MC-17-194 `
'', 3!$ 1 33 3 A'✓, I�� i �
Miami Shores Village �iff1 , '
10050 N.E.2nd Avenue NE �� It tio °
Miami Shores,FL 33138-0000
Phone: (305)795-2204 �
LORWA
Isi�ue»ata 3128i"ZQ17 Expiration: 09/24/2017
Project Address Parcel Number Applicant
561 NE 95 Street 1132060140750
MICHAEL HETTICH
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
MICHAEL HETTICH 561 NE 95 Street
MIAMI SHORES FL 33138-2731
Contractor(s) Phone Cell Phone Valuation: $ 600.00
AA MASTERS MECHANICAL AIR MOV (305)2440667 Total Sq Feet: 0
Tons: Available Inspections:
Additional Info:EXTEND DUCT
Inspection Type:
Classification:Residential Final
Approved:In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work:EXTEND DUCT Underground
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# MC-1-17-62721
DBPR Fee $2.25 03/28/2017 Check*1059 $ 109.10 $50.00
DCA Fee $2.25
Education Surcharge $0.20 01/25/2017 Check*1056 $50.00 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $159.10
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 trict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I a ume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICA LUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFI IT: I ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction an g. Fu ermore,I authorize the above-named con r or to do the work stated.
March 28, 2017
Authorize Sign ature:Owner / Applicant / Contractor Agent Date
Building partment Copy
March 28,2017 1
Miami Shores Village
Building Department
JA 2017
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 k
Tel:(305)795-2204 Fax:(305)756-8972 -- - -
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20
BUILDING (waster Permit Pio. 1Z-10'!J11
PERMIT APPLICATION Sub Permit No. mc -E 19�'
❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ®EXTENSION ❑RENEWAL
❑PLUMBING MECHANICAL E]PUBLIC WORKS ❑CHANGE OF ❑CANCELLATION ®SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 4 r I vE7 !3.5
sq-
City: Miami Shores County Miami Dade Zip: 3
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): t4i C h i&/%Z � Phone#:
Address: 52a` XJE !75 p
City: State: ��f�rG�iO zip:.-531 39
Tenant/Lessee Name: Phone#:
Email: qq'' n 90YI!2V,
CONTRACTOR:Company Name: AAJSreds �(ea4p uyAL 1'1 j" —Pho e#- 3995
Address: 15 5 9 10 f 414 re I/1r' A Dt __'����j' 1
City: ( )4 14 t State: �( A- Zip: 3 I(rrc
Qualifier Name: e Ue w't Phone#' us
State Certification or Registration M CA C 053-17 (P Certificate of Competency M �L
DESIGNER:Architect/Engineer:
Phone#:
Address: City State: Zip:
Value of Work for this PermlL•$ �,�/�®•®� Square/Linear Footage of Work:
Type of Work: ❑ Addition U Alteration ❑ New ❑ Repair/Replace ® Demolition
Description of Work: ���� �G
ktM
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ V CCF$ & CO/0 S
scanning Fee$ aRadon Fee$ 2 • DBPR$ Z Z S Nota►y$
Technology Fee$ LC5 b Training/Education Fee$ '� �® Double Fee$ ^®
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(RevisedO2/24/2014)
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$25w the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foreping instrunnt was acknowledged before me this The fir oing instrument was acknowledged before me this
17 day ofsowzvay 20 I / by day of 0 by
who is personall nownto �e`l ! wn o
®m or who has produced as me o` 3udM CO""11014#FF1 as
h ..,... �
identification and who did take an oath. identi wh did eS Com
�i@.Qt63
NOTARY PUBLIC: NOT
Sign: Sign:
Print: Print:
Seal: tblic State of Florida Seal:
inezission FF 019208
•►i►i►i►►i•►►►i• i • ! • • t tI ! i •►fi••••iti•i•i••!!►••t•••i••ii•iti••ii•••••tit!••ii••••••!ii!•
APPROVED BY V y� Ilans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
OR
gave „ Miami shores Village
Building
X11$ 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.
I. 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 acknowl e before me this day of Q y ,20J 7
B who is
y. ��-��.,��� personally known to me or has produced
as identification.
Notary:
0
SEAL: ; Loly Martinez
My Commission FF 019208
��ova° Expires 08/18/2017
AA Masters Mechanical Air moving &
engineering systems, Corp.
Date RZi7
1�621t7
State of Florida
County of Miami Dade
I �
Before me this day,personally appeared who being duly
sworn,deposes and says.
That he will the only person working on the project located at
Sworn and Subcribed before me this. day of I 2017 By
ersonally Kno
Produced Identifica
a..,.._...,t4,;. c
6 MY Jflpr,ax! >� # 20
ill.. E PIFIES �-
+ ,,eraiCe.Com
VidiaWl-
(b07)mgp.[ti
Notary Public,signature,Stamp
15591 Sw 105 Terr#525 Miami Florida 33196
PH:954-274 2639