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MC-15-2220 N Per�xrit lltf) A � 2 ■ Miami Shores Village ?o -echanic t- eSidential 10050 N.E.2nd Avenue NE mark ttran:Addl#ontAltetfion Miami Shores, FL 33138-0000 f* j ��wi -rte Plwm�i pat #.APPROVED -- Phone: (305)795-2204 ,K 11# t�'t�S Expiration: 0212812016 Project Address Parcel Number Applicant 1291 NE 94 Street � � 1132050100101 BRADLEY YORK Miami Shores, FL Block: Lot: Owner Information Address Phone Cell BRADLEY YORK 1291 NE 94 ST MIAMI FL 33138-2946 Contractor(s) Phone Cell Phone Valuation: $ 550.00 ECO MECHANICAL CONTRACTOR IN (954)362-7508 Total Sq Feet: 00 Tons: Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved: : In Review Review Mechanical Date Denied: Type of Work:CONNECT BATH FAN TO EXISTING Underground �JE Scanning:4 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# MC-8-15-56906 DBPR Fee $2.25 09/01/2015 Credit Card $ 168.10 $0.00 DCA Fee $2.25 Education Surcharge $0.20 Permit Fee $150.00 Scanning Fee $12.00 Technology Fee $0.80 Total: $168.10 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 zo . Futherm a thorize t ed contractor to do the work stated. September 01, 2015 Authorized Si a re: ner / plicant Contractor / Agent ate Building Department Copy September 01,2015 1 Miami Shores Village Building Department AUG Yzo1s 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Y: Tel:(305)795-2204 Fax:(305)756-8972 _ INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 L J BUILDING Master Permit No� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION EXTENSION RENEWAL ❑PLUMBING 6MECHANICAL [:]PUBLICWORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /2 9 r At& 9 9 5 I R c,--L City: Miami Shores County: Miami Dade Zip: 1 3S_ Folio/Parcel#: I 1 32-o5 o j b— ©1 r Is the Building Historically Designated:Yes NO Occupancy Type:-5f-, " Construction Type: 435 Flood Zone: BFE�: 9' + FFE: OWNER: Name(Fee Simple Titleholder): 13/?A-6 VQ 2h- Phone#:I30JJQL,S-- q 7-Z3 Address: l' Z R ► /�l L, Q1{ ST/l4sjCT City: /� �}/9 i S �D/1L S State: / . Zip: 33/38 Tenant/Lessee Name: _ Phone#: r Email: b re L" y �L'�' f be /ISU u Al, , /I e CONTRACTOR:Company Name: r(__ + G'XNkr C.�r Phone#:��4�-2 a � �S �✓� Address: -��tJ .`�.,�"� �� ,5•� City: i�h( L State: T,Cf'1('' [k Zip: .!:�5` Qualifier Name: IP-6S ir,-ci(n .N1encicp-zrra Phone#:(Q>4) 'zr-4-C%CG1CA State Certification or Registration#: C NAL 12-5 C) Certificate of Competency#: DESIGNER:Architect/Engineer: fV ,4&=f-�_50 Phone#: Address: 65-// /JoV f &. F 3 b y City: - State: iL Zip: 333177 Value of Work for this Permit:$ S5-4p Square/Linear Footage of Work: Type of Work: ❑ Addition [9 Alteration 'J ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Ci�/l f /�/�T� f/'yV 3�D 'X! S i� Li �'�� `7 e �Z)O� � e�=-.:. Specify color of color thru tile: Submittal Fee$ Permit Fee$ _ D� 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 w . occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be preved and a reinspection fee will a charged. Signa Signature OWNER or NT CONTRACTOR The foregoing instrument was a owledg/before me this The foregoing instrument was acknowledged before me this day of I�JA� A- 20 by �day of IA—t&420 by . who is personally known to La� !s' KER YJA DEOSI n known to G 11 Rip y GGIN "I Rip me or who has produced �-- U%��2/ �C�'n �C�i as me or who has* EXPIRES:Ja ary28, 18 as 9"eOF FLS identification and who did take an oath. identification ig th. ,r NOTARY PUBLIC: NOTARY BLIC: � Sign: 5_5 ` II,, Sign: Print: - r`� Print: cl ( Q =�p�'" ' ;•� TE ESA NUNEZ-APONTE Seal: • Notary Public-State of Florida Seal: �.: :N =My Comm.Expires Jan 26,2018 Commission#FF 086355 0 APPROVED BY IPIs Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,SNoREs y Miami Shores Village Building Department .... .,...� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 �ORtDp' 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): 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 AHU or PKG. UNIT MODEL# COND. UNIT MODEL# 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): 4. Size Disconnecting Means: �l Q_ Contractor's Company N. e: T—t7 1 � It , [Phone:q�V � q 1 ` )2 State Certificate or Registratio / / / 8 Certificate of Competency No. Signature Date: , alit a nat e) (Revised 02/24/2014) 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#:183-265027 Business Name:ECO MECHANICAL CONTRACTOR INC HEATING/AIRCONDITION CONTRACTI Business Type:(MECHANICAL CONTRACTOR) Owner Name:EDUARDO JCSF MENDOZA Business Opened:1 o/13/2 C 14 Business Location:5891 SW 21ST ST State/County/Cert/Reg:CMC 1250116 Business Phone:WEST PARK Exemption Code: Rooms Seats Employees Machines Professionals 4 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 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: ECO MECHANICAL CONTRACTOR INC Receipt #03B-14-00000182 5891 SW 21ST ST WEST PARK, FL 33023 Paid 10/13/2014 27.00 2014 - 2015 RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD . ti CMC 1250116 le MECHANICAL CONTRACTOR 3med below IS CERTIFIED ider the provisions of Chapter 489 FS. cpiration date: AUG 31, 2016 MENDOZA, EDUARDO JOSE a a ECO MECHANICAL CONTRACTOR INC. 5891 SW 21ST ST WEST PARK FL 33023 ■ ISSUED: 06/29/2014 DISPLAY AS REQUIRED BY LAW SEQ a L1405290001649 A�i 07//299/2015 CERTIFICATE OF LIABILITY INSURANCE °�� M /2015' 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 policy(ies) 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 lieu of such endorsement(s). PRODUCER NAME CT AJ Singh American Security Insurance,Inc. AHONNo E : 954967-0000 ac No: 9`'4-967-0202 6231 Pembroke Road E-MAIL amencansecurity@bellsouth.net INSURERS AFFORDING COVERAGE NAIC# Hollywood FL 33023 INSURER A: ATLANTIC INS CO INSURED INSURER B: EVANSTON INS CO ECO MECHANICAL INSURER C: AMTRUST NORTH AMERICAN 7958 PINES BLVD 134 INSURER D: ASCENDANT INS CO INSURER E; PEMBROKE PINES FL 33024 INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSRTYPE OF INSURANCE A POLICY NUMBER M DCY EFF MlWDPOLICY EXP LTR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE XCOMMERCIAL GENERAL LIABILITY PREMISES EaEoccurrence $ 1�� CLAIMS-MADE ®OCCUR MED EXP(Any one person) $ 5,000 A L017001091 07/28/2015 07/26/2016 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 1,000,000 1-1 POLICY PRO-JECT –1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ 25,000 D ALL OWNED SCHEDULED 141074 08/29/2015 08/28/2016 BODILY INJURY(Per accident) $ 50,000 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ 25,000 HIRED AUTOS AUTOS Per accident PIP 10,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS UAB CLAIMS-MADE XOVA833614 07/28/2015 07/28/2016 AGGREGATE $ 5,000,000 DED I I RETENTION$ TATUTH $ WORKERS COMPENSATION WC SIIIIT ER AND EMPLOYERS•LIABILITY T R IMIT R C ANY OFFICER/MEMBEREXCLUDEED?ECUTIVE Y❑ N/A AWC1045152 04/23/2015 04/23/2016 E.L EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) cmcl250116 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 10050 N.E. Avenue, Miami Shores, Florida 33138 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 'M 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: Business Name:ECO MECHANICAL CONTRACTOR INC Receipt#:183-265027 HEATING/AIRCONDITION CONTRACT Owner Name:EDU Business Type: (MECHANICAL CONTRACTOR) ME ,NDOzA Business Location: S89ARDO1 SW JOsE 21ST ST Business Opened:10/13/2014 WEST PARK State/County/Cert/Reg:CMC1250116 Business Phone: Exemption Code: Rooms Seats Employees Machines Professionals Number of machines. For Vending Business Only Tax AmountVending Type-, Transfer Fee NSF Fee 27.00 Penalty Prior Years ---------- 0.00 0.00 Cost Total Paid 0.00 0.00 00 27.1 II 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 lannin WHEN VALIDATED and zoning requirements.This Business Tax Receipt must be transferrePd wheng 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: ECO MECHANICAL CONTRACTOR INC 5891 SW 21ST ST Receipt #WWW-14-00133369 WEST PARK, FL 33023 Paid 09/30/2015 27.00 RICK SCOTT GOVERNOR KEN LAWSON,SECRETAR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUS-TRY LICENSING BOARD A The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date:- AUG 31, 2016 MENDOZA, EDUARDO JO1,A,5V,, *OR A% ECO MECHANICAL CO, ;!OR INC. 5891 SW 21 ST ST WEST PARK FL 33023 N '§C�s -slain S CA V�1 �i4UfiZ Q41649