MC-18-1555Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
•mit
Permit NO. MC-6-18-1" 555
Permit Type: Mechanical - Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 6/29/2018
Expiration: 12/26/2018
Parcel Number
Applicant
1084 NE 97 Street
Miami Shores, FL 33138-
1132050170190
Block: Lot:
1084 MIAMI SHORES LLC
Owner Information
Address
Phone
Cell
1084 MIAMI SHORES LLC
1084 NE 97 Street
MIAMI SHORES FL 33138-
(305)767-9693
1265 SABAL TRAIL
WESTON FL 33327-
Contractor(s)
CHAAR COOLING LLC
Phone Cell Phone
(305)898-1934
Valuation:
Total Sq Feet:
$ 400.00
0
Tons:
Additional Info: REHANG KITCHEN CABINETS TOP
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 1
Date Approved: : In Review
Type of Work: REHANG KITCHEN CABINETS TOP
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Penalty Fee
Permit Fee
Scanning Fee
Technology Fee
Work without Permit Fee
Amount
$0.60
$2.25
$2.00
$0.20
$100.00
$150.00
$3.00
$0.80
$150.00
Total: $408.85
Pay Date Pay Type
Invoice # MC-6-18-67828
06/29/2018 Credit Card
06/06/2018 Credit Card
Amt Paid Amt Due
$ 358.85 $ 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. Futhermore, I authorize the above named contractor t�} work stated.
Authorized Signature: Owner / Applicant / Contractor
Building Department Copy
June 29, 2018
Date
June 29, 2018
1
Miami Shores Village
RECEIVED
Building Department JUN os 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 cek,
INSPECTION LINE PHONE NUMBER: (305) 762-4949
F�•
BC 20P
BUILDING Master Permit No. 12 c._ 1E!). L S S
PERMIT APPLICATION Sub Permit No. MC 6 _ t<s
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING 'I MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
L c� /�•p / CONTRACTOR DRAWINGS
JOB ADDRESS: -70 A' �/ NG / 77 �'/. /% cZ � J L{�� (`ei Ti/ i 3 313
City: Miami Shores County: Miami Dade Zip: ? 4 13
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: / Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder)_ •—/-Qy tl, a.. st 47 ..1., Lc- Phone#:. 30S 64 S6�_3
Address: / 2 6 ( Sc 4A./ -174-G. c / _ `
City: //(%.0State: 4-t- Zip: ? 3 3 2- --
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: C:-4' a 0 /i
Address: / r 1p 5 rki 3 2- 54'
City:9 mT, State: �1. r)^ I CAC& Zip:
33/
Qualifier Name: - __.J r r " Phone#: 3"6 ecr
State Certification or Registration #: C� c^ / Z / ! 2 / Y
DESIGNER: Architect/Engineer: Phone#:
Phone#:
-cos-g r9iy
Address: .+ ,:., , t-z.• .
Value of Work for this
l' ' �'� _'• r ire•.'^ t. � ,�=b � � . .
Type of Work: ❑ Addition ;'Alteration ❑ New ❑ Repair/Replace 0 Demolition
r ara.w r wrrV yiq.i /i"Y✓
Certificate of Competency #:
Description of Work:
to -
Specify color of color thru tile: j
Submittal Fee $ Permit Fee $ v0 0 ti7VCCF $ CO/CC $
Scanning Fee $ Radon Fee $ a • DBPR $ c , '15- Notary $
Technology Fee $ Training/Education Fee $ Double Fee $ I • CO
Structural Reviews $ Bond $
04Z)
(Revised02/24/2014)
City: State: Zip:
Square/Linear Footage of Work: /, to Sgl/e e�
--clTOTAL FEE NOW DUE $ LDS • 9
Bonding Company's Name (if applicable)
Bonding Company's Address
City 5
State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's `Address
City 1 + State Zip
•
+ ` ) ; 1'
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. ,,.
♦� J ,4 t
"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 — — —J Signature
4 .•
ER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The'foregoing instrument was acknowledged before me this
day of JUitit , 20 , by 6to day of 0 I., 20 by
,/
JOY- 'l (Jf (A.419E-ehitiho is personally known to
1 tip y e os<Y):0,G o is personally known to
me or who has produced « P1 I3 -Q as me o who has pro wed as
identification and who did take an oath.
iY"v�e Astrid Ca macho
=x��'�,:, ':COMMISSION#FF14i883
9l: EXPIRES: JUL 15, 2018
r.
1*-"A' for•• BONDED THRU
,,, 1st FLORIDA NOTARY, LLC
NOTARY PUBLIC:
Sign: I
Print: * 5 c (6itrA(.ko
Seal:
******************************************
APPROVED BY
identification a
NOTARY PUB
Sign:
Print:
Seal:
Notary Public State of Florida
Juan Manuel Cheer
My Commission GG 191842
Expires 03/09/2022
Ile IRMA
s Examiner Zoning
(Revised02/24/2014)
Structural Review
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):
City: Miami Shores Village
County: Miami Dade Zip Code:
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 ❑ NO ❑ Contract Attached: YES ❑
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
KW HEAT
`
NOM TONS
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
YES
NO
REPLACING DUCTS
YES
NO
YES
NO
REPLACING THERMOSTAT
YES
NO
YES
NO
NEW 4"CONCRETE SLAB
YES
NO
YES
NO
NEW ROOF STAND
YES
NO
YES
NO
NEW RETURN PLENUM BOX
YES
NO
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: Phone:
State Certificate or Registration No. Certificate of Competency No.
Signature Date:
(Qualifier's signature)
(Revised02/24/2014)
CHAAR COOLING LLC
Date: 0(9aG(lig
State of t'W► I Gth
County of 1111;G(YYII " Dade,
Before me this day personally appeared 009,, U/)1 'eat) who, being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at: I ov-I 1\J-E ' St,
Ntinyivi � , R,
JORGE L. DENACIMIENTO
Sworn to (or affirmed) and subscribed before me this Z'1 day of June
'
JOkrGi OeY .ftVl(eV(
'Ppa. Astrid Ca macho
it? ,•. �k:COMMISSIONA FF 141883
: Tar=`�'• -EXPIRES: JUL 15, 2018
OF-frti , BONDED THRU
1 at FLORIDA NOTARY, LLC
. 20'k', by
Personally know
OR Produced Identification
Type of Identification Produced
Print, Type or Stamp Name of Notary
Notice to Owner — Workers' Com
p
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ensation 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.
r
Signature:
caner
State of Florida
County of Miami -Dade The foregoing was acknowledge before me this Z Tp
, day of J it , 20 1 .
By
\0s2 '\CLXcto au\ tO
foL LI;
Notary: tt Si1(J' 6-Amato
SEAL:
who is personally known to me or has produced
as identification.
4:6; Astrid Camacho
ti'... -:COMMISSION# FF 141883
? ;EXPIRES: JUL 16, 20t8
= (e„ BONDED THRU
let FLORIDA NOTARY, LLC