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MC-17-2964Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit No. MC-12-17-2964 Permit Type: Mechanical - Residential Work Classification: A/C Replacement Permit Status: APPROVED issue Date: 12/19/2017 1 Expiration: 06/17/2018 Project Address Parcel Number Applicant 10125 BISCAYNE Boulevard 1132050190190 BISCAYNE 10125 LLC Miami Shores, FL 33138-2647 Block: Lot: Owner Information Address Phone Cell BISCAYNE 10125 LLC 10125 BISCAYNE Boulevard (786)390-3177 MIAMI SHORES FL 33138- 10125 BISCAYNE Boulevard MIAMI SHORES FL 33138- Contractors) Phone Cell Phone SUNNY HORIZONS, LLC (305)281-1592 5 Valuation: $ 4,000.00 Total Sq Feet: 0 tional Info: NEW VENTILATION DUCTS AND NEW A/C sification: Residential oved: In Review ments: Date Approved:: In Review Denied: Type of Work: NEW VENTILATION DUCTS AND NEb ning: 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 Pay Date Pay Type Amt Paid Amt Due Invoice # MC-12-17-65934 12/18/2017 Check #: 2695 $ 50.00 $ 103.50 12/19/2017 Credit Card $ 103.50 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 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 an 14Qning._ Futhermore, I authorize the above -named contractor to do the work stated. December 19, 2017 MuthorizId'Signature: Owner / Applicant / Contractor / Agent uate Building Department Copy December 19, 2017 1 vo� � 4� \a e1\0)"-*' Miami Shores Village RECEIVED Building Department /DEC 18 1017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 ll INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2W BUILDING Master Permit No.1AL "(03`-'1 PERMIT APPLICATION Sub Permit No. NI 1 C l--i - C�L.111( ''l ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ® MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: of ZS !�1 aY E E7w*b • 0 <Wll i l C7k Q-s iru37, 1s.% City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: (1 - 3Z0S- 0141 -Q ('jl7 Is the Building Historically Designated: Yes NO Occupancy Type:Vh;J"oad: Construction Type:�Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): i�L�Gc�i�G 10125 Phone#: Address: ((D$D I-QiAtcibaK AA, 1�3(D City: LA i) -u I' dee /rC(A State: P L Zip: 37. 113 1 Tenant Email: CONTRACTOR: Company N,Qfamle: ! )+ q L4y2 q oL*4 Ito- Phone#: 3n5- 281 -1 S9- Z SW Address: L V80 D 8q S;bl-> e f::,Z City: wy� t 1, State: i✓ t-- Zip: 33 143 Qualifier Name: �Aitl �RD C' D;1 Phone#: 305- ZS 1 - Is�iZ State Certification or Registration #: L 0C as-Dq'7 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State Value of Work for this Permit: $ lI DO D - 00 Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition El Alteration El New ' W Repair/Replace ❑ Demolition Description of Work: .tit/ 1���%n (�4 , k CIA ,/ I x—o Alt 1b . Specify color of color thru. tile: Submittal Fee $ Permit Fee $ Y O CCF $ CO/CC $ Scanning Fee $ Radon Fee $ - DBPR $ 2 (d Notary $ Technology Fee $ Structural Reviews $ Training/Education Fee $ Double Fee $ Bond$ TOTAL FEE NOW DUE $ �O3 (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 I, 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. li4 Signatur Signature OWNER or A NT CONTRACTOR The foregoing instrument was acknowledged before me this 141— day of Jece, ,f 6es- 20 / 7 by v ,egon�o��, jjl% , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: /sue Print: G sbPi/4i 4we-, Seal: Pby:NO,,, Ldeth Lopez Pimentei a• COMMISSION tFFM57 == EXPIRES: September 30, 2019 as The foregoing instrument was acknowledged before me this W'1k _ day of`1120-giGLil 20 t' by ARtyc-`ROM&09---�- , who is personally known to me or who has producedaR&2 MQ-� f-7Z&- ( as identification and who did take an oath. NOTARY PUBLIC: Sign: Jessica Socarras Print/. '16 Seal: W4011 STATE OF FLORIDA Comm# GG079849 Expires 3/6/2021 ***************' •• ••**'WIIrVMI�:A/fR180E1M�************************************************************* APPROVED BY y F lA kam ner Zoning Structural Review Clerk (Revised02/24/2014) 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 constriction industry to exempt themselves from this requirement for any constriction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the constriction industry who employs one or more part-time or frill -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. Constriction exemptions are valid for a period of two years or until a voluntary revocation is tiled 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. = - `.. A etm M,-- State of Florida County of Miami -Dade The foregoing was acknowledge before me this 141 — day ofrieL�r 20-1-9-. By�y t U Re» e de Y-1 who is personally known to me or has produced as identification. Notary: SEAL: v�tlri � Lisbeth Lopez Pimentel COMMISSION #FF922657 EXPIRES: September 30, 2019 *1, .�RW WWW.AARONNOTARY.COM Sunny Horizons LLC 10800 SW 84 ST Suite F2 Miami, FL 33173 December 14th, 2017 State of Florida County of Miami Dade Before me this day personally appeared Ariel Rodriguez who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 10125 Biscayne Blvd. Miami Shores, FL 33138 Contractor Signature Sworn to (or affirmed) and subscribed before me this /'/ (A day o4re,?-,u3re bz- 20L, by &('qj 'PDdiu`I" of 4 Personally know or Produced Identification 6 -2- -06 a -- Type of Identification Produced !R a t�tr l Jessica Socarras NOTARY PUBLIC c o STATE OF FLORIDA : Comm# GG079849 ,.Fes 302021 pe 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 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): * ;7160,a� City: Miami Shores Village County: Miami Dade Zip Code: 33/vO 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 # A) D KW HEAT /19 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 YE NO YES NO REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES N 1. Minimum Circuit Ampacity (Wire Size): t(d .2 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): ZED V-1 P 4. Size Disconnecting Means: Contractor's Company Name: <L)!1VP(1 Phone: '30S -ZcKI 45"1 Z State Certificate or Reg ratio o. Certificate of Competency No. Signature Date: -L/2Z-:/ /I[Z Q I� ualifi s signature) (Revised02/24/2014)