NI TED COOLING LLC 196 SPEC MECHANICAL MECHANIC CQNTRACiOR W&ker(s) CACV817617 This LoGalis¢sinass TattRecejpt only confirms,payment of � Deal Business permit, or a dertificatioi. oh{he!holdees ifuali6cations to thrif iltass Holder i dor nongeornniental re�ule)oNi laws and requirements puhi sgph fj;adhe bt�s The RECEIPT NO abovEli ust bo displayed on all oommei arai ehiyfos- I M®DARE �'. r, , ;For more information, visit uuww.m�amided'e.aovl 201st zusiness is Chapter 8'A =Art 9;& 10 .PAYME RECEIVED BY TAX 00414CTOk 75.00 07102/2013 iniFDode Coda Soc 8a 276: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION rol '0 CONSTRUCTION INDUSTRY LICENSING SOARD CAC1817017 The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED 0� . Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 PEREZ, LUIS M DEDICATED COOLING LLC 8964 NW 174TH LANE MIAMI FL 33018 VIVA HOR10A 4 RICK SCOTT ISSUED: 07/25/2013 SEQ # L1307250000624 KEN LAWSON GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PR0FESSIONAL REG ULATI0N CAC1817017 11llM�;;;:.07/25/2013 CERTIFIED AIR C:OND CQNTQR PEREZ, LUIS M DEDICATED COOL1hiG_ LLG IS CERTIFIED under the provisions of Ch.489 FS. Expiration date : AUG 31, 2014 L1307250000824