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MC-15-2617
Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 Phone: (305)795-2204 vMIVZ I W-1 Expiration: 04118/2016 Project 8/2016Project Address Parcel Number Applicant 9020 BISCAYNE Boulevard 1132060110120 WAL MIAMI LLC Miami Shores, Fl- Block: Lot: Owner Information Address Phone cell WAL MIAMI LLC 275 MADISON Avenue NEW YORK NY 10016- 275 MADISON Avenue NEW YORK NY10016- Contractor(s) Phone Coll Phone Valuation: $ 1,200.00 DYNAMIC HEATING&COOLING (813)928-3646 (813)928-6898 Total Sq Feet: 0 Tons: Available Inspections: Additional Info:DUCT WORK Inspection Type. Classification:Commercial Ventilation Approved:In Review Final Comments: Date Approved::In Review Rough Date Denied: Type of Work: Rough Duct Scanning:I Duct Detector Test Review Mechanical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# MC-10-15-57431 DBPR Fee $2.25 10/15=15 Credit Card $50.00 $110.70 DCA Fee $2.25 Education Surcharge $0.40 10121=15 Credit Card $110.70 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 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 employee. 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 zoni khermore,I authorize the above-na�contractor to do the work stated. October 21,2015 Authorized Signature:Owner / Applicant Contractor / Agent Date Building Department Copy October 21,2015 1 ( Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-245763 Permit Number: MC-10-15-2617 Scheduled Inspection Date:April 20,2016 Permit Type: Mechanical -Commercial Inspector: Perez,JanPierre Inspection Type: Final Owner. HERMELEE,BRUCE Work Classification: Addition/Alteration Job Address:9020 BISCAYNE Boulevard Miami Shores,FL Phone Number Parcel Number 1132060110120 Project <NONE> Contractor. DYNAMIC HEATING&COOLING Phone: (813)928-3646 Building Department Comments DUCTWORK Infractio Passed Comments INSPECTOR COMMENTS False " V Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 19,2016 For Inspections please call: (305)762-4949 Page 4 of 46 T Y -� Miami Shores Villages BuildingDepartment o pCT sz015 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 BBY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 �j---- FBC 20 t� BUILDING Master Permit No.CC 151092 PERMIT APPLICATION Sub Permit No. MUS- -2.019 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ]PLUMBING Q MECHANICAL PUBLIC WORKS Ej CHANGE OF F-1 CANCELLATION E-1 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9020 Biscayne Blvd. City: Miami Shores County Miami Dade Zip: Folio/Parcel#:11-3206-011-0120 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FE {FFFE: OWNS:Name(Fee Simple Titleholder):Wal Miami LLC Phone#: 2- T_( cQ —O©Y 1/ Address.Mb Madison Ave 30th Floor City: New York state: NY Zip: 10016 Tenant/Lessee Name: Walgreens Co Phone#: Email: r CONTRACTOR:Company Name: Dynamic Heating & Cooling Phone#: '3(0 IAP Address: k2,A(Q /,J• lf!-a Cl4kE FAjf/U /QOAQ City: Lutz state: FL Zip: 33548 Qualifier Name: Darwin Encarnacion Phone#(8`1.? 9a8-cp�q� State Certification or Registration#: CAC 1813228 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ aim- 11 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �i?S�/¢C S J 12 1/(x/4 Specify color ,o�f{color thru tile: Submittal Fee$ `7y `CX� 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$ 6 (Revised02/24/2014) f r 1 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$2500, the applicant must promise in good fblth that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. t44 i)Jvtj ii+eG t Signature 4wf Signature OWNER or AGEOVPM CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of r)a0l6f— ,20 by ;-?Y day of 20 by !0CX -Fom ,who is personally known to rt/1 2!'1CQYi%101LII1/1 ,who ^^is��personally known to me or who has produced as me or who has produced t ayjd0..J W1W.NS 1ek—as identification and who did take an oath. identification d who did take an oath. NOTARY PUBLIC: NOTARY U IC: Sign'" Si : tea, Print: g pq�" Print 0 x> ey a o` 1 uaa G{i r rs'i^d14 Seal: NO. 4"70759? Seal: NASSAU :ffia ANNE DEL DONNO l CAU COU'iVTYNotary Public-State of Florida `OEXPIRES APRIL 39 2 ( ( ;f � My Comm.Expires Mar 7,2017 w�x*�k�x�sa�ww*ssr��xxeaa�**�*�`ax�aats+��+�xs*sxr �axxs*s*xe�taa*��x s3F$A� �*a+� fix* xs*�aasxw* APPROVED BY W Plan~s Examiner Zoning Ns Structural Review Clerk (Revised02/24/2014) �« MIN Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. V/ COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. `1 COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW Certificate Hold: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: }-r%Lx i coot_w& BUSINESS ADDRESS:r ,. _t-J. �V-i z C N U7 STATE Ft_ ZIP33_5�0 BUSINESS PHONE: 9a9-8 q(q(0 FAX NUMBER( 13 }`q9- 7-cq f CELL PHONE gi 113--a-IM f QUALIFIER'S NAME:_ -AL-J) J �,uc.�t2ns19 �tom QUALIFIER'S LIC NUMBER:, e /ri 3 a f RICK SCOTT GOVERNOR KEN LAWSON,SECRETARY ME • ••ty�<�:- •, •tip.• .a•ts, � • "dr ..qty ' -�'a. _ •�.�, � �r��@ ISSUED: 07/16M14 DISPLAY AS REQUIRED BY LAW SE0# L14071600W977 ACCOUNTwo. 2015 -2016 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES SEPTEMBER 30,2o16 [211355 OCC.CODE 1 ENEWAL 090.001000 Contractor Receipt Fee 18.00 Hazardous Waste Surcharge 40.00 Law UUary Fee D.00 CACIS13228 BUSINESS ENCARNACION DARWIN A 19239 N DALE MABRY HWY 321 LUTZ,FL 33548 201' 15m2016 NAME ENCARNACION DARWIN A MAILING DYNAMIC HEATING&COOLING INC ADDRESS 19239 N DALE MABRY HWY#321 Paid 14-625-068680 LUTZ FL 33548 07/10/2015 58.00 BUSINESS TAX RECEIPT 1)OW BELDEN,TAX COLLECTOR 04 813.83CEIPD nes t�coe�s a rax teacaPr WHEN VALIDATED. CERTIFICATE OF LIABILITY INSURANCE ,m16rm,6 THIS CERTIFICATE W NWED AS A MATTER OF WORNIATION ONLY AND CONFERS NO ROM UPON THE CERT TE HOLDEMTHW CERTIFICATE DOES NOT AFFWMATNMY OR NEGATIVELY AN(END,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 181KIING INSURER1816 AUTHORIZED RM ENTATIIIE OR PRODUCER,AND THE ATE Ham. nrmtbe enilorso& S is tl<elumand conditions of the policy,Certain pokes nsy r mpft an<endasemeaL AabdomentonftbmWicubdownatoodwfWftfadw ceRvica/e holder In on of etch Laz m MenNuadea Eagle Aawican Insurance Agency,U.C. IM gaTV-7844M , 3106 Tomp Rd 211&M un -0 llowdlp m I In OWSOW,FL 34877 Co oynlaatic HeaWeg&Cooling.Ino. 2101001RIC: 226 W Lute LaM Fern Road Lutz FL 3354 100001011111, 0OVERAQ8 tRITTIFICATE REVISION THIS 0 TO CERTIFY THATTH E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN WJED TOTHE E NAMEDABOVE FORTHO POLICY PERIOD INDICATED.NO WnWANDINGANYREQUIREMENT,I ORCONDMONOFANYON TRACTOR OTHER DOCxJMUWITHREWECTTOWHO!THIS CERTIFICATE MAY BE*1SSUED Oft WAY PERTAIN.THEMOURAICE AFFORDED SY THE POLICIES DESCRIBEDHEREINO f'f O ALL THE TERMS, EXCLUSIONS AND COMMONS OF S"POLICIES.LIMITS SHOWN MAY HAVE ill REDUCED BY PAID CLAIMS. is TvpsOpv4URm= Pommumm Am AM Lam cum.UAeaarr al860 00 A X c.mr a 1 � X OCCUR Y VBA415M lona IS 1WIW16 m temr P9rt $ AUTO B UAULM AWAUTO SCOLYQLR9LYowpwm* 8 �ovwm .Yff"wfRmaod11 Q!$ FRDAUTOS ALROg $ UMM8 aU uas oto 1 IS x XBS0066422 10MOMS 10MOMS AWMWM1 WtERSCOMpemimA 1• ANDBMPi.0YER8'LUIBIUTY NIA t�xexAe taWa s I T—=Of OPMTlOM9/LOftWC 1S/Yl§aC[=tAgmhA0Mm1.Adm Ste.Nmaeapmala $upply►and MstsH all HVAC r<mOwlels,oqukmvm%provide testlng mul de0rery►equ4nnaed per Plans and specKlostiom Darwin Enaamacion OCAC1813228 CERTIFICATE HOLDER CANCELLATION Mhrcni stNuea Verge end DepreAnOrd SHOULD THE tl»'�DA TIS. warms ee 10060 NA tad Ave ACCOROANCEW11 TIE pOLICY Miami Shores,FL 33136 lAVTHORMW 11ADONrTATNa —gq,*o- , 0 19884WWACORD CORPORATION. All ruts ACORD 2-:'MW" The ACORD and logo are n gistu+ed nuft of ACORD �'►C o® CERTIFICATE OF LIABILITY INSURANCE DATE" ' 011/ 12015 THIS CERTIFICATE IS ISSUED AS A MUTTER 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 ceriffleste holder is an ADDITIONAL INSURED,the poi (les)must be endorsed.If SU13ROGATI N IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endomement.A statement on this certificate does not corder rights to the certificate holder In lien of such endorsement(s). PRODUCER CORY= NAME: Automatic Data Processing Insurance Agency,Inc. WLEtIc No 1 Adp Boulevard Roseland,NJ 07068 DNSU AFFORDING COVERAGE NAICS naNlRERA: Technology Insurance Company,Inc. 42VS edM1RED INSURER 8: DYNAMIC HEATING S COOLING INC INSURERC: 226 W Lutz Lake Fern Rd.Ste 32 Lutz,FL 33648 INSURER D: INSURER E: DIMIRER F: COVERAGES CERTIFICATE NUMBER: 31 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. ow POLICY LTR TYPE OF INSURANCE POLICY NSR Lam COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADED OCCUR PREMISES Es ooaarerwe $ MED EXP("one person) $ PERSONAL&ADVINJURY S GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑M [71 LOC PRODUCTS-COMPIOPAGG $ OTHER: $ AUTOMOBILE LIABILITYW.M.W..5". NGLE $ ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS D SCHEDULED BODILY INJURY(Perms $ HIREDAUTOS AUTOS $ $ UMBRELLA LIA9 OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS41ADE AGGREGATE $ DED I I RETENTION$ $ 10 COMPEN8A710111 I ER AND EMPLOYERS'LIABILITY Y/N x STATUTE ER ANY PROPRIETOWARTNERIfiXECUTIVEEL EACH ACCIDENT $ 1,00%000 A OFFICERIMEMBEREXCLUDED? ®NIA N 1WC3491861 08/2312015 X16 p knddowy yes, in lEL DISEASE-EA EMPLo $ 1,000,000DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT $ 11000,000 OPTION OF OPERA79M I LOCA11MI VEHNLES(ACORD 101,Additional Reauokw Schedule,may be easched B rtewespe-M requioed) Job Reference:Supply and install all HVAC materials,equipment,provide besting and delivery equipment per plans and specifications. Contractor License:CAC61813228 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 Building Deportment ACCORDANCE WITH THE POLICY PROVISIONS. 10060 NAL 2nd Avenue Miami Shores,FL 33138 AUTHO161W REPRESENTATIVE 1 --A ®1988-2014 ACORD CORPORATION.All rights rGserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD