MC-17-376 Permit NO. 10110IC-2-17-375
�st!OREs- Miami Shores Village Et Permit Type:Mechanical-Residential
��' 10050 N.E.2nd Avenue NE Perl 11I Work Classification:Addition/Alteration
�- Miami Shores,FL 3313&0000 Permit Status::APPROVED
yYE,NO� Phone: (305)795-2204 -
F�OR'lDp'
Issue Date:7/31/2017 Expiration: 01/27/201$
Project Address Parcel Number Applicant
922 NE 91 Terrace 1132060000030
BBJJB LLC
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
BBJJB LLC 922 NE 91 Terrace (954)558-3959
MIAMI SHORES FL 33138-
922 NE 91 Terrace
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
Valuation: $ 10,000.00
BEL AIR SERVICES&AIR CONDITION (954)895-1534 Total Sq Feet: 0
Tons: Available Inspections:
Additional Info: INSTALL NEW DUCT WORK&INSTALL A/C Inspection Type:
Classification:Residential Final
Approved: In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work: INSTALL NEW DUCT WORK&INSTA Underground
Scanning: 1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $6.00
Invoice# MC-2-17-62933
DBPR Fee $5.25 07/31/2017 Check#:2405 $329.50 $ 50.00
DCA Fee $5.25
Education Surcharge $2.00 02/14/2017 Credit Card $50.00 $0.00
Permit Fee $350.00
Scanning Fee $3.00
Technology Fee $8.00
Total: $379.50
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. Futhermore,I autWiib the above-name contractor to do the work stated.
>T July 31, 2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
July 31, 2017 1
Miami Shores Village � `
g FEB 4 2017
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
FBC 20'1
BUILDING Master Permit No. l C
PERMIT APPLICATION Sub Permit No. MC
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
(j CONTRACTOR - DRAWINGS
JOB ADDRESS: -I -�" /V r 1�f%CvC Q
City: Miami Shores County: Miami Dade Zip-3d 1z??
Folio/Parcel#: Is the Building Historically Designated:Yes NO.
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):__)�,(,J _� fyv�Qr; Phone#:
Address:--91,9- AJ.E. QJ Urrac1Q.
City: M
, iiCtM- SA(fire6 State:_ I=lorI` Zip:331��
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Named: 13ar Pi r SQrke5 Ccyd 41 C.0fj;i'1P� "vg Phone#: y �"i537
Address: POO i"1 1� f1 ye'
City:_1401 Iy WID40 State: 1- �V r jo1 Zip: 33d��/
Qualifier Name: 10:ri RM62 Phone#: !. A/40<3-i3als
State Certification or Registration#: C&-C, 1&10,13 Certificate of Competency#:
DESIGNER:Arch�itect/Enginee rr i d m 1-JRr i of b n Phone#:
Address: �WG�0 :W1' "! r7ye City:r� �.auPet A�Q State:EL Zip: 339t
Value of Work for this Permit:$ as Square/Linear Footage of Work:
Type of Work: ElAddition TAIteration ❑ New Repair/Replace ❑ Demolition
Description of Work: ''I '- '-44A r l-
1NSfa.II /VEyj buGt WOrll (mssfaI 1 '
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ ®�� CCF$_ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Not $
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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. 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/,A �464rr�-
7
Sig
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_day of Le� 20 ' ,by -0 day of ge16 20 /-2 by
J04N Ruh,*, c 4 who is personally known to 76c,y/ )O who is personally known to
me or who has produced F4 as me or who has produced -,71, 0r.s
identification and who did take an oath. identification and o did take an oath.
NOTARY PUBLIC: NOTARY PUB IC:
Sign: Sign:
Print
: Print: MELT
P ' �C ;
COMMISSION#FF974952
Seal: MISSION#FF974952 Seal:
IRES Apri105,2020 �.� ,..° EXPIRES Apri105,2020
(401)395-0153 FwwsN0WrVServbe.c0m
X07 3SS-01S3 FgrgrNola
************************************************************************************************************
APPROVED BY P ns Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
C-193 REs y
Miami Shores Village
KENN
Building Department
10050 N.E.2nd Avenue
LORIDp' 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
� I-
The foregoing was acknowledge before me this day of J ,20].
BJ-D6,nJ �5 ,Lh who is personally known to me or has produced
Nn as identification.
MELIZA A
•'.L LVAREZ
: '' = I
Notary: 'j -OMMISSION#FF9749,52
F},. EXPIRES April 05,2020 t
SEAL: ,;x".0153 F,onaafttaryStmw.com
Company Letter Head
Date:
State of r
County of_ (�1 (� rC1
Before me this day personally appeared As(l Qo��`�—who, being duly sworn,deposes and
says:
That he_or she will be thWly person workingon he roject located at
Sw ed)and subscribed before me this day of P,6 201y
Personally known
Or Produced Identification
Type of Identification Produced
MELIZAALVAREZ
' MY COMMISSION#FF973952 1
o.n , EXPIRES April 05,2020
(407)398-0153 FlorWalloteryServft.00m
Wntje'
r St mp of Notary