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RC-24-1624 '0 0 ami Shores Village Ilding Department DEC 01 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ' Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2010 BUILDING Master Permit No.fkG ~I -').L1 PERMIT APPLICATION Sub Permit No. MO—1 `E— k ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 103 City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE��:O° 1 16 OWNER:Name(Fee Simple Titleholder): Phone#: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Pte. - p Phone#: Address: 189'q0 N W t'�' C + City /Yl q civ.- State: t ��Ziip: Qualifier Name: �1 41 S," a 4 Phone#W_7(l�L2(..3 / State Certification or Registration#: 0 1 Sr 7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ 'Re it/Replace ❑ Demolition Description of Work: v� ( U� P OA Specify color of color#hru# h P re., Submittal Fee$ Permit Fee$ �' CCF$ CO/CC;$w Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (ReviSed02/24/2014) e � s Bonding Company's Name(if applicable) Kr Bonding Company's Address v s City State Zip P ... 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 approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this t" day of � ,20 LS .by 1,10day of 20 t ,by who is personally known to P&A.L, g^Ari.l, ,who is personally known to® 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: Sign: Print: Print: 6'r Seal: muffulmy Het Seal: �`� : #FF125227 #1F128227 " 8 WM..Mrj 21, 2018 0WM k* 21, 2018 �'� .`��r WYr1A AARONNYARY.COM APPROVED BY V Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) s Miami Shores Village Building Department ■.,■ ,�,. 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): 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: Contractor's Company Name: Phone: State Certificate or Registration No. Certificate of Competency No. Signature Date: (Qualifier's signature) (Revised02/24/2014) Ong Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - 00 NOTPAY 721747 JL�_ T BUSINESS NAUSAAMATibN itSCBJPT No. ExP SOUTHEAST AIR CONDITIONING INC RENEWIRES AL SEPTEMBER R 30, 2®1E 13840 NW 6 CT 7�1?4;0 be gas NORTH MIAN€L 33168 played at place of business Pursuant to County Code Chapter SA-Art.9&10 owNM Sac.TYPE OF BUSINESS PAUL.M1 SMITH1llti SPEC AAECHANtCAI CONTRACTOR BY TAX CCRAJECTOR PAYMENr ROCGNEt) $45.00 07l13t2015 CHECK21-15-088291 This L=W Badwas Tsx ' a Payamat af&e Local Bush=TeX The i1*oeipt is and a license. ppemdL or a 0"Nesdoa of the Hoid*rs shy with aay govemo nW waongovwn=xwtegddmkmamreqdremw&wMchap*to*ebudaw-- rM NCdPT 90.ehove avid be dIVIeyed on oil caMrMeial vehicles-rami-tladeCC&Seagw_n& KEN LAWSON,SECRETARY RICK SCOTT,GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION q : CONSTRUCTION iNDUSTRY L.1GENSING BOARD CAC015467 to CLASS AAIR CONDITIONIPIG CONTRACTOR arced below IS CERTIFIED nder the provisions of Chapter 489 FS. xpiration date: AUG 31,2016 0LM MMMLVIN1V SMITH,PAUL M SOU' PEASTAIR CONDITIONING INC 13840 NW 8TH'FL 331682931 MIAMI SEQ# L140518(}pp1471 ISSUED: 018/2014 DISPLAY AS REQUIRED BY LAW _. CERTIFICATE OF LIABILITY INSURANCEDATE(UNO M'YY) a/J§2015 arms 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 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SL 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 WANED,subject to the terms and.condlitions of the policy,certain policies may require an endorsement, A.statement on this certificate does not confer rights to the certificate holder In Neu of such end s PRODD(w Cert Team Gateway-Ac entria Insurance Agency,LLC. PIIONE FAx 2430 W.Oakland Park Blvd. Fort Lauderdale FL 33314 COVER AM NAIL 4 WWRM A-Monme Guananty Ins Go . INSURED SOUA102 etsuftm Eftidgelield Casually Ins Qp Southeast Air Conditioning,Inc, pM c: Attn: Ms.NanSmith 13840 N.W.6 Court rNsuR>BR D: Miami FL 33168 RAE: INSURM F• COVERAGES CERTIFICATE NUMBER:224835328 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 REOUIREMENT.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. iNSAt TYPE OFlA13URAN+C£ AUM CYlaFF POUCYEV LIMITS A GENERALLIABILITY GL000377411 10/112DiS 1011/2016 EACH OCCURRENCE 51,0D0000 DwAr.E TO RENTED COMMERCIAL GENEWL LIABILITY 5100 000 CLAIM84VOC Q OCCUR MED EXP(ArW ate ) $5,0D0 T PENAL&ADVINAW S10000(10 GENEERAL AG NEGATE 5 COD 000 CAMLAUYREGATeUMITAPPLES PER: PRODUCTS-COMPfOPAGO S20D000D POLICY X LOC S AUTOMCM19 LIABILITYIT ANYAUTO S �OYMM SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS Alp O DAMA S S UMBRELLALIABOC" EACH OCCURRENCE S EXCESS LIAR HCIAMS44ADE AGGREGATE S 5 $ �OYEFOr NS Q19W714 1/1/2015 1/1/2DI6� X STA QTH AND YIN ANY PROPRIETOMPARTNEMEXECUT1VE E.LEACHACCIDENT 55D00tX) OFF10EItMHdBEREXCLUDED? N/A (It aes PTIinrV SL DISEASE-EA EMMC SSMA00 ON OF OPERATE E.L DISEASE-POLICY UNT I ww 000 DESCREPTTON OF OPERATIONS/LOCATXYNS I VEHHY ES(AtlaohAC01�109,Atodkiouol Ramerke .it more M Is raquUed) License#CAC016457 CERTIFICATE HOWFR 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 10050N.E.2AVENUE AUTHOEMED R0311ESENTATWE MIAMI SHORES FL 33138 �� 0ISM2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department OCT 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 (6 BUILDING Master Permit No. V-0-1 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [:] MECHANICAL ❑PUBLIC WORKS [CHANGE OF ❑CANCELLATION ❑ SHOP A ^-CONTRACTOR DRAWINGS JOB ADDRESS: i ��� ,V�-„ -aT r z 1 City Miami Shores County: Miami Dade Zip: S-51-3 Folio/Parcel#: l 3 �t�` ®��� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: A Flood Zone:: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 1 O Q saggzF l C Phone#: Address: r Qo� Nit: q99 SY�2 L l City: 14 1 A61., S 140(ZES State: Zip: 33 l 3 C3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: C C Phone#: 9-?D^ 379-9 23 0 r. r Address: t� City: Mr AA4 .- `4 State: T—L Zip: Qualifier Name: '*) Phone#: 5A--411,E State Certification or Regist ion#: In Aff k :kR(t 69� Certificate of Competency#: l DESIGNER:Architect/Engineer:,TA A S URAAM kE t D &C.Hf%PE�%Phone#: 3(2--2,Q&3 Address: -I 7 4 S W 1 q 5 TR) City:ISOM 4'- Mtate: 1-6_Zip: 1 Value of Work for this Permit:$ 0,0 ® Square/linear Footage of Work: 242 't-- eD Type of Work: ❑ Addition 2 Alteration New ❑ Repair/Re lace ❑ Demolition Descri tion of Work: C� 8 Specify c1 for of color thitile: Submittal Fe$$ u Permit Fee$ ' 63 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary S Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ i F? a (Revised02/24/2014) c 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. /n the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Q Signature OWNER or AGENT NTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of J6&,C ,20 V! ,by /S-"� day of �C7lJ��l� ,20 IS— ,by M tI V\lL\ h0 is personally known to C�,YPD ,who is known to me or who has produced as me or who has produced T' as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign Sign; Print: Print: Seal: VI ft H – Seal: ,�o��Y"`mom MILDRED Y.GOMEZ r 171 ;? 1 1 Y�r _, ' °" Notary Public-State of Florida etaCUMN;FF1=T ' cQr My Comm.Expires Aug 24,2017 p(pfFftMy 21, 218 Commission#FF 40660 �14g1� ########## ###WWT ll�fT 4�lial APPROVED BY NZ7�r 1 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department s 10050 N.E.2nd Avenue '"�ORNA Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR/ARCHITECT :-ermit N.R-r-j %-4- I G Vy ( nler's Name_.(Fee.Simpde Title Hader):. 1662 WIL qgA4- Phone#_(geg Owner's Address: Fzz� a©g City: 19 State: ft, Zip Code: x233 Job AddreSS.(ofwhere work is being done):_ Ica 7 IVS <1 PCS agk City: Miami Shores State:_Flortda Zip Code:_331 ?FC Contractor's Company Name: (In Phone#: gc3LI— 61 /- -7L?,r7 AddreSIN 8 .e4 City. M e h State:__)F�t_ zP Code: 33`I e Qualifier's Name: Lic. Number. jhQ l? Scli Architect/Engineer of Record Name: �01 ...n L" —Phone#: Address: — S�-c- #- City: State: Zip Code:.­1.a�_A t(p Describe Work: C- e.� I hereby certify that the work has been abandoned andlor the contractor/architect is unable or unwilling to complete the contract. I hold the BuildingOfficial a� "'A Miami Shores harmless for all legal involvement. -� Signature Signature The foregoing instrument was aknbwledged before me The foregoing instrument was aknowledged be ftid this B—day of�k- ,20�,by this_�day of ,20 4y Who i personally known tom r who has produced who i rsonally known tom r who has prods 3 as indentiflcation. as i Jill'�•, 'NoteryPubli . � �, Hear muk" ' • _ f ff1�7 Notary Publi Sign, "g t1, 2018 Sign: Seal: r�'''��r i�h��� wWW.AAROMAAY.COM «btu Seal: SLUYTER CONSTRUCTION LLC Date: I�(tC11 �5 State of County of t1A,'DE. Before me this day personally appeared NDEQfj Y AUU",)5L-�')w�ing duly sworn,deposes and says: That he or she will be the only person working on the project located at: 1432 S M Sworn to(or affirmed)and subscribed before me this day of .20-x,by Personally know OR Produced Identification c-- -1---'fo-2Y1-(�b-)Q4—O Type of Identification Produced E---1 QUE uOENS�- Print,Type or Stamp Name of Notary Notary Public State of Florida Sindla Alvarez. My Commission FF 158750 �pR Expires 09!0312018 lose Miami shores Village Building Department 1pR ► 10050 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 of20 15 . By va OA COay. M� M Q�rs pe sonally known to me or has produced l-k N SA as identification. Notary: SEAL: Notary Punic State of Florida t • SMia Alvarez FF 158750