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MC-05-60 Miami Shores Village RE "° r 1 Building Department MAY 10 2805 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 =:z BUILDING - BUILDING Permit No. 1 Awi (00 PERMIT APPLICATION Master Permit No. FBC 2001 Permit Type (circle): Building Electrical Plumbing ;Mechanical Roofing Owner's Name(Fee Simple Titleholder) �_/ �� ,� �L — Phone Owner's Address CtR I I N'_ 13 A VC City R(AR( �40U State 1-t_ Zip 3 $ Tenant/Lessee Name Phone# Job Address(where the work is being done) 1 A)e- 4-Ten City Miami Shores Villggq County Miami-Dade Zip Is Building Historically Designated YES NO Contractor's Company Name z4RJ,4 Phone# Contractor's Address -?,;2 j i(J /0 2'_� T City �fJ. Al// / SStatte /`�, Zip _S7 Qualifier 4�lee_l State Certificate or Registration No. g Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# $Value of WorI'Foh4h'is Permi .00 Square Footage Of Work: Type of Work: ❑Alteraffon ❑New / c(o mouton r, Describe Work: �� U� Submittal Fee Permit Fee$ s A0 CCF$ 'i CO/CC Notary$ Training/Education Fee$ �_ Technology Fee$ Scanning$ Radon$ Zoning Bond$ Code Enforcement$ Structural Plan Review.$ Total Fee Now Due$ G , 3f (Continued on opposite side) Bonding Company's Nar (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) 1�1 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 pro e and a reinspection fee will be charged. Signature Signature Owni I Agent / o o" The foregoing instrument was acknowledged before `me this `� The foregoing instrument was a owledge before me this / day of Q ,by {!! �iCA day of ,20C) ,by vj©t�le- who is rs ally know e o whop has produced who is x nally known t me or who has produced As identification and who did take an oath. take an oath. NOTA U NOTARY PU Pv; ^o m oossza�t c; Sign: Sign: C� ' Flo Print: Print: ••• M Commission �0�u(80oHSZ-4284' Z L Y p 2� My Commission Expires: L� NM"Assn..Inc k APPLICATION APPROVED BY: Plans Examiner Engineer Zoning Chc 05/13/03 ADDENDUM TO BUILDING. PERMIT APPLICATION (AN APPLICATIPj FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED," THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL ECHANICAL I ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TLC SWITCH OUTLETS SPACE HEATERS BIDETLIGHT OUTLETS CENTRAL HEATING DISHWASHER I RECEPTACLES (WIND) DISPOSAL SERV ICE TEMPORARY A/C (CENTRAL) DRINKIFG FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIRAAETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPIW. INTERCEPTOR RANGE TOP UNDERGROUW TANKS LAVATORY OVEN ABOVE GRDUND TANKS LAUNDRY TRAY WATER HEATER I U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0 1 HP STEAM BOILERS I SHOWER MOTORS OVER 1- 3 FP HOT WATER BOILERS I SINK, POT/3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION � I SINK, RESIDENCE MOTORS OVER 5-- 8 HP TRANSPORTING ASSEMBLIES I { SINK, SLOP MOTORS OVER 8- 10 W ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET I MOTORS OVER 10- 25 FE' FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 hP COOL INIG TOWERS WATER CLOSET MOTORS OVER 100 W VIOLATION 10 RECT WAST-ES A✓C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS ( I A/C UNIT STRIP HEATER FIRE SPRINKLER { I GENERATORS TRANSFORMERS { HEATER-NEW INST. GENERATORS TRANSFORMERS I HEATER-REPLACE { GENERATORS TRANSFORMERS I I LAWN SPRINKLER-WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY-SEWER SIGN TIME CLOCK UTILITY-WATER FIXTURES SEPTIC TANK ANTENNA I RELAY E TELEVISION O'ilTLETS DRAINFIELD, 4' TILE/RES. { VIOLATION I I PUhP & ABANDON SEPTIC TANK REINSPECTION { I SOAKAGE PIT CU. FT. { ( { CATCH BASIN DISCHARGE WELL DOMESTIC WELL I f AREA DRAIN I ROOF INLET I SOLAR WATER HEATER FIRE STANDPIPE I POOL PIPING I { I C E LAWN SPRINKLER SYSTEM I I I I f GAS RANG ! I I { { { { l METER SET (GAS", I I I { I I GAS PIPIT G i Nio� , General Liability NOVA CASUALTY COMPANY RENEWAL CERTIFICATE DIRECT BILL EFFECTIVE 06/17/04 POLICY NUMBER F, ICY P1GD TO POLICY PERIOD t1GE`I"i' 09AL032199 06/17/04 06/17/05 12 : 01 AM STANDARD TIME NFLUUI>b6 NAMED INSURED AND ADDRESS AGENT NAME AND ADDRESS SERGIO R NUNEZ & ANACHRIS AIR WAHLSTROM ASSOCIATES INC CONDITIONING ETAL STE 209 821 NE 109 ST 145 MADEIRA AVE MIAMI FL 33161 CORAL GABLES FL 33134-4520 IMITS OF INSURANCE - ------ -------------- 3ENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS-COMPLETED OPERATIONS) ,560C , 000 ?RODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT. . . . . . . . . EIXCLUD_;D JERSONAL & ADVERTISING INJURY LIMIT . . . . . . . . . . . . . .$3GC , 000 TACH OCCURRENCE LIMIT. . . . : . . . . . . . . . . . . . . . . 6300 ,000 SIRE DAMAGE LIMIT (ANY ONE FIRE) . . . . . . . . . . . . . . . `�1CC ,OOC MEDICAL EXPENSE LIMIT (ANY ONE PERSON) . . . . . . . . . . . . . . . Y` , OUC ERRORISM COVERAGE . . . . . . . . . . . . . . . . . . . . . . . SEE ENDORSE_rXE'I_' I JOCATION ADDRESS (ES) --------------------- LOCATION 1 SERGIO R NUNEZ & ANACHRIS AIR CONDITIONING ETAL 821 NE 109 ST MIAMI FL 33161 i COVERAGES I i ITEM LOC TERR CLASS PREMIUM BASIS EXPOSURE DEDUCTIBLE j 1 001 1 91111 Payroll 20000 $250 PER CLM-PL DESCRIPTION: i Premise/Operations Liability Air Conditioning Systems or Equipment LIABILITY PREMIUM . . . . . FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART LOC ITEM ENDORS NO ED DATE LIMIT DESCRIPTION T R.E Ii :I 1 1 IL1201 11-85 , Policy Changes INSURED: SERGIO R NUNEZ & ANACHRIS AIR CONDITIONING Sc REFRIGERATION, INC --- TO'!',-"L ADVANCE-PREMIUM-------------.--_----------- . . . ----------- -- -:?SCO`00-- - INSURED RE-ISSUANCE 01-15-2004 I • w- i STATE OF FLORIDA TOM GALLAGHER DEPARTMENT OF FINANCIAL SERVICE CHIEF FINANCIAL OFFICER .DlVIS10N OF WORKERS' COMPENSA ** RE-ISSUANCE OF CONSTRUCTION INDUSTRY C TIFICE OF EXEMPTION certificate exempts the Officer of the Corporation o nation Law forefnber of: the theLperiod nimited ldiibccactedty Cbellopwny This I listed below from the provision of Florida Workers mile '� TE: 09/08/200S EFFECTIVE DATE: IxY[RATION DA 01/09/2004i CORPORATE OFFICER/ SERGIO R LLC MEMBER NAME: NUNEZ i FEIN: 6504030 C��RIS AIR CONDITIONING & REFRIGERATION IN A.. BUSINESS NAME AND ADDRESS: - ? NORTHEAST 109TH STREET. MIAMI FL 33161 1 DITIONING SCOPE OF BUSINESS OR TRADE: HEATING & AIR CONelects a certificate of election under this section may not recover 1 IMPORTANT: Pursuant to Chapter 440 . 0 5(141 , F .S . , an officer of a corporation who exemption from this chapter t fi�in9 benefits or compensation under this chapter . QUESTIONS? (850) 488-2333 DWC-253 RE-ISSUANCE OF CONSTRUCTION INDUSTRY CERTIFICATE OF EXEMPTION REVISED 11-03 Miami Shores Village Mechanical Permit 10050 NE 2nd Avenue ..s. Phone: 305-795-2204 Permit Number: MC2005-60OR ` Printed:5/16/2005 Page 1 of 1 Applicant: CONNIE BISCHOFF Owner: BISCHOFF CONNIE JOB ADDRESS: 9879 NE 13 AVE Contractor ANACHRIS A/C & REFRIGERATION INC Contractor's Address: 821 NE 109 ST Local Phone: 305-899-1187 Parcel # 1132050090490 Legal Description: 5 53 42 EARLETON SHORES PB 43-80 LOT 4 BLK 4 LOT SIZE 93.490 Fees: Description Amount FEE2005-6176 Building Fee $175.00 Total Fees: $186.38 FEE2005-6177 CCF $3.00 FEE2005-6178 Training and Education Fee $1.00 Total Receipts: $0.00 FEE2005-6179 Technology Fee $4.38 FEE2005-6180 Scanning Fee $3.00 Total Fees: $186.38 Permit Status: APPROVED Permit Expiration: 11/6/2005 Construction Value: $5,000.00 (ds Work: CHANGE OUT 5 TON SYSTEM Signed: (INSPECTOR) 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 responisibility for all work done by either myself, my agent,servants or employes. Signed: (Contractor or Builder) BY: