MC-17-1805Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. MC-7-17-1805
Permit Type: Mechanical -'Residential
Work Classification: Addition/Alteration
Pennit Status: APPROVED
Issue Date: 7/19/2017
Expiration: 01/15/2018
Parcel Number
Applicant
347 NE 98 Street
Miami Shores, FL 33138-
1132060135621
Block: Lot:
ARTHUR BAKER
Owner Information
Address
Phone
CeII
ARTHUR BAKER
347 NE 98 Street
MIAMI SHORES FL 33138-
(917)345-4387
Contractor(s) Phone CeII Phone
MONTES DE OCA STATE CORP (305)741-8355
Valuation:
Total Sq Feet:
$ 9,500.00
540
Tons:
Additional Info: REPLACE DUCTWORK REMODEL 28 FT INST
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 1
Date Approved:: In Review
Type of Work: REPLACE DUCTWORK REMODEL 2E
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$6.00
$4.99
$4.99
$2.00
$332.50
$3.00
$8.00
$361.48
Pay Date
Invoice #
07/13/2017
07/19/2017
Pay Type
MC-7-17-64578
Check #: 01114
Check #: 1043
Amt Paid Amt Due
$ 50.00 $ 311.48
$ 311.48 $ 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:
construction and zon
certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
Fythermore, I authorize the above -named contractor to do the work stated.
Authorized 15ignature:Owner / Applicant / Contractor / Agent
July 19, 2017
Date
Building Department Copy
July 19, 2017
1
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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING Et MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS:
,,..// T pa_L g
City t 15► tof ttl hores
Master Permit No.
RECEIVED
JUL 13 7017
54\
FBC 20N
Sub Permit No. MC C R-1710-5
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
County: Miami Dade
zip: 3`s138
Folio/Parcel#: 1 \3 9 n coo V,Sfo 2.t Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
�—f\(+fvJt(L keg. rPhone# ( (%/ 3L 5` 1/367
CbWNER: Name (Fee Simple Titleholder):
Address: ' i 9 Nel e ✓ r
City: Wif 14vV `t State: Zip: 6
Tenant/Lessee Name: Phone#: CI 3 5 G% 6 9-
Email: g rli i - f+ Pi ( - 17 1 'A l L F G® tstA
CONTRACTOR: Company Name: 110QS
Address: \Sgg2 Sw l S-ko2 (C
City: ,
Qualifier Name: �..moo 111Z 0Is1�QS
State:
Atz 00A
Phone#: 3&c (e( 2)3Sc-
j os-e- 3os- 3_'u - 2 a 23
Zip: 33 ('0‘
Phone#: lja S J l (R 3�S
State Certification or Registration #: C..ke k250 c l3 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for, this Permit: $ liltq'QO eSquare/Lineal Footageof.Workr 640
Type of Work: ❑ Addition ❑ Alteratiop I ❑ Neweny.\Repair Replace . ❑ Demolition
-? Description of Work: - �1D@X e•' wWail..0 YA-t)� ka J
Z -. `acfaik,.�•�
9._ 2_;k44-0
Specify color of color thru tile:
Permit Fee $ ' 3 2L5v CCF $ CO/CC $
DBPR $ Notary $
Training/Education Fee $ Double Fee $
Bond $ C�
TOTAL FEE NOW DUE $ � ( I ' l G
Submittal Fee $
Scanning Fee $ Radon Fee $
t=;
Technology Fee $
Structural Reviews $
(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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
(Signature. -r--Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this The foregoing instrument w:s acknowledged be ore me this
day of 1,101-1, 20 �, by
}tr ��1vf '<-Qv , who is personally known to
me or who has produced FL I�, Q� 11 C vt Q as
identification and who did take an oath.
NOTARY PUBLIC.
Sign:
Print:
Seal:
4
\.\\\vtoi-oV1sec cX
,,"""', WILLMOR A. FONSECA
SPRY PV9 ��i
`'C',Notary Public - State of Florida
_E • • "c My Comm. Expires Aug 7, 2017
a IIII # e�
Commission # FF 043297
*'?`'u '0***ttritIt tlirc lettgli$iltal`itletfl'tjiA fi
APPROVED BY
*
C• TRACTOR
day Alai/ , 20 /7 , by
1/7017,t'.L MAI& is personally knowq to
me or who has producedas
identification and who did take an oath.
NOTARY PUBLIC:
Sign: / LY1�ll.J
Print: /i i Natalie King
State of Florida
A./ My Commission Expires 12/16/2019
OF op Commission No. FF 944254
Seal:
************************************************************
7PI ns Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)
ME CH A'N.I C"K L
AIR°CONDITIONING.
& REFRIGERATION SYSTEM
15892 SW 138 TERR
Miami, Florida 33196
305-741-8355
CMC1250513
www.mdoairconditioning.com
07/11/2017
State of Florida
County of Miami Dade
Before mee this day personally appeared Julio Montes de oca who, being duly sworn, deposes
and says:
That he or she will be the only person working on the project located at: 347 NE 98 St Miami Shores FI.
R044-% Ite&ei& NA
Sworn to (or affirmed) and subscribed before me this iu day of .141J , 20n_ by J OIII 'Moikf
de O 4
Personally Know
Or Produced Identification
Type of Identification Produced 4101; a ( uto �t
MARIA CAROLINA GOMEZ
Notary Public, State of Florida
Commission# FF 209431
My comm. expires Mar.12, 2019
Print, Type • Stamp Name of Notary
Miami Shores Viiiage
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 ACKN(}WLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this '5 day of )014Q. , 20l1 .
By arA4Aui 3 r414k. (
Notary:
who is personally known to me or has produced
VA\t s r )‘( 1 SQ. as identification.
SEAL: WILLMOR A. FONSECA
^`'� UB` Notary Public - State of Florida
• = My Comm. Expires Aug 7, 2017
Bonded Through National Notary Assn.