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MC-18-2163y` Miami Shores Village `yeoR£s 10050 N.E. 2nd Avenue NE �• ""� Miami Shores, FL 33138-0000 Phone: (305)795-2204 FCORtDA Permit NO. MC-8-18-2163 Permit Type: Mechanical - Residential Pen t Work Classification: Addition/Alteration Perit Status: APPROVED Issue Date: 8/17/2018 1 Expiration: 02/13/2019 Project Address Parcel Number Applicant 1199 NE 102 Street 1132050190010 Miami Shores, FL 33138-2649 Block: Lot: ANELIA SHAHEED Owner Information Address Phone Cell NIHAR PATEL 1199 NE 102 Street (248)561-1523 MIAMI SHORES FL 33138-2649 1199 NE 102 Street MIAMI SHORES FL 33138-2649 Contractor(s) Phone Cell Phone AIR SYSTEMS CONTRACTOR INC (305)224-3972 Tons: Valuation: $ 14,000.00 Total Sq Feet: 0 iional Info: RENOVATION AND HOME IMPROVEMENTS TO sification: Residential oved: In Review ments: Date Approved:: In Review Denied: Type of Work: RENOVATION AND HOME IMPROVE ning: 1 Fees Due Amount CCF $8.40 DBPR Fee $7.35 DCA Fee $4.90 Education Surcharge $2.80 Permit Fee $490.00 Scanning Fee $3.00 Technology Fee $11.20 Total: $527.65 Pay Date Pay Type Amt Paid Amt Due Invoice # MC-8-18-68544 08/14/2018 Credit Card $ 50.00 $ 477.65 08/17/2018 Credit Card $ 477.65 $ 0.00 tivanaoie mspecuons: 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 rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructionjaad-Z6-nW. Futhermore, I authorize the above -named contractor to do the work stated. August 17, 2018 A Afior ed Signature: Owner / Applicant / Contractor / Agent Buil ing Department Copy August 17, 2018 Miami Shores Village l Building Department WAUGI18 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 200 � BUILDING Master Permit No. �9(, ` S-�ri—Io1�S PERMIT APPLICATION Sub Permit No. RC 2163 ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING 0 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1199 NE 102ND STREET City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3205-019-0010 Is the Building Historically Designated: Yes __ NO X Occupancy Type: Load: Construction Type: Flood Zone: X BFE: NA FFE: OWNER: Name (Fee Simple Titleholder): NIHAR PATEL/ANELIA SHAHEED Phone#:954-261-5218 Address:1199 NE 102ND STREET City: MIAMI SHORE State: FL Zip: 33138 Tenant/Lessee Name: NA Phone#: NA Email: AILENALOVE@HOTMAIL.COM CONTRACTOR: Company Name: Li / Srili7 S ��'%' 'Y��C 7�'� Phone#: ��'� 2e? d Address: -i -,"Sad -Ve,j4 �-^1A r '- City: State: �C!-1<<�-� // ,,.." Zip: ( p / k- �,-'4-4 cl QQ/��1 ,1 'sJ Phone#: - 7� Z Z 4 3G!_-i z. Qualifier Name: � ,.,.° State Certification or Registration #. / 3 % 7 / Certificate of Competency #: DESIGNER: Architect/Engineer: STEPHEN BRASGALLA PA Phone#: 954-614-3801 Address:6991 W BROWARD BLVD SUITE 100 City: PLANTATION state: FL Zip: 33317 Value of Work for this Permit: $ / Lyi047`1 '. Square/Linear Footage of Work: Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition Description of Work: RENOVATION AND HOME IMPROVEMENTS TO EXISTING HOME, KITCHEN BATHROOMS AND GENERAL OVERALL. Specify color of color thru tile: I Submittal Fee $ v a 1 Ck Permit Fee $ q /� Radon Fee $ ly DBPR $ Notary $ Scanning Fee $ Technology Fee Structural Reviews $ Training/Education Fee $ v CCF $ CO/CC $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) NA Bonding Company's Address NA City NA State NA Mortgage Lender's Name (if applicable) AIG HOME LOAN Mortgage Lender's Address PO BOX 77404 city EWING State NEW JERSEY Zip NA Zip 08628 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 OWNER or AGENT el The foregoing instrument was acknowledged before me this q1\ day of M OJJ 20 (O , by ochle'l 141 -S hAeewl. who is personally known to me or who has produced identification and who did take an oath. NOTARY Sign:_ Print: Seal: = , "'g :, Notary Public -9tateofFlorida • ` Commission # GG 097441 N�• , Mv4omm. Expires Aug 20, 2021 Bonded throuahNational Notary Assn Signature '5�e CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 by who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print: MY COMM IM 8 GG 211203 Seal: ; , EXPIRES' My24,2M Ai"O; as APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Date: 3 State of County of Before me this day personally appeared 1&WVt1,. 44Z,4) who, being duly sworn, deposes and say: That he or she will be only person working on the project locate at: r� Con ra or signature Swo n to (or affirmed) and scribe before e 's - day of 2018 by k, ,vd .. Personally knout _.• JUANL.CABALLERO MY COMMISSION # GG 211203 Or produced identi 7 ation �.F EXPIRES: July24,2022 Eox F`� Bonded Thru Notary Public Underwriters Type of identification produced='"' Print type or stamp name of notary Notice to Owner — Workers' Com Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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 The foregoing was acknowledge before me this i 3 day of Agaves -Z , 20 . 1 � Byj�Q, j ( �hahe (c� who is personally known to me or has produced as identification_. ' OFUM FERN Ndwy pwft • sun of fww COnWMooioa 0 FF 9n?9? IV Com. Exekaa Jan 22 "A ( STATE OF FLORIDA DEPARTMENT db&'*-%r ROF BUSINESS p EGULATION AND PROFESSIONAL CAC1817321 ISSUED:06/29/2018 CLASS B AIR CONDITIONING CONTRACTOR SANTANA, ALEXANDER AIR SYSTEMS CONTRACTOR INC 0-SjghatuFe LICENSED UNDER CHAPTER 489, FLORIDA STATUTES EXPIRATION DATE: AUGUST 31,'2020