MC-15-2653 MC 0
Miami Shores Village e:,Mechanical-R ld
10050 N.E.2nd Avenue NE �bes�o . )� �
Miami Shores,FL 33138 0000
h e f ##7!t' :AIPPA1110
e N� Phone: (305)795-2204
F oRroA
Expiration: 05/14/2016
issue l 'l'i/'16120 6 p
Project Address Parcel Number Applicant
1451 NE 103 Street 1132050310180
Miami Shores, FL Block: Lot: LORETTA MCWILLIAMS
Owner Information Address Phone Cell
7
LORETTA MCWILLIAMS 1451 NE 103 ST
MIAMI SHORES FL 33138-2625
Contractor(s) Phone Cell Phone Valuation: $ 2,500.00
REA AIR CONDITIONING INC 305-266-6627
Total Sq Feet: 0
Tons: Available Inspections:
Additional Info:REPAIR SWEATING DUCTWORK IN ATTIC. Inspection Type:
Classification:Residential Final
Approved:In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work: Review Mechanical
Scanning:3 Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80
Invoice# MC-10-15-57470
DFee $2.00
DCACA Fee $2.00 11/16/2015 Credit Card $67.80 $50.00
Education Surcharge $0.60 10/19/2015 Credit Card $50.00 $0.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $117.80
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in complia$nce 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 ify, hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoiOng. Fu"rmore,I authorize the above-named contractor to do the work stated.
November 16,2015
Auth r' a SI ure:Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 16,2015 1
�°ry Miami Shores Village
; 0 C TAl2015
�
7, Building Department
1� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 P`
l o
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTIONS PHONE NUMBER: (305)762.4949
BUILDING Permit No.
PERMIT APPLICATION Master Permit NolvI-i s - 2G 53
FBC 20
Permit Type: MECHANICAL f //
OWNER:Name(Fee Simple Titleholder): 6_04.1 Xea,l111"X hone#: 365-
_31r 4471(
Address: /�S l �• C� 4d g
City:_ %f/p � ��� State: - Zip:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: /�t `
City: Miami Shores County: Miami Dade Zip:
Folio/Parcelk
Is the Building Historically Designated:Yes NO Flood Zone:
CONTRACTOR:Company Name: C� E L� hone#:� � 7
Address: �s� /
State: ' Zip:
Qualifier Name: `°t ;` e , Phone#: �
State Certification or Registration#: ��' l 7� Certificate of Competency#:
Contact Phone#:�� �'��� ��� Email Address:
DESIGNER:Architect/Engineer: (Phone#:
Value of Work for this Permit:$ �� ° 0 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New epair/Replace ❑Demo 'tion
Description of Work: L'tc'"
* *x*xxxxxxxxxxxxx **Fees* xxx� xxxxxxxxxxxxxxx*
Submittal Fee$ Permit Fee$ wo t1M CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ —
Bon4nng Company's Name(if applicable)
E Bonding Company's Address
City State Zi�
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 ha
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulatin;
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 al
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OI
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOF
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIIS
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORF
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 mus
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the persol
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job sit,
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, th
inspectionwill not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The fo=Ixv
instrument was acknowledge2e;17,
is The foregoinf instrument was acknowledg be ore me Pis-
17
of20�� by r�/�O o day of � � ,20 l 5,by
who i erson own to me or who has produced who i ers mown to me or who as produced
As identification and who did take an oath. as identification and who did take an oath.
Me/9Z/Ol Sandx RANDOLPH CASANAS
NOTARY PUBL 3 ®�eL g�y�s NOTARY PUB v s TARP PUBLIC
Z69Lb633#wwoD TATE OF FLORIDA
3.l b1S
DIl9(ld A2iV1ON vo c Comm#EE141642
Sign: 2 bm eavi�`'a Sign: ��
Print: Print:
My Commi sion Expires: My Commis n Expires:
APPROVED BY v Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Local Business Tax Receipt
Miami.-Dade County, State of Florida
TI IIS IS N01A RILL - DO NOT PAY7fi275f3
LBT
1305INESS NAME/LOCATION RECHFIr NO EXPIRES
R F A AIR CONDITIONING INC: RENEWAL SEPTEMBER 30, 2016
7 i',I NW / S1 R 262 758 Mu•;t be displayed at place of business
MIAMI Fl.33126 F'Ursuant to County Corte
Chapter 8A..Art.9& 10
OWNER SE C. TYPE Or BUSINESS
R C A AIR CONDITIONING INC 1% 51 FC MECHANICAL CONIRAC I OR TAX COI.[.LFCT(]PAYMENT HFCTO D
E3V R
Worker(s) 70 CACW'241;1 1 1 i.OU 07/211/201 Li
C'i1FCK7.l- IS--IOAOGS
This local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license.
permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply In the business.
Thr.RCCEII°T NO.above most be displayed no all commercial ve.hucles-Miami-Dade.Code Sec Ba-276.
For more information,visit www.miamida 1n,gnv(taxc1i tq tpr
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
' PROFESSIONAL REGULATION
CACO22414 ISSUED. 08/13/2014
CERTIFIED AIR COND CONTR
JOSEPHARNETTE RICHARD
R E A AIR GOND T ON NGINC
IS CERTIFIED under the provisions of L 40 B3 0 S87
Expiration date AUG 31.2016
From:Christine Piersol FaxID: Page 2 of 2 Date:10/19/2015 02:39 PM Page:2 of 2
REAA101 OP ID: CP
CERTIFICATE OF LIABILITY INSURANCE
DATE 10119/20/ YY)
10/19/2015
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 pollcy(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 endorsement(s).
PRODUCER CONTACT
FILER INSURANCE,INC. PHONE.
Christine Piersol
9440 S.W.77 Avenue c No E :305-270-2161 Arc No): 305FAX -270-2195
KeithMiamFL 33156 E-MAIL c iersol filerins.com
Keith R.Miller
INSURER(S)AFFORDING COVERAGE NAIC B
INSURERA:Allied P&C Insurance Co 42579
INSURED REA Air Conditioning, Inc. INSURER B:Bridgefield Employers Ins.Co. 10701
7351 NW 7 Street Suite R
M lam i, FL 33126 INSURER C:
INSURER D:
INSURER E:
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,
��ggEXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
ALWL SUBR POLICY EFF POLICY EXP
L'rRR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIDDYYYY LIMITS
GENERAL LIABILITY E CHOCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY ACPGLP05964074286 07/01/2015 07/01/2016p EMISES Ea occurrence $ 100,000
CLAIMS-MADE FX_I OCCUR MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
POLICY JECT PRO LOC $
AUTOMOBILE LIABILITY COeBINEDiSINGLE LIMIT $ 1,000,000
A X ANY AUTO ACPSAPC5964074286 07/01/2015 07/01/2016 BODILY INJURY(Per person) $
ALL OWNEDSCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) $
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
AUTOS PER ACCIDENT $
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR HCLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION WCSTATU- OTH-
AND EMPLOYERS'LIABILITY X T X
B OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE YIN N r A 083052718 06/07/2015 06/07/2016 E.L.EACH ACCIDENT $ 500,000
(Mandatory in E.L.DISEASE-EA EMPLOYEE $ 500,000
If yes,describe under �
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
Contractors License #CACO22414
CERTIFICATE HOLDER CANCELLATION
CITY056
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10050 NE 2 Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE
�vylµ. ,,,, VBG CHRISTINE PIERSOL-A207=
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD