MC-15-558 (2) � 01, 40A .
`SoaEs y�r Miami Shores Village � ��� 0, ChatilCBi Resiclr#tta�
� 10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 8101, Wei
i 'per Phone: (305)795-2204 r <., �OR
8
�F... C►ate Expiration: 09/13/2015
z
Project Address Parcel Number Applicant
� 21 79 NE 97 Street 1132050090440
I JORGE&MAGALYS TOLEDO
Miami Shores, FL 33138-2559 Block: Lot:
Owner Information Address Phone Cell
JORGE&MAGALYS TOLEDO 1279 NE 97 Street
MIAMI SHORES FL 33138-2559
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
MARVINS AIR CONDITIONING CORP (305)541-8408 [
Total Sq Feet: 0
Tons: Available Inspections:
Additional Info:DUCTWORK Inspection Type:
Classification:Residential Final
Approved: In Review Rough Duct
Comments: Date Approved: : In Review Review Mechanical
Date Denied: Type of Work: Underground �JE
Scanning: 1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee Invoice# MC-3-15-54794
$2.25 03/17/2015 Check#:8078 $ 110.70 $50.00
DCA Fee $2.25
Education Surcharge $0.40 03/13/2015 Check#:8067 $50.00 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $160.70
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-nam d c ntractor to do the work stated.
March 17, 2015
Authorized Signature:Owner / ApplicanContracto / Agent ate
IV Building Department Copy
March 17,2015 1
I h, CS Miami Shores Village
3 g - .
Building Department MAR 13 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 '°o
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No. 'RC 12� I q 1g6�5-
PERMIT APPLICATION Sub Permit No. COS 515
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:_ �2_7� IK L— `I-1
City: Miami Shores County: Miami Dade Zip: 33 '13 6
Folio/Parcel#: i ( �20 S 00 C?0 c�qd Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): a kq'_ kvs 1_6keao Phone#:
Address: 1 (?`(C'k c� �SA �7
City: State: Zip: 3
Tenant/Lessee Name: Phone#:
Email:
` ' a i
CONTRACTOR:Company Name: MC.,(Vw &_VXAV V7%Ttg Phone#: c�-
Address:_7k :3w t 0, (err tGf—
City: Stater zip: 3j 13S`
Qualifier Name: 'T TAtgay-) I)el� `�
CC1 Phone#: 3CS=9N ^/6 �i2
State Certification or Registration#: 6A Q e I a �f y Certificate of Competency#: _
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 21604- > Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile: I
Submittal Fee$ Permit Fee$ L ' v CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ _
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
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$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.
Signatu re l J Signature
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of Mc,/'GL-r 20 t.S by `'7vl day of eai r'c:h 20 / S by
��Vic)L2* rte. who is personally known to �1�n y�j.Lz�y n ��,1 c,c ,who is ersonally known o
me or who has produced 71430-q3Z' '"3Z 5V as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: _ ,Cd.�pe1y
OF
Print: r-Ega'Vi' + A�r Print: t -res
? c
Seal: MS
Sealto`I'arr
: �4/c ERICKAA FLE7ES
S
EXr''�E_ :May31,201' * �� * MY COMMISSION#FF 088456
�'+rEOF FV ° bailed Thru Budget Notary Services v EXPIRES:May 31,2018
'+4E F,O#' Bonded Thru BudgdNotary Service,
r
APPROVED BY Plans Examiner Zoning
r
Structural Review Clerk
(Revised02/24/2014)
5NoRFs y
owns Miami shores Village
Building Department
�OR 1D 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' 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 Florida
County of Miami-Dade I'
The foregoing was acknowledge before me this day of AtrclA 20 /,5 .
By who is personally known to me or has produced
-Tq,3(j -LI 3 Z `78"3 Z S—U as identification.
Notary:_
* , MY COMMISSION#FF 088456
SEAL: EXPIRES:May 31,2018
Banded Thru Budget Notary Serves
Marvin's Air Conditioning Corp
License CAC1816314
1761 SW 11 Terrace-Miami,Fl. 33135
Off Ph: (305)541-8408- Fax: (305)541-1856- Cell: (786)487-0801
March 12, 2015
State of 000`01q
County of _T> 1:-_s .
Before me this day personally appeared ::117 tin.Y►q n 'T)g who, being
duly sworn deposes and says:
I, Jonathan Delgado and Marvin Delgado will be the only ones working from Marvin A/C at this
project located 1279 NE 97th St.
Sworn to (o i eCy�dsubscribed before me this day of /�v,���-, 20 E ti-
by
Personally Know
Or Produced Identification
Type of Identification Produced --- --
t�er'o ERICKA A.Fl.ETES
* * MY COMMISSION#FF 088456
EXPIRES:May 31,2018 �� e z�
"'V,' ,50r Bv*dTftBu*NoWyServices Print, ype or Stamp Name of Notary
Marvin's Air Conditioning Corp
License CAC1816314
1761 SW 11 Terrace-Miami, Fl. 33135
Off Ph: (305)541-8408- Fax: (305)541-1856-Cell: (786)487-0801
PROPOSAL
March 12,2015
To: Oscar Longa Jr.
Address of Work:
Toledo Residence
1279 NE 97" St
Miami, FL
1. Supply and installation of(3) new air supply exits (R-6)
2. Supply and installation of(3) air returns for bedrooms
3. Reconfigure the current existing duct work system
4. At the end of the project , do a maintenance on the existing unit
a. Washing evaporator coil with acid
b. Flushing out drainage lines
c. Recharge unit with Freon
5. Supply and install new digital thermostat
6. Process permit
7. Supply and install new vents
Value of this job: $ 2,200.00
Payments:
Payment in advance............................................... $ 1, 200.00
After final inspection.............................................. $ 1,000.00
Notes:
• The client is responsible for permit fees
• We are not responsible for the following:
o Carpentry
o Residential Plumbing ,
o Electricity r !ft
o Test and Balance '
Marvin Delgado
Marvin's A/C Corp
Mar 12 15 01:18p Marvin's A/C Corp. 3055411856 p.1
RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD -
CAC1816314 s �1
The CLASS 8 AIR CONDITIONING CONTRACTOR
Named below IS CERTIFIED
.Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
DELGADa, JONATHAN R
%Rol MARVIN'SAIR CONDITfONING COR
1761 SW 11TH TERRACE
MIAMI FL 33135
ISSUED: 06/01/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1406010002146
]oslsz
Local Business Tax Receipt
Miami—Dade County, State of Florida
THIS IS NOTA BILL — DO NOT PAY
64626$] LBT
�/
BUSINESS NAMElt.00ATION RECEIPT NO- EXPIRESMARVINSAIRCONDITIONINGCORP RENEWAL
1761 5SEPTEMBER 30, 2015114!11 TERR 6752431 Must be displayed at place of business
MIAMI F133135 Pursuant to County Code
Chapter SA—Am 9&10
OWNER SEC.TYPE OF BUSINESS
iMARVINS AIR CONDITIONING CORP 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED
CAC1816314 13Y TAX COLLEC I FZ
Worker(s) 1 $45.00 07/14/2014
CREDITCARD-14-026592
This Local Business Tax Receipt only cont-amts payment of the LCcal Sasinass Tax.The Recaiptis not a license,
permit.or acertiftcationofthe holdersqualificadans,todubusinam Holdermustcomply with am,govencm al
or nangovemmerdal regulatory laws and requirements which applyto the business.
The RECOFT N0.above must he displayed ori all cemmerciat vehicles-Miami-Dade Code Sec fla-216.
Farrnareiafarmetion,visitwwwmiamidadevo��+axrnll -�
Mar 12 15 01:19p Marvin's A/C Corp. 3055411856 p,3
' CERTIFICATE OF LIABILITY INSURANCE
UArt(MRVIJI.J/YYYYI
7/7/2014
THIS CERTIFICATE IS ISSUED AS A PEATTER 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 POuaES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING LNSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policyjtes) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain Policies may require an endorsoment. Astatement on this certificate does not confer tights to She
cedificete holder in lieu of such endorsement(s).
PRODUCER
BEACON INSUILANC'E GROUP INC NAME
8567 Coral Way #301 (AIC,HHUNNo,w (305)266-9706 (arc,Nor.{305)458-65fl3
M±Pini r EZ 33155
AODREss angel@insurer.com
INSURERS) AFFORDING COVERAGE NAIC8
INSURER A- GRANADA INSURANCE Co.
r�uRE❑ MARVINS AIR CONDITIONING CORP INSURER B:
1761 SW 11TH TER INSURER C:
MIAMI, FL 33135 INSURER D:
INSURER-F:
INSUREF F:
COVERAGES CERTF3CATE NUMBER; REVISION NUMBER:
THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEIR OD
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 AVO CONDITIONS OF SUCH POLICIES. LIMITS SHCWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
RL'M TYPE OF INSURANCE IN N POLICY NUMBER {MA
COMMERCIAL GENERAL UA#3aIlY (MMJDDfYYYY) LIMITS
CLAMS-MADE D OCCUR F_ACH OCCURRENCE S 1 000 000
PREN1SFS(Ea oaamnoe) $ 50,000
A MED EXP(Anyonapersml S0()
GEN'L AGGREGATE LIMIT APPLIES PER:
0185FL00051143 07/22/14 7/22/15 PERSONAL 4 AOV INJURY s 1 000 000
POLICY a PERCOT D LOC GENERAL AGGREGATE s 2 r OOO r 0d0
PRCDU'CTS -CAMPrOPAGG s 1 000 000
OTHER
AUTOMOBILE LABILITY S
ANYAUTO Ea acodeM $
ALL ONANED SCHEOU:_ED DOCILY INJURY(Par person) s
AUTOSAUTOS
NON-OWNED BOCILY INJURY(Per accident) $
HIRED AUTOS AUTOS P P -Y AMA E S
(Par aaiGeml
UMBRELLA LLAB $
OOC;tR
EXCESS LrAB CLAIMS Mq�E EACH OCCURRENCE s
AGGREGATE y
OED RETENTsON s
'NORKERS COMPENSATION $
.PND EMPLOYERS'LIABILITY YIN STATUTE Fit
CFTICERMEMSER EXCLUDED? NIA E.L EACH AOCIDENT $
(Mandatary In NH)
It yes,dasQDe Lnder E.L DISEASE-EAErtPLOYEE S
OESCRI PTLON OF OPERATIONS twlow
E.I-DISEASE-POUCY LIMIT $
DESCRIPTION OF OPERATICkJS ILOCATgNS JVEH ICL?=3 (ACORD 7o1,Adddionel Remarks ScheduFe,may teattachew more space is required
CACIB16314
CERTIFICATE HOLDER
CANCELLATION
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
MIAMI SHORES,FL 33138 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORiZEO REPR ENTATIVE
ACORD25(2013104) 9)1982013 ACORD CORPORATION-A3I rights reserved.
The ACORD narne and logo are registered marks of ACORD
Mar 12 15 01:19p Marvin's A/C Corp. 305541 1856 p.2
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This eaf ifies that the indh4dual fisted belaw has etacled to be emmpt from Florida Workers'Compensafion law.
EFFE:67VE@ATE 9JW013 EXPIRA7MDATE 91812015
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