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MC-17-2715 Permit NG MC-11-17-2715 9 swO1 s i,� Miami Shores Village Permit Type: Mechanical-Residential 10050 N.E.2nd Avenue NE Per�� Work Classification:AdditionlAlteration Miami Shores,FL 33138-0000 Permit Status:APRROVE F—moo` Phone: (305)795-2204 ° toRtnA sue Date.1/1612018 Expiration: 07/15/2018 Project Address Parcel Number Applicant 440 NE 91 Street 1132060190050 Miami Shores, FL Block: Lot: JEFFREY COOPER Owner Information Address Phone Cell STEPHANIE LOPEZ GOMEZ 440 NE 91 Street MIAMI SHORES FL 33138- 440 NE 91 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone $12,421.05 Valuation: GRANA ELECTRIC&AIR CONDITION[ (772)206-1381 Total Sq Feet: 0 Tons: Available Inspections: Additional Info:NEW DUCTS AS PER PLAN NEW LAYOUT,N Inspection Type: Classification:Residential Final Approved: In Review Rough Duct Comments: Date Approved: : In Review Review Mechanical Date Denied: Type of Work: Underground Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $7.60 Invoice# MC-11-17-65660 DBPR Fee $6.52 DCA Fee $4.35 01/16/2018 Credit Card $419.41 $50.00 Education Surcharge $2.60 11/15/2017 Check#:2653 $50.00 $0.00 Permit Fee $434.74 Scanning Fee $3.00 Technology Fee $10.40 Total: $469.41 low In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT- a ify th all h foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo ' . F her re a orize the above-named contractor to do the work stated. January 16, 2018 Aut 0.4zed Signatu :Owner Applicant / Contractor / Agent Date i Building Department Copy January 16, 2018 1 Ro-00LF0 Miami Shores Village CRUD Building Department " V 1 5 D17 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC20lg5 - BUILDING Master Permit NoTQ B— PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION .❑ EXTENSION ❑RENEWAL ❑PLUMBING N MECHANICAL []PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR- DRAWINGS JOB ADDRESS: 4A0 1. F- -k\ S�YJt City: Miami Shores County: Miami Dade zip: 33i3`?j Folio/Parcel#: 11 — 320_ E — O 1°C —00 S O Is the Building Historically Designated:Yes NO ✓ Occupancy Type: Load: Construction Type: Flood Zone: BFE: +FFE: OWNER: Name(Fee Simple Titleholder): Phone#: O 1 Address: 440 Ur oak City: kAip VA1 fa Q'V- > State: `i 7L_ Zip: Tenant/Lessee Name: Phone#: Email: C-OLA CONTRACTOR:Company Name: ,'(S7 ��0-1 c( c��G7'0W4$/L Phone l Address: y X c,4j 9c— City: Or 7�--5�� y `� State: /=L 3 Y5-� Qualifier Name: _V C)I^S b rG&":L V6/4o Phone#. �c t 3 8 I t y lz _ State Certification or Registration#:CAL '81-t 1 S-7 Certificate of Competency#: /Q(=' l— DESIGNER:Architect/Engineer: Phone#: L Z0 6—t 7 81 Address: City: State: Zip: 2 2- ' Value of Work for this Permit:$ ( j Square/Linear Footage of Work: ...J Type of Work: ❑ Addition ❑ Alteration ❑ New '91i(?! 0'i,;C{ ❑ Rep{air/Replacevi � - O bemolition Description of Work: Q=—tA� 'bL7 - :Lys, ' >m 04ar p i� y ¢t «•. f Specify c616r'.of color,tl%ri ,tile <:Y �, r� {r�Y • � r..''p ms's; yy.. r ,fi O e Submittal Fee$� Permit Fee$ o CCF$ CO/CC$ Scanning Fee$ Radon Fee$ C 4 DBPR$ J 2— Notary$ r M Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ / ' ( TOTAL FEE NOW DUE$ 41 a. (Revised02/24/2014) Bonding Company's_Name,(if applicable) Bonding Company's Address I -rdi 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. In the absence of such posted notice, the inspection will not be a ved and a reinspection fee will be charged. Signature Signature OWNER or AGENT '661N TRACTOR NTRACTOR , 1 µ a The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 64, "��" �© day of N(tVQvvl�jc�• 20 (� by 1 l day of_,L) VPyt1 G� 20 by who is personally known to ; i GRANA Electric & Air Conditioning October 3rd, 2017 State of Florida County of Miami Dade Before me this day personally appeared JORGE GRANADILLO who,being duly sworn, deposes and says: That he will be the only person working on the property located at 440 NE 91st Street Miami Shores FL 33138. Sworn to (or affirmed) and subscribed before me this -?:> day of 20 R , by-� ��1�a — Personally Known OR Produced Identification Type of Identification Produced Print,Type or Stamp Name of Notary Ricardo Dominguez ,W s4= Commission # FF958686 " Expires:February 8,2020 Bonded thru Aaron Notary 144 SW Dalton Circle, Port St. Lucie FL 34953 f 5�0' s� Miami shores Vi.11age .�. Billet" Building Department 10050 N.E.2nd Avenue 'res RIDA 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; E 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. Signaturd> Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of CCCcYL ,20 )Fq By'31FPQV-� f4�a-)e-v_ c= ksv-!E7,L who is personally known to me or has produced as identification. Notary: ^��t Ricardo Dominguez SEAL: S4. ? Commission # FF958686 •. , Expires:February 8,2020