MC-17-2449Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. MC-10-17-2"9
Permit Type: Mechanical - Residential
ertI I Work Classification: Addition/Alteration
Permit Status: APPROVED
Parcel Number
Issue Date: 11/30/2017 1 Expiration: 05/29/2018
Applicant
7 NE 91 Street 1132060130080
ANCAR GLOBAL COMPANY
Miami Shores, FL 33138- Block: Lot:
Owner Information
Cell
ANCAR GLOBAL COMPANY 7 NE 91 Street (786)484-9143
MIAMI SHORES FL 33138-
7 NE 91 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
GARP CONSTRUCTION GROUP INC (305)506-5068
4dditional Info: AC CHANGE OUT, MINOR ALTERATIONS
classification: Residential
kpproved: In Review
Date Denied
Scanninq: 1
Fees Due
Amount
CCF
$2.40
DBPR Fee
$2.10
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee
$140.00
Scanning Fee
$3.00
Technology Fee
$3.20
Total:
$153.50
Valuation: L4,OOO.00
Total Sq Feet:
Date Approved:: In Review
Type of Work: AC CHANGE OUT, MINOR ALTERAT
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC-10-17-65338
11/30/2017 Check #: 1472 $ 103.50 $ 50.00
10/12/2017 Check* 1442 $ 50.00 $ 0.00
Avauame 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 as me re onsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRIC PLU G, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFID/11T. I cert' that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction andi _ orize the above -named contractor to do the work stated.
November 30. 2017
Authdrized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
November 30, 2017
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
W9
� CT 2017
Y:
FBC 2014'
BUILDING Master Permit No. Rc n— I(,Z(
PERMIT APPLICATION Sub Permit No. MC -- (i 2441
BUILDING M ELECTRIC M ROOFING REVISION EXTENSION RENEWAL
❑PLUMBING 4 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�CONTRACTOR DRAWINGS
JOB ADDRESS: 1 0 Q q I _�
City: Miami Shores County: Miami Dade Zip: IV
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1-1 on/;C._C C—, LQ bCi / ,2M.WthiAe#:
Address: :2 hi. i I
City: (n 1&jm'k s k =C a" State: t' 1 Zip: LET
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: n� Jn�"' Phone#:
Address: a LV S� B.& 7S -4 4 - 9143 -� M I Kf
City: State: Zip: ?N301(0
Qualifier Name: tl//��_;4't Phone#:
State Certification or Registration M e40, /9/906.2- Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ �� f� O� Square/Linear Footage of Work --
Type of Work: ❑ Addition Alteration ❑ New " u Repair/Replace
II❑Demolition
i
Description of Work: '
Specify color of color thru tile:
Submittal Fee $ C Permit Fee $ CF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ 1 Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 1 133 ` T'0
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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.--7 ('?
Signatur Signature -I
OWNER or AGENT CONT ACTOR
The foregoing instrument
was acknowledged before me this
1 day of d "l 20 by
B S ViVea0, who is personally known to
me or who has produced Q C,S,Spn as
identification and who did take an oath.
NOTARY PUBLIC: r�a�;;;�RICCARDO MILE
Commission # PF 87042
-* *' My Commission Expires
Sign:
%:'•afti�.� anuary 28, 2018
r� ,,,,���•��
Print:
Seal:
The foregoing instrument was acknowledged before me this
'i✓a day of 20 by
t �
who is personally known to
me or who has produced 1 SN as
identification and whi
NOTARY PUBLIC:
Sign:
Print: C'
Seal:
RICCARDO BAILEY
Commission M PF 87042
My Commission Expires
January 28, 2018
*******:�*****s***•x*s:�****s*ss*******ss*t***�s*ss*sss**********#s*s********sra*ss*sus***�****s*s��****s*r
APPROVED BY � � � � PI s Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
/.4
0
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.
_ P
Job Address (where the work is being done):& W j
City: Miami Shores Village County: Miami Dade
Zip Code: _:n 1
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
i
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
A U
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
I&
YES
NO
REPLACING DUCTS
YES
N
YES
NO
REPLACING THERMOSTAT
YE
NO
YES
NO
NEW 4"CONCRETE SLAB
Y
NO
YES
NO
NEW ROOF STAND
Y S
NO
YES
NO
NEW RETURN PLENUM BOX
E
NO
1. Minimum Circuit Ampacity (Wire Size):
2
3
4
Maximum Overcurrent Protection (Fuse/Breaker Size):
Voltage of Circuit (208C180):
Size Disconnecting Means: T -A
Contractor's
State Certificate
Signature
Phone: --�/� Sd r� V,
Certificate of Competency No.
(Revised02/24/2014)
GrA�
('ONSJ'Jk[X"J fON QR.C)UP !NC
Date: j
State of PlAir' rY�c.
County of n 10,616,
Before me this day personally appeared Gwho, being duly sworn,
deposes and says:
That he or she will be the only person working on the project located at:
c
Contr ctor Sianatu/
Sworn to (or affirmed) and subscribed before me this la day of gn . .20_t_T,
by�y
Personally know,
Or produced Identification
Type of Identification Produced
FERNANDO ARI r
Notary Public �sm
t ri
My com 19,
ommission067i .
Print, Type or Stamp Name of Notary
Miami shores Village
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:
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;
The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
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.
Signat e:
O er r
State of Florida
County` of Miami -.Dade
The foregoing wads• acknowledge before me this % � day of
G CA
,20 1-1 .
By e V ► V who is personally known to me or has produced
as identification.
Notary:
SEAL: „Y ..:. BAILEY
.. fi 'Cl:.
+ IS
( innuis'. ui B PF 87042
s. �c PS,, Comiwss-un Expires