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BC-14-1428 � 4 Miami Shores Village r Building Department JUL 02 2014 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2WO BUILDING Master Permit No.Ai jy-6 PERMIT APPLICATION Sub Permit No.lie PIZ- SY_� ❑BUILDING F-1 ELECTRIC ROOFING REVISION EXTENSION ❑RENEWAL ❑PLUMBING UATECHANICAL ❑PUBLICWORKS ❑ CHANGE ❑CANCELLATION ❑ SHOP 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 Titleholder): CPhone#:Ighs `I CA Addr ss City: ,Uad0699 State Zip: Tenant/Lessee Name: Phone#: Email: //�� /'' jj�� /� �• CONTRACTOR:Company Name:yz4ex�� N/��i/% �&_ -�hone#: Address: City: State: Zip: Qualifier Name:��T,l D C—V2� �91�r g Phone#:3c>y-Rds-J State Certification or Registration#<ACO S-2-2®�, Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$�_ 00. 15C� Square/Unear0ootage of Work: Type of Work: •tiQ� Alteration El New F-1 Repair/Replace ❑Demolition Description of ork: G J• Specify color of color thru tile: /� Submittal Fee$1• V • Permit Fee$ (8z. V0 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ ��h• �� i d - , 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 absence of such posted notice,the inspection will not be approved and a reinspection fee ill be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged �before �m(e�thiJ-3 The foregoi instrument was acknowledged before rn this day of .20I ,by �..Q-/f-1�4 day of 20 by who is personally known to me or who has produced who is personally known to me or who has produce S As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign. °c`da Sign' e Print: to P �+ 25� Prin Ni7Ex N ; . N° ° mmep 24:2017 My Commissi E �,y �+ss+0 My � ommF 024124al Notary Assn. ••'•sr4)E pF F,� '''�ll lllll >1111t>11Ijt 7�11(I1�t 7�1*7k*�*>jt* 1[17(1 711 7k��*Ik>k>k**>k>Kf(t>11�1 );s APPROVED BY Examiner Zoning Structural Review Clerk Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) r ' t .. Miami Shores Village "--- MV" Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 To/. (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):=� 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 ARI(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 Contractor's Company Name: ,�/ I Phone� State Certificate or Registration Na�'O_�OY Certificate of Competency N. Signature Date: (Qua/ s signature only) ATLANTIC AIR CONDITIONING & REFRIGARATION LIC.CAC057704 10670 N.W.123 STREET ROAD MEDLEY,FL 33178 PH.786-985-36376 acsolutionsery@hotmail.com CONTRACT REF:571112 CUSTUMER:Dede Cohen JOB:571 NW 112 Street DATE:01/15/2014 Miami Shores,Florida ITEM DESCRIPTION AMOUNT 1. Base on all Specification shown in Joaquin Aguirre,Architectural plans,pages M.We Are please to propose the work to be preform at the property 571 NW 112 Street. Replace Duct Supplies Lines and Returns as Specify in plans. $5,200.00 ATIROVED TOTAL $5,200.00 Acceptance of proposal:The above prices,specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified in plans.This agreement is between Atlantic Air Conditioning& Refrigeration and the CUSTOMER whose name and address are first written above.I understand and agree to the terms and conditions of this agreement including those on the reverse side. CUSTOMER SIGNATU -'�e �&— DATE: /��L/ .__................ ..--....... -- __.......... - _.....___ RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC057704 The CLASS AAIR CONDITIONING CONTRACTOR,` Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 Z S� w GONZALEZ,GREGORIO ATLANTIC AIR COND&F, - 1067t).NW 12 STREET ..AI, � BAY 101 , MEDLEY ms's-'� � �` � ��`" a � '•JON1 ISSUED: 07/03/2014 DISPLAY AS REQUIRED BY LAW �. SECI# L1407030000724 W1174 Local Business Tex Recellpt Miami—Dade Count* State of Florida THIS IS NOTWOILL — 00 NOTPAY 1476704 Btrsma"N^m"ock-n" RECEWr No. E C�IRFS atwmcat�coNomt�n�uv ItEr + anoN JIF SEPTEMBER 30, 2 '15 10670 NIN 123 ST RD 101 1418704 Must be displayed at place of busing" MEDLEY FL 33178 Nituant to County Code Chapter SA-Art;9&10 OWNER SEC.TY09 OR BUSINESS FLA AIR GOND&REFRIGERATION INC 196 SPEC MECHANICAL CONMCTOR PAYMENT RECEIVED BY TAX COLLECTOR CAC057704 Worker(s) 10 $45.00 07/28/2014 CHECK21-14-036882 This�Ca1 Business Tax Rett onlp 0006mrs patrma�n of dn►Local Business Tax Tha Recaipt is not a Rcems, p or a certiRcefiou of the holder's quali6cati ls,to do busiaess Holder tnlSt complirrVidl am governmental or aolgfavernmeldat teglllatory laws aml requireai whicb a�pLy to tl�e,bl The RECEIPT N0.above m tllo displayed atl ilro J fade Code See 8a.M. Formore information.vis(t `mow°;;�' FLOUIR-02 SSIMEON CERTIFICATE OF LIABILITY INSURANCE 1/27/2015 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(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 lieu of such endomme s. PRODUCER CONTACT Collinsworth,Alter,Fowler 8 French,LLC PHONE 305 822-7800 FAX 8000 Governors Square Blvd W. ( A� N91:(305)362-2443 Suite 301 aooREss: Miami Lakes,FL 33016 INSURER(S)AFFORDING COVERAGE NAIL 0 INSURER A:Scottsdale Insurance Company 141297 INSURED INSURER B:Business First Ins Co 11697 Florida Air Conditioning 8 Refrigeration,Inc.DBA:AtiarMtic AIC 8 Refrigeration INSURER C: 10670 NW 123 St Rd INSURER D: Bay 101 8102 INSURER E Medley,FL 33178 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. NOTWTHSTANDING 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. Iim NSR TYPE OF INSURANCE men POLICY NUMBER LIMITS A X COMMERmAL GENERAL WAsarry EACH OCCURRENCE $ 1,000, j CLAIMS40ADE I -- OCCUR ICPS2134955 01IMO15 01/04/2016 LIPMRIW TU PREMISES Meoccurrence) $ 50. MED EXP(Any one person) is 510 !— I PERSONAL&ADV INJURY $ 1,0W,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY u JEC LOC I PRODUCTS-COMPIOP AGG S 1 r000, OTH • $ AUTOMMOBILE LIABILITY $ ANY AUTO BODILY INJURY(Pm person) $ ALL OY&ED SCHEDULED IAUTOS AUTOS I BODILY INJURY(Pet eft) $ HHIRED AUTOS NON-OWNED Oi � DAMAG• $ I $ UMBREILJt LUQ OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIM.-MADE I AGGREGATE $ DED RETENTION III $ MFORKER.9 COMAEMI8ATION L. AND EMPLOYERS'LIABILITY YIN X STAT ER B ANY PROPRIETORIPARTNERFXECUTIVE 19136200 12/29/2014 12/29/2015 E.L.EACH ACCIDENT $ bOAr OFFICERI MEMSER EXCLUDED? ® N I A (Mandatory In NH) E.L DISEASE-EA EMPLOYE $ SOD, DESCR OF OPERATIONS below E.L.DISEASE-POLICY LIAR $ 60Or I i i j I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addillonal Remarks Schedule.may be aid N more apace Is required) Gregorio Gonzalez CACOF"04 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 N.E.2 Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ®1988-2014 ACORD CORPORATION. Ail rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD _ — RICK SCOTT,GOVERNOR - �Z (2�C `q_ q 2 j ` t 4— ((t31KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC057704 The CLASS AAIR CONDITIONING CONTRACT• -.' .w;, "- Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 GONZALEZ,GREGORIO , � LL • ATLANTIC AIR COND,&' k, 10670 NW 123 ST 1 BAY 101 yp MEDLEY FL ISSUED: 07/03/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407030000724 0004M i 011 =T1 N0'r MN tlT PAY ,L N4. toi�nlTI�NIctclArlf,>� Ilial. SM 'l3©, 20'I WO NW 123 ST RD 101 1478704 Must be diWayed at plow of business A 1.>w1'FL30178 Pw$uant to County Code Ompter&A-Art.9&10 OWNER- SEC.TYPE OF B:USIAHt". PAYMENT RECEIV® FlA AMID&REFRIGEMMON INC 196 SPEC MECHANICAL C#31VnAcroR BY TAX COLLECTOR W3 10 CAC057704 $45.00 07/20/2015 CHECK21-15-099372 This BusI TaXReceipt o*ocaiinns p tkf$te:LcNlnl Btaiaess Tax The Receipt is not a license, p ppa certificadataf the hour ualiii di► Holder mus; rh any govemmeMal ar:ti4e$ ammeattegulatory Iaaregninanteatewhltlhaptothe bum The BkC6PT N0.abo�re must be d t ed on all odmmercial vehicles-M"ff40ik Sec 8e-276. For stere iniomiation,vlaftwwwiniamida