The URL can be used to link to this page

RC14-689 w t Miami Shores Village RF�CF,IVFD Building Department! JUN 10 2014 10050 N.E.2nd Avenue,Miami Shores,Florida 331�$3y;_ Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 20 l C�) BUILDING Permit No. d PERMIT APPLICATION Master Permit No�(y Co R-q Permit Type: MECHANICAL JOB ADDRESS: q�� N. t3a�s S(,•o,re, ,rte•., City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: k, ` -52 L C 2� — 07 Is the Building Historically Designated: Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): 4,5" Phone#: Address: N G 2 City: V-&l� y State: Zip: 7,1 Tenant/Lessee Name: 11'' ll Phone#: Email: U K u i C,t1n S kA (Q 0 kr-\C\. CONTRACTOR: Company Name: AA Ly— Phone#: 9314- Rci 0465 Address: tt of N u �q1 51 408 City: v-..3 a.�-�- State: f 1. Zip: 1-1 V19 Qualifier Name: Phone#: -$-4- 20$- So LZ U State Certification or Registration#: CAC. Al syy$ Certificate of Competency#: Contact Phone#:-_ "A86- ZD 11 - %Q Z)L Email Address: LA CLI %,%A Q-4 `Z 0; DESIGNER:Architect/Engineer: "�/ Phone#: 1'1�0 Aft Value of Work for this Permit: $ '!'4500— Square/Linear Footage of Work: 4 Type of Work: ❑Address Mkteration ❑New DRepair/Replace ❑Demolition Description of Work: 1\00 N U 0 �rCt Qr 2 �d�vJ =,A— Submittal Fee$ Permit Fee$ i B� CCF SL_ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$j('Fj - ( �[„/ Bonding Company's Name(if applicable) . f Bonding Company's Address N 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 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 appro ed and a reinspection fee will be charged. Signature V SWt Signature weer or Agent �.J� Contractor The for oing' strument as acknowled ed before me this�� The foregoing instrument was acknowledged before me tJ— day of ,20 ,by A 11 t day of I�JJiC..�t , 20(`t ,by'R2Cp t v .KS who i rsonally known tom r w o has produced who isrso lly kno me or who has produced As identification and who did take an oath. as identification and who �� NOTARY PUBLIC: RAYL A DeouARTO TARY PUBLIC: Notary pAc,State of Florida Commission#DD997834 _ "NO 6 Sign: My eemm.expires June 2,2014. Print: rA4 Aeigl( ._—�-- Print: V lt�ld� v� �� 0F FL \\N\ My Commission Expires: My Commission Expires: %, APPROVED BY le> t Lf Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) `��R�• ' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDKYYY) s 3/27/2014 THIS CERTIFICATE IS ISSUED AS A MATTER 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 POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlflcate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, 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(leu of such endorsement(s). PRODUCER "INT UT Alexander Dopazo Dopazo and Associates PHONE (305)470-8500 FAC teeele4T-9673 8725 NK 18th Terr Ste 300 alexadopazo.cotn Miami 87L 33172 INsuRERA WOSICo Insurance Company 5011 INSURED INSURER B:PrO ressive Ex reqs Ins Co 0193 All Air Solutions Inc INSURER C Mount Vernon Fire Insurance Cc 6522 1101 N$ 191 street #408 INSURERD:BuaineAs sirst Insurance Co. 11697 INSURERE: Miami FL 33179 1 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1432706782 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW 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 OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY OLICY EXP POLICY NUMBER MMlDMM/DDKYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY 7 q occurrencel $ J.00,000 A CLAIMS-MADE ®OCCUR 01144762-00 /27/2014 /27/2015 MED EXP(Any oneperson) 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY 7 PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea acc dent) 11000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OV.NrDSCHEDULED 2132056-1 /27/2019 /27/2017 AUTOS AUTOS BODILY INJURY(Per ooddent) $ HIRED AUTOS NON-OVMIED PROPERTY DAMAGE AUTOS Peracdtlent $ PIP-basic $ 10,000 UMBRELLA LIAB �3c OCCUR X EXCESS LIAB EACH OCCURRENCE 5,000,000 C CLAIMS MADE AGGREGATE $ 5,000,000 DED RETENTION L2118239C /27/2014 /27/2015 D WORKERS COMPENSATION $ WC STATT 77- AND EMPLOYERS'LIABILITY Y/N X 1TQPYL IMfTS ANY PRO PRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? Y N/A E.L.EACH ACCIDENT 100 000 (Mandatory In NH) 521-04444 /23/2013 9/23/2014 E.L.DISEASE-EA EMPLOYE $ 100 000 Ifns,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ((Attach ACORD 101, Schedule, Additional Remarks If mors space Is required) Air conditioning sales, intallation and repair. CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami shores ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, BT, 33138 Alexander Dopazo/AD ACORD 26(2010106) ®1988-2010 ACORD CORPORATION. All rlghte reserved. INS025 ontonst nl This Cr nRn names and Innn arks ranlalararl marks of ar npn