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RC-14-2550 (2) RECEIVED Miami Shores Village Nnv 25 20% Building Department 13Y: D�t: �O 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 fel:(305)795-2204 Fax:(305)756-8972 INSPECTION LIME PHONE NUMBER:(305)762-4949 FBC 20►kD BUILDING Master Permit No. RC K4—g;?5S 0 PERMIT APPLICATION Sub Permit No. Mcm-2 5579 F-JBUILDING M ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ]PLUMBING 4MECHANICAL (PUBLIC WORKS M CHANGE OF ❑CANCELLATION ❑SHOP �y�av CONTRACTOR DRAWINGS JOB ADDRESS: V N c City: @MiamiShores bozo ��County: Miami Dade Zip: Folio/Pani#: �l- �rclp '®l�" bozo Is the Building Historically Debated:Yes NO Occupancy Type: Lodd: Construction Type: FI BFE: !�FFE:oi�iy OWNER:Name(Fee Simple Titleholder): ne#: � l.' S21 Address: City: $_ State: Zip: Tenant/Lessee Name: hone#: Email: ' ^^ CONTRACTOR:Company Name: 1°'t L %z /Phone#-. Address: LEAK- 2k City: State: fi Zip: s3d39 Qualifier Name: 2 Phone#: State Certification or Registration#: QAV- ��JE-� (� CLificate Co' petency#: DESIGNER:Architect/Engineer: Phone#: Address: CState: Zip: Value of Work for this Permit: Square/Linear Footage of Work:"' a Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: 6 l rl cA-L- IA�X-fc- 6y(— I Specify color of color thm tile: Submittal Fee$ Permit Fee$ LtO F60 CCF$ CO/CC$ Senning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ C� iawi%Pdmi24»a141 Bonding Coy Wy s Nam IN ) Bonding Company's Address City State Zip Mortgage tender'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 nas 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. i "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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person ,whose property is subjett to attachment Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not approved and a reinspection fee will be charged. Signature Signature \\ OWNER or AGENT CONTRACTOR The foregoing Instrumentwas acknowledged before me this The foregoing Instrument was acknowledged before Mme this day of l VQV [Jc(, .20 �'� .by day of l�`Q �C— .20 _ "I ,by CSP_ �"1JQL�2a(1 ,who is personally known to SRr1('! e?- .who is rsonally known o me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: 5i Print• Print�� l ►M•��a� �� Seal: Seal: R BBCA M.PASTRANA REBECA M.PASIRANA My COMMISSION 0 U87MA MY COMMISSION 9 EB872624 EXPIRES:Famaamy07.2017 ,� EXpMES:Fdxumy07,2017 ******** *************************** ********************* APPROVED BY Clans Examiner Zoning Structural Review Clerk (RevL%ed02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (950)487-1395 1940 NORTH MONROE:STREET TALLAHASSEE FL 32399-0783 SANCHEZ,SERGIO ENRIQUE ALL Alfa SOLUTIONS INC 1101 NE 191 STREET,#40$ MIAMI FL 33179-2523 Congrz I > thisbecome million FWdiwm by XDte.ct#th+� sriy of Business and Professional Regulation. Our prokmmionals and businesses range ST`AT'E.OF.FLORIDA from er llfes s fio yacht bfo6cers,from boxers to bartmpue restaurants, DEPAI�TIi ENT'3 BUSINESS AND and they keep Fbrida`s economy strong. PROFESEtfl4� �E�UtAT ION Every day we work to improve the gray we do business in order to CAC-1815113 I� fJIrD ;aD810 0 44 serve you utter. For WAxtrratioa kbout ourservices,please W9 onto www.myttorklelicenae eom. 'There you can find more information CERTIFIED AIR Ci3R�t ONTR about our divisions and uiatians that knpac�you,subscribe SAPICHEZ,SERGIO-* �ilQt3E to newelettmd and learn rause about the Departments ALL�ilR L6,�'Y'�t�NS INC initiatnres. Our mission at the Uepartrnent is:License Efficiently,Regulate Faidy. _. We constantly a to sure you better So-that you can serve your custorners. you Wdoing business In i=WWa, IS CERTIFIED a+s�id!�t tfie,pr6v..stca%0 C 3 489 FS. and congratulatl+ons on your new Ikcenssi DETACH HERE RICK SC011GOVERNOR KEIT LAWSON,SECRETARY STATE OF.FLORIDA DEPARTIBENT bF BUSINESS AND PROFESSIONAL REGULATION C ►PTRiJCfION:lNOtlST�tY LICEIMR:B4ARD S kuKX y d SI The.CLAASSAAIR,CONf3#T#ONING CC I`d . CTOR Namacf bel6w ISCERTIFIED Moder t j}TD A"'i 1s f-G ter. "FS, d�app Exp{ra6on dafrcU :3'f ..2:18 f LB SANCHEZ;SERGIO ENR#CUE ° ALLAI t SOLUTIONS INO` 11 t11.fi#E'I91 S"I REQ;#,4x: FL' 17 ';' *SUED: OSM302014 DISPLAY AS REQUIRED BY LAIN SEQ L140sooOxl 7 W4M jwg6.l.* ec � •' am1d� C®t�rrgt oFl . as i+ r' �u 'Pkv ass NJ►tiAr'�t4i«oCATi�i' a�rea►r ago :: :� ���5 AL sO ,nn s �`���R '1615 Y � ovt►aa r :::. SEC.TV"os e ALL.Alk OUrrK*S 196 sped'' CfiAfV1CAL Gt)I�fTRA R 8Y TAX COURCTOR 1No* s) 1AC181s11$ $75.00 07J29/2014 CREDffCAPD-14--0313549 .L Y�af •' �t�eLac� Yea.7fm �aeli+s ,. a tens iA t l lett... Code ftoOR-= x�t , ATE AICCO O® CERTIFICATE OF LIABILITY INSURANCE 11/19 DD014 k,,,,,,,�- 11/19/2014 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 terns 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 CONTAC Alexander DOpazo DOpazo 5 Associates Inc PHONE (305)470-8500 FAX (866)647-9673 8725 NN 18th Terr Ste 300 'MAS :alex@dopazo.com INSURER(S) AFFORDING COVERAGE NAIC# Miami FL 33172 INSURERAWesCO Insurance Company 5011 INSURED iNguRERB.-Progressive Express Ins Co 10193 All Air Solutions Inc INsuRERcMount Vernon Fire Insurance Co 26522 1101 NE 191 Street #408 INSURER p Business First Insurance Co. 1697 INSURER E: Miami FL 33179 INSURER F: COVERAGES CERTIFICATE NUMBER;CL1492608208 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. INSR TYPE OF INSURANCE POLICY NUMBER ADDPOLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RERTIM X COMMERCIAL GENERAL LIABILITY a PREMISES o c,• $ 100,000 A CLAIMS-MADE aOCCUR P1144762-00 /27/2014 /27/2015 MED EXP(Any one person) $ 5,000 ' PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE UMIT APPLIES PER: I PRODUCTS-COMP/OP AGG 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED S NGLE LIMIT(Ea accident) 11000,000 B X ANY AUTO BODILY INJURY(Per parson) AALOWNED ASC LED 2132056-1 /27/2014 /27/2015 BODILY INJURY�accident) $ OS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per a PIP-Basic $ 10,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 `. X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED I RETENTION 118239C /27/2014 /27/2015 $ D wORIMN COMPENSATION X WC snw, OTH AND EMPLOYERS'LIABILITY 71 ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBEREXCLUDED? NIA 521-04444 /23/2014 /23/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If y�describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) Air conditioning sales, intallation and repair. HVAC Contractor License# CAC1815118 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10052 NE 2 Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE M Dopazo CPIA/MAD � '"" �' � � ACORD 25(2010/05) ©1988-201 O ACORD CORPORATION. All rights reserved. INS025(9n1awn1 The Ar:nR11 name anti lnnn am rnn(etararl marls of Af`npn