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MC-15-213 Permit Nov,MQ , -1$ 11 % 17, 77M,yMiami Shores Village 'k�l �+ 8 E»C�tt Ga)=Res a tial 10050 N.E.2nd Avenue NE Workt/Altelration Miami Shores,FL 33138-0000 Petrrtetsl�PR��VECt y p� Phone: (305)795-2204 F[oRioA issue Data:416/2015 Expiration: 10/03/2015 Project Address Parcel Number Applicant 680 NE 97 Street 1132060171610 ROSALINE FRAME Miami Shores, FL Block: Lot: Owner Information Address Phone Cell ROSALINE FRAME 680 NE 97 ST MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone Valuation: $ 2,500.00 I ALANIS A/C S HEATING, INC 954-986-4101 Total Sq Feet: 500 r Tons:1 Available Inspections: Additional Info: 1 NEW UNIT AT THE CONVERTED GARAGE. Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Underground Date Denied: Type of Work: Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# MC-1-15-54318 DBPR Fee $2.00 04/06/2015 Check*295478 $ 111.80 $0.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $111.80 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AF that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction zo in F thermore,I authorize the above-named contractor to do the work stated. 4.11 April 06,2015 Authorized S ture:Owner / Applicant / Contractor / Agent Date Building Department Copy April 06,2016 1 Miami Shores Village Building Department VJ . 'Shores,Florida 33138 NOV 12 2015 BonkT 7g-2 Fax: 305 7 6-8972 �y. e� E E ( 05)762-4949 FBC 2010 BUILDING _ aster Permit No. PERMIT APPLICATION Sub Permit No. �tC. 15_ 2. 13 ❑BUILDING ❑ ELECTRIC ❑ ROOFING EVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL [:]PUBLICWORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP VX CONTRACTOR DRAWINGS JOB ADDRESS: Ls(D F— 9 '] City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Phone#: '�0j Address: City: State: V\Cir,, 0.4 Zip: X313 Tenant/Lessee Name: Phone#: Email: OlCA \0 Ir �C- ('Sla-, C 0'Y` CONTRACTOR:Company Name: ""hone#: Address: C� City: _ 034 State: VC Zip: Qualifier Name: Ce � + Phone#: State Certification or Registration#: CAC\q 1 (2,�1 'A Certifica e of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ a C?S d Square/Linear Footage of Work: Type of Work: ❑ Addition EJ Alteration ❑ New`` ❑ Repair/Replace ❑ Demolition Description of Work: AC J AS�l1 am -\- Coe A-CA R arcLo'e- Specify color of color Niru tile: Submittal Fee$ Permit Fee$ 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 Lenders Name(if applicable) Mortgage Lenders 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. Signature Signatur OWER rAGENT CONTRACTOR The foregoing instrument wa acknowledged before me this The foregoing instrumentwasacknowledged before me this day of � � 20 by day of AL20 (5 by whole e�rsoonally known to who is personally known to me or who has produced Pv !� as me or who has produced 194K as identification and who did take an oath. identification and wh did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: P Pr' s e�Cr�S�l�cL�� Y .►"Y°&e Notary Public State of Florida �. FSECA RM Seal: o c Seal: Joanna M Feliciano * * MYCO+i#►4ISSIQAIiFF151242 �'or wok ExpMy ires 01112/2'0181ssion FF 082753 m., EXPIRES:September 23,2018 �•as 'r`O Tin 8�1 No"swo APPROVED BYan Examiner Zoning Structural Review Clerk (Revised02/24/2014) `SHS Miami Shores Village Building Department .... 9Im 10050 N.E.2nd Avenue Miami Shores, Florida 33138 p� Tel:(305)795.2204 NOV 12 201 Fax:(305)756.8972 BY: AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC t-s�— This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are ngt acceptable. Job Address(where the work Is being done): I fe `6�.S+ City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO❑ ARHI Sheet Attached:YES ❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER (f� AHU or PKG. UNIT MODEL# F01 TOO COND.UNIT MODEL# A 16 KW HEAT NOM TONS o AHU CU PKG 1)M.C.A AHU CU PKG AHU CU PKG 2)M.O.P AHU CU PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES O YES NO REPLACING THERMOSTAT E NO YES NO NEW 4"CONCRETE SLAB ES NO YES NO NEW ROOF STAND YES 600 YES NO NEW RETURN PLENUM BOX S NO 1, Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): �9_Gq 4. Size Disconnecting Means: (( �1 . �" j_ r �1 Contractor's Company Name: 11 y SCP., j i W I�-q,r W'1�[A&,1�?D Phone: State Certificate or Registration No. GSL k 6 Ib9-I 3 Certificate of Competency No.. Signature Date: Tice, .S (Qualifier's signature) (Revised02/24/2014) 07`x'1.TT;I- REs JUN 16 2UIS Miami shores Village Building Department pLOR 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR4 ARCHITECT { Permit N. s - i l Ra wLe Owner's Name(Fee Simple Title Holder): r+ Y r6L VO–t– Phone#: I hI Owner's Address: 6 �-W'Lse,-r City: C./I I A-Y—I State:ff-�--"1-3 A- Zip Code: Job Address (Of where work is being done): Z�U lL� -7 % "�-- City: Miami Shores State4Florida Zip Code: 'F2 13 Contractor's Company Name: Phone#: Address: zz City: S t Zip Code: Qualifier's Name: � Lic. Number: @, � Architect/ Engineer of Record Name: 6" CG MCa. C L.L Phone#: Address: • -7 &lt 9 ^2- City- City:y9//M 1 I+t '' State: !ejC41Ut 0 i— Zip Code: l 3 Describe Work 0AV 6tS i 0VT 1 hereby certify that the work has been abandon e and/or ems*is unable or unwilling to complete the contra . I hold th uil cial e 'a harmless o 1 legal i v Signature r Si 'ature i'Owner or em Cotmacto or Architect The foregoing instrument knowledged before me T foregoing instrument was ged before me tr,i;/ day of . 1�,20� ,b��y17� this-�—day of �`/hl� ,201 Jby Who is personally known to me or who has produced who �iiss,personally known to me or who has produced p as indentification. l%��r ' �'3u-c_ as indentification. No ubli< Notary Pu Sign: Sign: Seal: Seal: 'e+►u, Notary Pubiit State of Flsrlda3 Joanne M Feliciano �y µy Cammieaian ff Oe2793 'tpp•R Expiresow2l20tn r/ it s �� Miami Shores Village Building Department RECEIVET-3 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 JAN 2 095 Tel:(305)795-2204 Fax:(305)756-8972 B INSPECTION LINE PHONE NUMBER:(305)762-4949 IFBC 20 (C) BUILDING Master Permit No. `�C Ko— - ["�83 PERMIT APPLICATION Sub Permit No.-M( (s- 2-13 F-]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING rZkECHANICAL ❑PUBLICWORKS [:] CHANGE ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: NO �4'6 9*1 S't City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load:moi.-. Construction Type: Flood Zone: BFE: FFE: e OWNER:Name(Fee Simple Titleholder �i:f 4wte Phone#:3E)5-335—gT63 Address: 6S �j'L ci S h City: `_K4vvK S {f �ial St ' Zip: 33i3� N' Tenant/Lessee Name: Phone#: Email:�`(a`Me ' fOSc v�d 'E!J4k - CONTRACTOR:Company Name: l4 kn4i`_.� C& ,`.a Phone#: Address: ok i­, ,-L City: State: Zip: Qualifier Name: I.J•e 5i-e_7 W-t X Phone#: 193Y State Certification or Registration#: COS-7 EM Certificate of Competency#: DESIGN :Architect ngineer: (N(AAA,,- A. C.o./M.P(S C— L` Phone#: '3yS '7 S L( .'L'S 119 Address: 37 3 iNJ 1E CI'L S r City: VA-i l Lo-%l � f wW_ S State: �- Zip: ;S(3 CR Value of Work for this Permit:$ U Square/Linear Footage of Work: Type of Work: ❑Addition Alteration ❑New ❑ Repair/Replace ❑Demolition Description of Work: C I AI& VN t T A 7 D C.otjVL►?,100 6�AA,E Specify color of color thru tile: l '��� l �N f �/-�L- ('T' Submittal Fee$ Permit Fee$ 0 O V. CSO CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ L� o 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 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 a sen e of such posted otice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OvUer or Agent Contractor The foregoing instrumentwasacknowledged before me this The foregoing instrument was acknowledged before me this�O day of )� ,20_/by A2(6111/ 4Ca l e day f 20�by "�'C/LOY who is personally known to me or who has produced who is personally own to me or who has produced Z.�2 UL/q®�as identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Pri Notary public State of Florida Print: oanna Jones My Commi i �eycommission FF 082753 .`,�►rP� a le xpirommssi 2018 My Commission Vii' commissioN#EE073688 OF 'qI D(PIRES:MAR.14,2015 wwW.AARONNoTARY.eom APPROVED BY Plans Examiner Zoning Structural Review Clerk RevisedO2/24/2014)(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) 41940 STATE OF FLORID DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 � NORTH MONROE STREET TALLAHASSEE FL 32399-0783 NEELY, WESLEY EDWARD ALANIS AIRCONDITIONING& HEATING INC 4208 S W 24TH ST HOLLYWOOD FL 33023 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEpAFiTM T QF BUSINESS AND and they keep Florida's economy strong. PROI S S� ALS ULATION Every day we work to improve the way we do business in order to CAC057850 06/1$/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more information CERTIFIED AIR �S(3 about our divisions and the re ulations that impact you, subscribe g Y NEELY,VASD _ to department newsletters and learn more about the Department's ALANIS AlRCO IQ�t N I(NG i IftltlatiV@S. Y Our mission at the Department is:License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your " customers. Thank you for doing business in Florida, IS CERTIFIED undor the provisions of Ch.488 FS. and Congratulations on your new licenses Expiration date AUG 31,2016 L14061BOOMSO DETACH HERE RICK SCOTT,GOVERNOR KEN t AWSON, SECRETARY STATE.OF f LORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION NSTRUCTION INDUSTRY LI E SI G BOARD =(�AC057850 The CLASS AAIB CONDITIONING G( NTRACTOR Neared below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 " Pi NEELY,WESLEY EDWARDX—,�-g� ALANIS AIRCONDITIONINING: ` 4208 SMI24TH§ HOLLYWO®D- I �02 Broward Tax 2015.JPG https://mail.google.com/, /Scs/mail-static//js/k=gmail.main.en.... BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,201S DBA: Receipt#:HEATI183 NG/AIRCONDITION CONTRACTR Business Name:INC AIR CONDITIONING & HEATING Business Type:(CLASS A AIR CONDITION CONTRACT) Owner Name:WESLEY E NEELY Business Opened:06/01/1999 Business Location:4208 SW 24 ST State/County/Cerf/Reg:CAC057850 99-CU-219 WEST PARK Exemption Code: Business Phone:954-986-4101 Rooms seats Employees Machines Professionals 1 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 1 0.00 0.00 0.00 1 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A 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: WESLEY E NEELY Receipt #ICP-13-00006199 4208 SW 24 STREET Paid 07/15/2014 27.00 WEST PARK, FL 33023 2014 - 2015 Aw A•\I l-\•� AA••\•sem/ • AA!• T•••A•\•rAA T�\/ Ar Ar�P►T 1 of 1 1/29/15 2:26 PM 2014 LIABILITY&WORKERS MIAMI SHORES VILLAGE jpg https:Hmail.google.com/Jscs/mail-static/1Js/k=gmail.main.en.... A �® CERTIFICATE OF LIABILITY INSURANCEDATE�(MWODfYYYY ) 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 certificate holder is an ADDITIONAL INSURED,the poli es must be endorse& SU ROGATION 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 lieu of such endorsemerd(s)_ PRODUCER GUNIAUT NAME: Futurity Insurance,Inc. PHO . (561)361-8331 (561)361-8332 PO Box 4277 ppm; INSURI MS►AFFORDING COVERAGE NAC 0 Deerfield Beach FL 33442-4277 INSURERA: Accident Ins.Co. INSURED INSURER a: NOIGUARD Ala is AironiRiontng 8 Heating,Inc. INSURER C: 4208 S.W.24th St. INSURER 0: INSURER E: Hollywood FL 33023 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHATTHE 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 CONTItACT OR OTHER DOCUMENT WITH RESPECT M WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT MALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAINLS, LTR TYPE OF INSURANCE Gp3R W POLICY NUMBER AYD MMR) LMM GENERAL LIABILITY EACH OCCURRENCE $ 1.000.000 COMWERCULL GENERAL LIABILITY PREMISES Fa oodarane S 100.000 CLAINSMADE ®OCCUR MED EXP(Any ala Person) S 5.000 A 14-3743 02/1612014 02116!2015 pERSDNAL&ADVINJURY 3 1.000.000 GENERAL AGGREGATE S 2,000.000 GEMLAGGREGATE UMrrAPPLIES PER PRODUCTS-COMPIOPAGG S 2.000,000 POLICY JEC7 n LDC a AUTOMOBILE LIABILITY (Ee eocMant $ ANY AUTO BODILY INJURY(Pa prion) S ALL OWNED UTHEDULED BODILY INJURY(Per eccldad) S AOS AUTOS H6tEDAUTOS AUTOSMON-OWNED Per ecddent) S S UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAe�-NIADE AGGREGATE S DED RETENTIONS S YYORlE7t8 COMPFNBATON AND EMPLOYERS,LL49U , TORY ACCIDENT ER ANY PROPRIETORIPARTNEIVEXECUTNE YIN EL EACH ACCIDENT $ 1000000 OFFMERIMEMSER EXCLUDED? N/A ATWC454532 1/27/2015 1/27/ams (spry b1 NH) E.L.DISEASE-EA EMPLOYEE S 1,000,0()0 tl yes.cla=bo urlda DESCRIPTION OF OPERATIONS betuw E.L.DISEASE-POLICY LUdrr S 1000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AMach ACORD 101,AddiUaral Remarks Sehedulo,B mac apace M required) Air Cohd180Nng,Heating.Installation and RePak CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES VILLAGE FL 33139 Tw ACORD ( �� O 1988.2010 ACORD CORPORATION.All rights reserve& The ACORD name and logo are registered marcs Of ACORD 1 Of 1 1/29/15 2:26 PM Robert& Rosalind Frame 680 NE 97th Street Miami Shores, FL 33138 305 302 1784 Industrial Electrical Systems, Corp Attn: Nestor Corvea 10257 NW 91h Circle# 205 Miami, FL 33172 Date: July 14, 2015 RE: Master Permit RC-14-1383 Sub Permit EL -15-212 680 NE 97th Street Mr. Corvea, My wife Rosalind and I have elected to go with another contractor for the work to be performed at the above address. Please sign and notarize the attached Change of Contractor form and return to the above address. A self-stamped envelope is enclosed. Please feel free to call me with any questions. Thank You, J Robert Frame t . DELIVERY DoSECTION , ■ Complete'Itemd 1,2,and 3.Also complete A. r 0 Agent Item 4 If Restricted Delivery Is desired ❑Addressee ■ Print your name and address on the reverse C e De!<very so that we can return the card to you. p B. eiv�gy(Printed�V e)p 7 a a� 0� ■ Attach this card to the back of the mail lece, l C ( F d or on the front if space permits. D. Is delivery a ress different from item 1 as i. Article ,A��d��dr�Qessed to: f if YES,enter delivery address below: E3 No "lam I&viVenv1-e+t- F° ��� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 7ReWcted 1 Mal{• I7 Priority Mail Exprase d ❑Return Receipt for Merchandise ail ❑Collect on Delivery elivery?(Extra Fee) ❑Yes 2 Article Number 7p14 p150 0002 0867 5853 (Transfer from service label 1 PS Form 3811,July 2013 Domestic Return Receipt � • o ■ Complete ite;ns,1,2,and 3.Also complete A. Sig ❑Agent item 4 if Restricted Delivery is desired. X ❑ dd ee ■ Print your name and address on the reverse a of e► ery so that we can return the card to you. B. elv y ted N ■ Attach this card to the back of the maiipiece, or on the front if space permits. D. Is delivery address different from item 1 Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No A lapis C Co 'o��l� WVI-r We-SltLeet� IIIIIIIII111111IIIIiI IIIIIIIIII II IIIIIIIIII III �. \�p e 4z% (� % S ,` •�(4 4 ,` S-Ft/��{ 3. Service Type {tdV W c�"C ❑Certified Mall® ❑Priority Mail Express [3 Registered E3 Return Receipt for Merchandise " ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7 014 0150 0002 0867 5846 (transfer from service taboo PS Form 3811,July 2013 Domestic Return Receipt Inspection Worksheet Miami Shores Village ,00so N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-227411 Permit Number: MC-1-15-213 Scheduled Inspection Date: January 22,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: FRAME, ROSALINE Work Classification: Addition/Alteration Job Address:680 NE 97 Street Miami Shores, FL Phone Number (305)302-1784 Parcel Number 1132060171610 Project: <NONE> Contractor: BEL AIR SERVICES&AIR CONDITIONING INC Phone: (954)895-1534 Building Department Comments 1 NEW UNIT AT THE CONVERTED GARAGE. Infractio Passed Comments INSPECTOR COMMENTS False ,�- Inspector Comments Passed Failed a �s Correction Needed ❑ Re-Inspection - Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 21,2016 For Inspections please call: (305)762-4949 Page 2 of 40 iY11At 111 JI I%jl c.J v HILA%%. F ' ---- ----------- -----_Buildng_Department ��j 6 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 2 203 1 A Tel:(3#5)795-2204 Fax:(305)756-8972 ay C INSPECTION LINE PHONE NUMBER:(305)762-4949 !� =2—�— FBC 2010 BUILDING Master Permit No. `2C-- 114 - !3T3 PERMIT APPLICATION Sub Permit No. RC-- cS- 213 ❑BUILDING F-] ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKSCHANGE OF ❑CANCELLATION r-1SHOP A c CONTRACTOR DRAWINGS JOB ADDRESS: City Miami Shores County Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titlehholder):�0e Phone#:�3d�—W /- Y!P, Address: lel y, Ay 1q" C�/ City: G I I lat State:_�il,C�a-L. Zip:�� �J 7J Tenant/Lessee Name: Phone#: I Email: oqa-'�Xc a q ° com Ili CONTRACTOR:Company Name: . t v s Phone#:�S`� —/!!;3q 61 Address: 7 City; state: L4 zip:JJ b %''4ualifier Name: e i t' i ( Phone#: t '-� State Certification or Registration#:( �L / 0 b 13 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New {k Repair/Replace ❑ Demolition Description of Work: C'c+'XA-GCtd''N r Specify color of color thru tile: Submittal Fee S Permit Fee$ ® V(9-6 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ coi,N(!;c (T coo7rjx�Q_ • 3 -�s ,(j�) TOTAL FEE NOW DUE$ A - • r 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 on 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 Signature O ER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ¢�day of �'C ,20 by G Z day of a�� ,20 by dr4NNeis personally known to TAI J 190a ,who is ersonally known me or who has produced as me or who has produced s identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Si/nn• Pri Print: ��1o�Ca �Q1b 40 Notary Public State of Florida Se :� ;.Joanna M Feliciano Seal: ��r nuB� REBECAROJO My Commission FF 082753 *�' j �` MY CCAISSION t FF 151242 6 ao�' Expires 01/12/2018 * � EXPIRES:September23,2018 mq� 00 Bonded Thtu Budget Notary SetYhCb F F 6ans APPROVED BY Examiner Zoning Structural Review Clerk ♦SNORE S l,I�► �o Miami Shores Village Building Department �ZORI 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N.MC-1-15-213 Owner's Name (Fee Simple Title Holder): ROSALINE FRAME Phone#:305-302-1784 Owner's Address: 680 NE 97 ST City; MIAMI SHORES State : FLORIDA Zip Code: 33138 Job Address (Of where work is being done):680 NE 97 ST City: Miami Shores State:—Florida Zip Code. 33138 Contractor's Company Name: CITY CONNECTION AC REFRIGERATION INC Phone#:3053807217 Address: 10304 SW 130TH CT City: MIAMIState:FLORIDA Zip Code:33186 Qualifier's Name : FELIX DE JESUS GUERRA Lic. Number: CAC1816558 Architect/ Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: AC INSTALL AT CONVERTED GARAGE hereby certify that the work has been abandoned and/ort ontractor/architect is unable or unwilling to complete the contract. I I ilding Official and the Miami Shores harmless of all le I ment. Signature ti Signature Owne r Agent ontractor or Architect The foregoing instrum t was aknowledged before me The foregoing in ment was aknowledged before me thi day of ®C .20jAby W/&W cyP7e this 27 day of OCTOBER ,20 by 2015 Who is personally known to me or who has produced who is personally known to me or who has produced 77 0C as indentification. as indentification. Notary Publli No ry Pu lir. Sign: Sign: YV—;-z X�Ik� Seal: Seal: �� 0& Notary Public State of Florida ,•'' AIMEE MEDINA •. Joanna M Feliciano �: d' My Commission FF 082753 ` MY COMMMION 0 E010245 '�a w Expires 01/12/2018 EXPRE8 June 23,2018 3884199 Fumalote ift -ca cum iFS Miami Shores Village Building Department n IOOSO N.E. 2ND Avenue ■■■■ ■■■■■� Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Change of Contractor/Architect or Engineer A change of contractor, architect or engineer must be done under a permit number. There is a $75.00 charge for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized signatures. If the signature of the previous contractor cannot be obtained the owner must send a certified letter/return receipt notifying the previous contractor, architect or engineer the reason for the change. The owner must allow 10 business days for the contractor, architect or engineer to respond. A permit application must accompany the change of contractor form, with the information and signature of the new contractor. The new contractor must be registered with the Village or must submit the required documents to register with the Village. 1. Change of Contractor form completed, signed and notarized. 2. Permit application by new contractor. 3. Required fees. 4. Copy of original letter sent via certified mail along with the returned receipt In addition to the requirements above the architect or engineer of record must authorized the new architect or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed. RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC 1816213 q 4- The The CLASS B AIR CONDITIONING CONTRACTOR f ' Ilk 6., Named below IS CERTIFIED '` u Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 ROJO, IAN 1 a•.' a BEL AIR SERVICES&AIR CONDITIONING INC 2700 NORTH 72ND AVENUE HOLLYWOOD FL 33024 •;• ISSUED: 10/21/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1 41 021 0000635 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 DBA; Receipt#:HEATING/AIRCONDITION CONTRACTR ype: Business Name:BEL AIR SERVICES & AIR Business T CONDITIONING INC (CLASS B AIRCONDITION CONTRACTR) Owner Name:IAN I ROJO Business Opened:05/21/2009 Business Location:2700 N 72 AVE State/County/Cert/Reg:CAC1816213 HOLLYWOOD Exemption Code: Business Phone: Rooms Seats Employees Machines Professionals 1 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee I NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 L).001 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A 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: IAN I ROJO Receipt #iCP-14-00023922 2700 N 72 AVE Paid 09/03/2015 27.00 HOLLYWOOD, FL 33024 2015 - 2016 CERTIFICATE OF LIABILITY r DATE(MMIDDfYYYY) _ _ _ __ _ LITY INSURANCE _ _ _ _ _ __ 08/10/15 THIS CERTIFICATE IS ISSUED ASA 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 A THE POLICIES i 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 certificate holder la an ADDITIONAL INSURED,the 11011CAles)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 conferrights to the certificate holder In lieu of such endorsement(s). t PRODUCER Accredited Insurance PHONE 6099 Hollywood Blvd (954)964-5444 (954)964-0772 insureyourhome®aci.com 1 - -- --- - Phone 33024 Hollywood, INSURERS)AFFORDING COVERAGE_ — Nalc (95454)964-5444 — FaX (954)964 0772— — INSURER A: MAXUM INDEMNITY INSURANCE — INSURED ------ — _ -- !- _ - -_ Bel Air Services$Air Conditioning,Inc INSURER B.- ILNSURER C—. - 2700 N 72nd Avenue INSURER D: — — — -- -- — — Hollywood,FL 33024 (954)895-1534 INSURER E: -- - - -- ---- - --- .-- — --- — --— INSURER F: ! COVERAGES _ _ _CERTIFICATE NUMBER:_ _ REVISION NUMBER:_ J 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. INSR — — — — - _TYPE OF INSURANCE — IWS LR i WVD I POLICY NUMBER i 1� ),I IMS )I - LIMITS GENERAL LIABILITY I T -- — EACH OCCURRENCE_ S 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED -— J LJ CLAIMS-MADE 0 LPREMISES OCCUR (Ea ocairrence)__ $ 100,000.00 I A ❑ -- — -- I n I BDG0089031-01 I O8/092015 08/09/2016 I MED EXP(Any one person) $ 1,000.00 PERSONAL S ADV INJURY I $ 1_,000_00_0.00_ ❑ - -- -- - I I I I GENERAL AGGREGATE S 2,000.000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG1 $ 1,000,000.00 POLICY ❑ PFrOT- ❑ LOC I I $ - --- -I i AUTOMOBILE LIABILITY INEEDiDSINGLE LIMITANY AUTO I $ ❑ ALL OWNED SCHEDULED I I I BODILY INJURY(Per person) ❑ AUTOS ❑ AUTOS BODILY INJURY(Per accident $— NON-OWNED Y DAMAGE 1 ❑1 HIRED AUTOS ii❑-- AUTOS I I LPROPERLeraccEdentl _$ UMBRELLA LIAR i OCCUR I EACH OCCURRENCE $ ❑ ❑ ❑ EXCESS UAB ❑CLAIMS-MADE j AGGREGATE - $ L- DED RETENTION$. _ ` WORKERS COMPENSATION ' -- - - - - --- Lk- AND $ — WC STATU- OTH- ; AND EMPLOYERS'LIABILITY Y/N I � ��TORY LIMITS. _ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A _ (Mandatory in NH) I ! I E.L DISEASE-EA EMPLOYEE S If yes describe under _— DESGRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) AIR CONDITIONING SERVICE,REPAIR,INSTALLATION,ETC. CERTIFICATE-HOLDER HOLDER CANCELLATION -- ------ -------- ----------- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE VILLAGE OF MIAMI SHORES THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 1 ORED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF 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 **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: 4/8/2015 EXPIRATION DATE: 4/7/2017 PERSON: ROJO IAN I FEIN: 202895759 BUSINESS NAME AND ADDRESS: BEL AIR SERVICES&AIR CONDITIONING INC 8310 NW 15TH CT PEMBROKE PINES FL 33024 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 certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the 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 and certificates of election to be exempt shall be 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 longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 ♦SNC.I G� BOB Miami shores Village Building Department �OR10050 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 The foregoing was acknowledge before me this day of ,20),( . By 1 j qC`l ��'/�f'�?1� _ who is personally known to me or has produced as identification. State 01 Florida %otatv public °M V-608n0 CIO Nota �R �� My�5��1121201 ,2r5,3 J?t'' SEAL: vaExW� Bel Air Services&Air Conditioning, Inc 2700 N.72 Ave Hollywood, Florida 33024 Lic#CAC-1816213 EPA Lic.#000216783 Date: November 9,2015 State of Florida County of Miami Dade Before me this day personally appeared Ian Rojo and Mario Rojo who, being duly sworn,depose and say: That they will be the only persons working on the project located at: 680 NE 97"'Street Miami Shores, Florida. Sworn to(or affirmed)and subscribed before me this It day of tits) 11 ,2015, by Personally know Or Produced Identification Type of Identification Produced � v REBEN Rojo * * MYCOM�,;;,,;4,w Ff 151242 F EXP►AE Print,Type or S ftoot" ary SNs Miami Shores Village Building Department .... o...� 10050 N.E.2nd Avenue Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet.Multiple units on single sheets are not acceptable. Job Address(where the work is being done: 680 NE 97 STREET MIAMI SHORES, FL City: Miami Shores village County: Miami Dade Zip Code: 33138 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO❑ ARHI Sheet Attached:YES ❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER a it AHU or PKG.UNIT MODEL# 5 1 o il/ COND.UNIT MODEL# / 4/ KW HEAT NOM TONS AHU CU PKG 1)M.C.A AHU CU PKG AHU CU PKG 2)M.O.P AHU CU PKG AHU CU PKG 3 VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER / YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): Z 3 4. Size Disconnecting Means: Contractor's Company Na n .(eh f� C� i 04 111 Phone: State Certificsy ate or Re i ra i • k,�� Certificate of Competency No. Signature Date: 08/06/2015 Iral es signature) (Revised02/24/2014) Miami Shores Village Building. Department s 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 1 AUG 17 2015 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20 iQ) BUILDING Master Permit No.RC 6 14 1383 PERMIT APPLICATION Sub Permit No.04 �l�_ �1 ❑BUILDING ❑ ELECTRIC ❑ ROOFING pVEVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ro—I MECHANICAL [:]PUBLICWORKS ® CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 680 NE 97 STREET MIAMI SHORE, FLORIDA 33138 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206-017-1610 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: NA BFE: FFE: OWNER:Name(Fee Simple Titleholder):ROBERT & ROSALIND FRAME Phone#: 305-302-1784 Address: 680 NE 97 STREET City: MIAMI SHORES State: FLORIDA zip: 33138 Tenant/Lessee Name: Phone#: Email. FRAME.ROSALIND@YAHOO.COM CONTRACTOR:Company Name: CITY CONNECTION AC REFRIGERATION INC Phone#: 305-380-7217 Address: 10304 SW 130TH CT City: MIAMI ,J zip: 33186 Qualifier Name: FELIX DE JESUS GUERRA Phone#: 305-380-7217 State Certification or Registration M CAC 1816558 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ YaO d a OV Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: INSTALLATION OF 1 NEW UNIT IN THE OFFICE CABANA AS PER PLANS Specify color of color thru miler Submittal Fee$ Permit Fee$ 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be approid and a reinspection fee will be charged. •ice Signature Signature OWNERr AGENT CON CTOR - The foregoing instrument was ac ledged before me this The forego! nn- ent was acknowledged before me this day of � 20 �by 06 AUGUST 2015 ,by o is personally known to FELIX DUS GUERRA o is personally known o me or who has produced— as me or who has produced as identification and who did oat identification and who did t e oath. NOTARY PUBLIC: NOT PUBLIC: Sign: Sign. Ph t:t: ON 4 Print Joanna M Feliciano :. Seal: My Commission FF 082753 Seal: _ : : MY C.OMMII33ION EE21Q246 �p�R O Expires 0 111 2/2018 E)PRE$Jum 23,2016 � f�elaueh ## APPROVED BYffi##ffiffi###ffi 91171 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) OR n ..,. ,....M Miami shores V Building Department IORIDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 MIAMI SHORES VILLAGE NOTICE TO BUILDING DEPARTMENT OF EMPLOYMENT AS SPECIAL INSPECTOR UNDER THE FLORIDA BUILDING CODE I (We) have been retained by r 4 go9Awt iw r P-4mE to perform special inspector services under the Florida Building Code at the & qE 4`1 Tk4 caT project on the below listed structures as of (date). I am a registered architect or professional engineer licensed in the State of Florida. •••• PROCESS NUMBERS: . . •Goes• *a•0:9 ❑ SPECIAL INSPECTOR FOR PILING,FBC 1822.1.20(R4404.6.1.20) • "•• • • ❑ SPECIAL INSPECTOR FOR TRUSSES>35'LONG OR 6'HIGH 2319.17.2.4.2(R4409.6.17.2.4.�;•• •• •••••• K SPECIAL INSPECTOR FOR REINFORCED MASONRY,FBC 2122.4(R4407.5.4) •••••• • • ❑ SPECIAL INSPECTOR FOR STEEL CONNECTIONS,FBC 2218.2(R4408.5.2) •••• • • :00••; SPECIAL INSPECTOR FOR SOIL COMPACTION,FBC 1820.3.1(R4404.4.3.1) •••..• ;"•" 60:9• ❑ SPECIAL INSPECTOR FOR PRECAST UNITS&ATTACHMENTS,FBC 1927.12(R4405.9.12}e.. •. �: •• ❑ SPECIAL INSPECTOR FOR .. .• •• • • • Note:Only the marked boxes apply. The following individual(s)employed by this firm or me are authorized representatives to perform inspection:••• • 1. 2. .. . 0 •••••• 3. 4. •• • *Special Inspectors utilizing authorized representatives shall insure the authorized representative is qualified by education or licensure to perform the duties assigned by the Special Inspector. The qualifications shall include licensure as a professional engineer or architect; graduation from an engineering education program in civil or structural engineering; graduation from an architectural education program;successful completion of the NCEES Fundamental Examination;or registration as building inspector or general contractor. I, (we)will notify Miami Shores Village Building Department of any changes regarding authorized personnel performing inspection services. I, (we) understand that a Special Inspector inspection log for each building must be displayed in a convenient location on the site for reference by the Miami Shores Village Building Department Inspector. All mandatory inspections, as required by the Florida Building Code,must be performed by the County.The Village building inspections must be called for on all mandatory inspections. Inspections performed by the Special Inspector hired by the Owner are in addition to the mandatory inspections performed by the Department. Further, upon completion of the work under each Building Permit I will submit to the Building Inspector at the time of final inspection the completed inspection log form and a sealed statement indicating that, to the best of my knowledge, belief and • professional judgment those portions of the project outlined above meet the intent of the Florida Building Code and are in substantial accordance with the approved plans. Engineer/Architect Name Wllr L- PP Address DATE: Phone No. Created on 6/10/2009