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DEMO-15-533 Permtvo Dfl- -' 533 ORES i„ �? Miami Shores Village Perflf hype ' ) �■h <y� 10050 N.E.2nd Avenue NE 1 cit sCl �`tcato&,,M , ha al Miami Shores,FL 33138 0000 ' PehO S'WuS:API EC o� Phone: (305)795-2204 ORI 7114120is Expiration: 01/10/2016 Project Address Parcel Number Applicant 9935 NE 13 Avenue 1132050090470 FABIANO SILVEIRA AGUILAR M Miami Shores, FL 33138-2634 Block: Lot: Owner Information Address PhoneCell LFAB�IANO SILVEIRA AGUILAR MARIANA 9935 NE 13 Avenue --- MIAMI SHORES FL 33138-2634 9935 NE 13 Avenue MIAMI SHORES FL 33138-2634 Contractor(s) Phone Cell Phone Valuation: $ 500.00 AMERICAN HVAC-R SERVICES (954)779-5042 Total Sq Feet: 0 Type of Demo:Mechanical Available Inspections: Additional Info:demo duct work+air handler conden Inspection Type: Classification:Residential Final Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# DEMO-3-15-54755 DBPR Fee $2.00 DCA Fee $2.00 03/11/2015 Credit Card $50.00 $58.60 Education Surcharge $0.20 07/14/2015 Cash $58.60 $0.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108. 00 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 f ing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin Futhermore, I orize the above-named contractor to do the work stated. July 14, 2015 Authorized Siaur :Owner / Applicant / Contractor / Agent ate Building De artment Copy July 14, 2015 1 Miami Shores Vi I lage �+fx T y i Building Department MAR 1 I fah' 10050 N.E2nd Avenue,Miami Shores, Rorida 33138 BY: Tel: (305)795-2204 Fax: (305)756-8972 INS'ECIION UNEPHONENUMBER (305)762-4949 MC 20 BUILDING Master PL-rmit No. bjv,o PL/1 I T APPLI CAII ON Rab PL-rmit No:-V7E M C) kS- 53 ❑BUILDING ❑ B-EKTRC ❑ ROORNG ❑ FT--M90N ❑ E)CTMON ❑RENEWAL ❑PLUM E NG M BaMl CAL ❑RJBUCWOF4<S ❑ Q iANGE OF ❑ CANCEIATION ❑ a iOP CONTRACTOR DRAWINGS .JOB ADDRESS ��' �' / /? ,�l✓ City: Miami Shores (bunty: Miami Dade Zi P: Folio/Parcel#: Isthe Building Historically Designated: Yes NO Occupancy Type: c�X- Load: Construction Type: Rood Zone: BFE FFE OWNB2 Name(Fee Smple Titleholder): �—AC-2) aAD cJ(l-4-yt— Phone#: Address: r' city: -��I j p�T Elate: �' —Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR company Name: _ 1 _ VA-C 5f-f /L-vl5 Phone#: Address �'sV C ' s^v �1 l.� (I S 2. city: Elate: 14 Zip: Qualifier Name: G Phone#:-L ��a Elate Certification or Fbgistration#: C C9 J p certificate of Competency#. DESIGNER Architect/Engineer: Phone#: Address: City: Elate: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: /V t,+- Type ,+-Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Fbpair/Feplace VDemolition Description of Work: _g s'1il 0 `I��c l�A `C �— ,o A Specify color of color thru tile: N Submittal Fee$ Permit Fee$ CCF$ (b/OC$ canning Fee$ Fbdon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Elructural Faeviews$ Bond$ TOTALFEENOW DUE$ i 10 (revised02/24/2014) <�4 • i, Bonding Company's Name(if applicable) Bonding Company's Address City Elate Zp Mortgage Lender's Name(if applicable) ` Mortgage Lender'sAddress City Elate 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, SGN$ PO= FURNACE$ BOILER$HEATER$TANK$AIROONDITIONER$ ETC.... OWNEF7SAFRDAVIT 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 CIDM M ENCEM ENT MAY RESULT IN YOUR PAYING TWICE FOR I M PROVEM BAIT S TO YOUR PROPERTY I F YOU INT END TO OBTAI N FI NANa NG, CONSULT WITH YOUR LENDER ORAN ATTORNEY BEFORE RECORDI NG YOUR NOII CE OF COM M ENCEM ENT." 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. Ir 9gnature ��b ""�' 6� Eignatur e' OWNER or AGENT CONTRACTOR The foregoing instrument wasadmowledged before methis The foregoing instrument wasadmowledged before methis -r_3 day of_7 tQ(N Uny-y 20 1 4:�_ by day of r-i art _ ,20 /,1" by 1-(A"6ho is personally known to who is pernown to me or who has produced �t 1��Q Y�L 1 CL'V1 S-L as me or who has produced L .,�-� as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC NOTARY PUBLIC Sgn: 9gn:: %C' 1 � Print: U Print: FATMCUCARMEN ESTER JUSINAmal: mal: uy Poic-8"oEflori0� MY COMMISSION#FF046931 MY Comm 6,2018 "� oP EXPIRES August 19,2017 ,'o°ry o` Commission/EE 656660 9 auma (407)398-0153 FloridallotaryService.com **■w.** ::,t,tw*:,t,r* ,t,r,r, *+r+t********r•******.,.r•r •,r ,t * * • r•***:�***. i APPROVED BY R s Examiner Zoning Elructural Review Clerk (PeAsed02/24/2014) RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PRt�P0-01ONAL:REGULATION CONSTRUCTI ! ®USfiRY1CMSNt3 13OARD X6846 . . T CI.A SAAR' 0 , DIT CONTRACT N ,rred pelo :IS IF1FIVD lJndpr'1he'oro� lung of"Ci�apter48 FS: A xplrati6h d; e. AU '111 rt - F 4 : ul�©nrA :nn,Ir:1�A�1,SCJ D a r.5 . 3 C *q.i i � • 1 '. ISSUED: 07/07/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407070000675 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 DBA: Receipt#:HEATING/AIRCONDITION CO CTR Business Name:AMERICAN HVAC R SERVICES Business Type:YP (CLASS A AC/VENTILATION) Owner Name:MICHAEL JOSEPH CULOTTA Business Opened:lo/08/2003 Business Location:750 E SAMPLE RD B5/2 State/County/Cert/Reg:CAC058484 POMPANO BEACH Exemption Code: Business Phone: 9 54-7 84-74 3 1 Rooms Seats ,w Errkployees !nes',- Professionals „t For Vending Business Only Number of Machines: Vencling Type: Tax Amount Transfer Fee NSE Fg Goiecl;on Cost TaW Pard 27.00 0.00T t3 12)4 ' THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMESA TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: MICHAEL JOSEPH CULOTTA Receipt #05B-14-00000032 xx` PO BOX 5431 Paid 10/09/2014 29.70 LIGHTHOUSE POINT, FL 33074 2014 - 2015 �,�, 25 tt�aF7a i23K•7 , .T it'X•A 1'. /dIF/ - W�d tl w q__-_'*— ®L A 1 � �',�.� � tl�. _ — _ .: U �U K*?P Mil t��r��", ,,�t* ,,s :�cs t •A j,a} � s t �,� �* � �'�.3 t.P�'i � ' � t � m,��} t; "����, k � ��,,, s MIT "Most k i a 3 � NMI W X t 'rw +;»- x x s i „�y5..y.�,' t a ,F• 3., n h 3 4 Y At "�' � ��^"• V 'ens �v` Nt R`k �' A`1 a �.g a�"� x �^ 3 � a ,Sr > x"`k h ��zE�` ��„q ti� bis Sj �S Y •�k,F � 3yz k- i ^�' �,�:+.'� 3 �_ �"',. : " `�' t �� �r-a 6� ... � � �•J^ �"r �2+�.,Ad,'R'":n 3�;n g � .� ��`� 'r yr zv�.g � i�tl� j s t .� '� :�.� ! �."�s'e}Gs"�..��E'G+ � S�i�c�si.,t i.�'�S�'+'��k•'� 4 �,'�,..9.�� �h '�i fw.x., a -"a 5��,� t�a� fi€,E t r�'� k e.' �. ! ~t ^art '" �'�' t� r ? �, �-�1+ -�m�• _ a _ J� i'r'r7'�a°$1ysTs a sgx r;", ek rrhm� n - ,3 ,.c 3FW d '7• spa r t 'Y 1-4V +�`E s r' A �. x � J , f 4y no y L �• K 'n,*, 'W -"—q�`a t-.,. aT?��P"OR � _nW�A „filEq _u x ;,q�dklt. ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE.(MM/DDIYY) 07/13/15 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY PREMIER INSURANCE AGENCY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER.THIS 113 S MONROE STREET CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER,THE COVERAGE TALLAHASSEE, FL 32301 AFFORDED BY THE POLICIES BELOW. Phone: (561)291-5166 Fax: (561)892-2999 INSURERS AFFORDING COVERAGE INSURED American HVAC-R Services, Inc dba INSURERA: Lloyds of London Environmctal Engineer Group INSURER B: PO BOX 5431 INSURER C: Lighthouse Point, FL 33074 INSURER D: Phone: (9-z4)729-5042 INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTHWITHSTANDING 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY EACH OCCURANCE �is 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 100,000 CLAIMS MADE❑X OCCUR MED EXP(Any one person) $ 5,000 A CIBFL0008441 06/15/2015 06/15/2016 PERSONAL AND ADVINJUR'r $ 1,000,000 GENERAL AGGREGATE '$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PRODUCTS-COMP/OP AGG $ 2,000,000 PER: X POLICY nPROJECT n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED A: OS (Per person) - HIRED AUTO" BODILY INJURY $ NON-OWNED.A r'OS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABIL11 Y AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ UTO ONLY: AGG EXCESS LIABILITY EACH OCCURANCE $ OCCUR❑CLAIMS MADE GGREGATE $ DEDUCTIBLE RETENTION WORKERS COMPENSATION AND WC STATUTORY EMPLOYERS LIABILITY LIMITS n OTHER E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYLF $ E.L.DISEASE-POLICY LIMIT, -$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDROUSMENT/SPECIAL PROVISIONS AC and/or heating service; CERTIFICATE HOLDER I JADDITIONAL INSURED:INSURED LETTER: I ICANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1�DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION ON LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. MIAMI SHORES VILLAGE BUILDING DEPARTMENT AUTHORIZED REPRESENTATIVE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Mailed to: mikecoolsit@yahoo.com + ACCORD 26-S(7/97) ACORD CORPORATION 1988 1 a � JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION "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: 7/19/2014 EXPIRATION DATE: 7/18/2016 PERSON: CULOTTA MICHAEL FEIN: 201175843 BUSINESS NAME AND ADDRESS: AMERICAN HVAC-R SERVICE PO BOX 5431 LIGHTHOUSE POINT FL 33074 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-COND Pursuant to Chapter 440.08:;' officer of F.S.,an ofof a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or my, :-rrsation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...appy only within the scope of the business or trade listen on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall:-s subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no kxrger meets tine requirements of this section for issuance of a certificate.The department shall revoke a certtficate at any time for failure of the person named on the certificxtz to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 Post Office Box 5431 Lighthouse Point, FL. 33074-5431 954-532-3002: Fax 954-946-4935 • • 1 1 March 2015 State of Florida County of Broward Before me this day personally appeared Michael J Culotta, who being duly sworn., u'eposes and says: I Mic'-ael J Culotta as qualifier for American HVAC-R services inc, hereby state that no person from inn corms s*will work on the project 9935 NE 13 ave, Miami Shores Village under Demo permit 15-148. Sworn to,or affirmed subscribed before me this 11 day of March 2015 by Michael J CuJfftt4.. Personally Know - Produced Identification Type of Identification �� Prin sa�.pv v•y, PATRICIA SNYDER . NoWy►uWe•8qb of Florida J.1 My Can. on 8 2016 ComwhsWn*EE 856660 . . . . . . . . . . . . . . . . . . . . . . . . . E/,INS..: CELL CE IN THE HVAC-RV PU3STRY n Miami shores Village Building Department LpRipp 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 i£ 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. In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore,you may be personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contractor J� l7Lr Print Name: �a ` G � Print Name: Signature: fhe?t4A,, Signatur State of Florida) State of Florida) County of Miami-Dade) County of Miami-Dade) Sworn to and subscribed before me this_� Sworn 1¢aad subscribed before me this day of ,20 day of By �� \ By RMEN ESTHER JUST 0 0� my Comm Expim Doe$,Im (SEAL)F:i;7 (SEAL) r;�:��' `)rrr^ssion#fEE 85WT e of ibirTON Type of -7XEd = (407)398.0153 FloridallotaryService.com