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MC-18-553Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 390 NE 104 Street Miami Shores, FL 33138- Owner Information Address Permit Issue Da Permit NO. MC 3-18-553 Permit Type: Mechanical - Residential Work Classification: Addition/Alteration PermitStatus: APPROVED 3/8/2018 Expiration: 09/04/2018 Parcel Number 1121360130160 Block: Lot: Phone Applicant CHRISTIAN & DREIRDRE DUNHI Cell CHRISTIAN & DREIRDRE DUNHAM 390 NE 104 Street MIAMI SHORES FL 33138- (305)804-2767 390 NE 104 Street MIAMI SHORES FL 33138- Contractor(s) Phone PRIME AIR SERVICES CORP (786)308-1422 Cell Phone Valuation: Total Sq Feet: $ 3,800.00 0 Tons: Additional Info: NEW KITCHEN AND BATHROOM Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: NEW KITCHEN AND BATHROOM Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $2.00 $2.00 $0.80 $133.00 $3.00 $3.20 $146.40 Pay Date Pay Type Invoice # MC-3-18-66663 03/08/2018 Credit Card 03/05/2018 Credit Card Amt Paid Amt Due $ 96.40 $ 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 inform- i. is accur a and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above- . m=. contracr to do the work stated. March 08, 2018 Authorized Signature: Owner / Applicant / ontractor / Agent Date Building Department Copy March 08, 2018 1 tAA BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC PLUMBING MECHANICAL 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 ❑ ROOFING RECEIVED MAR 05 2018 FBC'20 Master Permit No. 2-1, iR - 1 S \ Sub Permit No. I ` I C' S.S • ❑ REVISION ❑ EXTENSION ❑ RENEWAL ▪ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 560 Nib 6 o 1 City: Miami Shores Folio/Parcel#: 8-1 County: ll� 213(e,013.rOjtb Occupancy Type: Load: Construction Type: Miami Dade Zip: 3313' Is the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): e10 �� Cl.n ! a rOl r-e Q4n #: L/ tpi Address: ,, 9-AD NIS 1 O`"(ST City: Mitt r u S h t S State: Tenant/Lessee Name: Email: Slr L /S Q' j-o •ctYtv CONTRACTOR: Company Name: P �� LA.. Or Su Address: 3 ° Z p i''" City: 1/M.P WIC- , State: Qualifier Name: 1 J'CI(Pi Zip: 3313 ) Phone#: Phone#: 3 3O9 -/6/7L Zip: 30 T , Phone#: _ State Certification or Registration #: Certificate of Competency #: C 1 1 r I S ZJ DESIGNER: Architect/Engineer: Phone#: 9%� Address: ;,� % City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ,,, ❑ Ne }-�� n Repair/Replace�1❑ Demolition Description of Work: NtNV )L /- / LJf a I C L r J 3 ) -1-'U Ct( Specify color of color thru tile: �t Submittal Fee $ Permit Fee $ _ �>iivoriiiira AirCCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ 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 Signature 3.'Gz ,��-- CONTRACTOR The foregoing instrum,et was acknowledged before me this The foregoing instrument was acknowledged before me this 1 F �day of b � Y , 20 by 2...day of fiAarck , 20 �_ , by X Pt _ , who is onally kn OWNER or AGENT me or wh. as . roduced identification anl who did take an oath. NOTAR PUB C: _ Sign: Print: Seal: ro` LORETTA COMES MY COMMISSION # FF 954664 !'� EXPIRES: March 21, 2020 4�op Fog. Bonded Bonded Thai Budget NotarySerrkes me or who has produced identification : not who id take an oath. N ' ffARY P Sign: Print: Seal: 41111.41111111111 _ Ili o LORETTA COMES * r * MY COMMISSION # FF 954664 EXPIRES: March 21, 2020 o,+rfoFFtd Bonded Thru Budget Notary Services as i ######*#*******#####*######]E####*** #### ###############################******############################# APPROVED BY Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk U i (jot �� ; ! �( ` ,fC.-t..' 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 ��t �Y-�.wFee - w:-�� fix. �iL�#._.: Y'�ii[�� _t�1��t'4f» � X��Y4�.6�U!`r �• �u..�•'Mi i/9 ':'"L�"�iAMi,..p�..�l, fi"^� sws...� 4..w .. .�.e .,., _..,. _. e..... .. 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 I. 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; i 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 s .cknowiedge before me this'.' day of tAr4../r, 70 (� . By No ry: w . is personally known t9 me has produced as identification. ra �� LORETTA COMES SEAL: * -(_� o* MY COMMISSION 0 FF 954664 ! EXPIRES: March 21, 2020 vrireoppd Bonded Thru Budget Notary Services Prime Air Service Corp 30120 SW 156 Ave., Miami FI. 33033 October 26, 2017 State of Florida County of Miami -Dade Before me this day personally appeared Bernardo Pla who, being duly sworn, deposes and says: ,That he will be the only person working on the project located at: 390 NE 104 Street Miami Shores, FL 33138 Sworn to and subscribed before me this 26th day of October, 2017 by Bernardo Pla Personally known/ R Produced Identification Ty• = of Identif tion Produced 4,ofe Type tbgeftwak§ of Notary * . * MY COMMISSION 0 FF 954664 EXPIRES: March 21, 2020 d>.44,0Fri Bonded ThruBudgetNotary Services