MC-16-1994J
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Term
Issue Dad
t
Permit NO. MC -7-16-1994
Permit Type: Mechanical - Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
12/16/2016
Expiration: 06/14/2017
Parcel Number
Applicant
445 NE 94 Street
Miami Shores, FL
Owner Information
Address
Phone
Cell
Darren Ockert
445 NE 94th Street
Miami Shores FL 33138
917 573-9022
Contractor(s)
AIR COOLING INC
Phone
CeII Phone
Valuation:
Total Sq Feet:
$ 39,500.00
0
Tons: 2
Additional Info: MECHANICAL WORK FOR REMODEL AND ADD
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 1
Date Approved: : In Review
Type of Work:
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$24.00
$20.74
$20.74
$8.00
$5.00
$1,382.50
$3.00
$32.00
$1,495.98
Pay Date Pay Type
Invoice # MC -7-16-60626
12/16/2016 Credit Card
07/18/2016 Credit Card
Amt Paid Amt Due
$ 1,445.98 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Rough Duct
Review Mechanical
Underground
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 employes. 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 zoning. Fu ermore, I authorize,. e above-named contractor to do the work stated.
December 16, 2016
Authorized Signet re: Owner / Applic. / Contractor / Agent
Building Department Copy
Date
December 16, 2016 1
BUILDING
PERMIT APPLICATION
El BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
RECEIVEID
JU 1 e Zeis�
�l
BY:
FBC 20 I`4
Master Permit No. — j t 9
Sub Permit No. VI �t 1,9c
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION D SHOP
DRAWINGS
❑PLUMBINGJy1ECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
``�� CONTRACTOR
JOB ADDRESS: 445 NE 94 ST, Miami Shores, FL 33138-2845
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#:11-3206-014-0520 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): DARKEN OCKERT
Phone#: 917.573.9022
Address:445 NE 94 ST
City: Miami Shores State: FL zip: 33138
Tenant/Lessee Name: N/A Phone#:
Email:
CONTRACTOR: Company Name: A 1 Q CC`kv-N5 C•
Address: ` .--1(oCo LAJ
Phone#: SG / 2.3c -3<N.0
City: V-!% \-CA' N State: 'F L.
Qualifier Name: =QJ.Q L ave N 0
Phone#:
zip:33 O I'
State Certification or Registration #: ./ r (. , D ` S . Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value.of-Work"for'thiis`Pe mit: $ 3 g)U
Type of Work: ❑ Add' ion
Desc iption of Work:
Square/Linear Footage of Work:
❑ Altera ion New
spPair/Repl.ce j7 Demolition
Specify color of of{ccolo(r thru tile: �
Submittal Fee $ W " " Permit Fee $ fib — CCF $ 2 4' 0) co/cc $
Scanning Fee $ Radon Fee $ 2-G - DBPR $ 2.0 • `I Notary $ G. (b
. Citi
Technology Fee $ 3 2. 3O Training/Education Fee $ 9 • W
Structural Reviews $ p Bond $ T ; �j
TOTAL FEE NOW DUE $ f/ Lf T� q0
S. (
Double Fee $
(Revised02/24/2014)
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. 1 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
OWNER or AGENT
Theforegoing instrument was acknowledged before me this
1f9 day of 3UL^-j , 20 ��o , by
DP42 2 t' (K.t_52 , who is personally known to
me or who has produced t\.., s
identification and who did take an oath.
NOTARY PUBL
Sign:
Print:
Seal:
SCc A f UJ
a {603 Pt.*, Notary Pubiic State of Florida
w1iSindia Alvarez
° a My Commission FF 156750
**************** #:r*ate#evp^JPb3rfErpe******r
APPROVED BY
(Revised02/24/2014)
*
•
CONTRACTOR
Theforegoinginstrument was acknowledged before me this
1 J day of a) *y , 20 \L, , by
L L. i `I-'c�Q) , wh ersonall kno to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
*********************************************************
ans Examiner
Structural Review
Zoning
Clerk
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): L4 (AS N S Ls
City: Miami Shores Village County: Miami Dade
Zip Code: 3 3 I f 0
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 k NO 0 Contract Attached: YES ❑
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER (,
c.'cs .
L, , eX
•
AHU or PKG. UNIT MODEL #
-c
C4? X j 2. si. V - O 24-c
COND. UNIT MODEL #
XC'Z.l,—•
O •Z•A •
KW HEAT
Lk•8
NOM TONS
2.:TX114- •
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
:L / - f /1 , 2/0 .
YES
NO
REPLACING DUCTS
4115rilio
NO
YES
NO
REPLACING THERMOSTAT
(V NO
YES
NO
NEW 4"CONCRETE SLAB
(1E
NO
YES
NO
NEW ROOF STAND
YES C
YES
NO
NEW RETURN PLENUM BOX
NO
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3 .04
3. Voltage of Circuit (208/240/480): 2_o t 1 Z..3 O0.13
`•�1..s
4. Size Disconnecting Means:
Contractor's Company Name:
AAA.,Yl..(Lis IN .
Phone:1 2.3 (z W O
State Certificate or RegistraS'on No.4' C IAC. �e 1S-72 tgrtificate of Competency No.
Signature
(Revised02/24/2014)
alifier' signature)
Date: D�/(,ri/ 61 •
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•
Miami Shores Village:
Building Department
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:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this 9 day of
By tJ Q Jc) 2X
Notary:
SEAL:
Jul
,20 I .
who is personally known to me or has produced
(..k_Cf(V 7 as identification.
456 PoeNotary Public State of Florida
Sindia Alvarez
a), c 44 My Commission FF 156750
''Pool,,o� Expires 09/03/2018