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MC-15-1469Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-236872 Permit Number: MC -6-15-1469 Scheduled Inspection Date: July 15, 2015 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: TIED, TUYEN Work Classification: A/C Replacement Job Address: 10634 NE 11 Avenue Miami Shores, FL Phone Number Parcel Number 1122320280650 Project: <NONE> Contractor: ARTIC BREEZE AIR CONDITIONING CORP Phone: (305)485-4085 Building Department Comments REPLACE 2 A/C UNITS Infractio Passed Comments INSPECTOR COMMENTS False r Po l Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. July 14, 2015 For Inspections please call: (305)762-4949 Page 16 of 39 `yNoaes Miami Shores Village 10050 N.E. 2nd Avenue NE CCF $2.40 Miami Shores, FL 33138-0000 yap Phone: (305)795-2204 Permit IVO. MC -6-15-1469 Permit Type: Mechanical - Residential erm'It work Classification: A/C Replacement Permit Status: APPROVED Issue Date: 7/7/2015 1 Expiration: 01/03/2016 Project Address Parcel number Applicant 10634 NE 11 Avenue 1122320280650 TUYEN TIED Miami Shores, FL Block: Lot: Owner Information Address Phone Cell TUYEN TIEU 10634 NE 11 Avenue MIAMI SHORES FL 33138- 10634 NE 11 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone ARTIC BREEZE AIR CONDITIONING C (305)485-4085 3 Additional Info: REPLACE 2 A/C UNITS Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Fees Due Amount CCF $2.40 DBPR Fee $3.15 DCA Fee $3.15 Education Surcharge $0.80 Permit Fee $210.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $225.70 Date Approved:: In Review Type of Work: Valuation: $ 4,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC -6-15-55981 06/15/2015 Credit Card $ 50.00 $ 175.70 07/07/2015 Credit Card $ 175.70 $ 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 certifAthat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and kning. Futh ore, I authorize the above-named contractor to do the work stated. t July 07, 2015 Author" -e ,S"ner / Applicant / Contractor / Agent Building Department Copy July 07, 2015 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 Civt, Cl BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING 1-, ,W%/Ir JUN 16 2615 I , a—&J FBC 20t6 Master Permit No Sub Permit No. iM e cT ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING XMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ! y {61 �� 1 V L. f 1 1y"� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO (— Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee ` I vSi/mplee &�6w Titleholder): 6b � ���Ane#: 1� I 24 LZ�j Address: 1 V� 3q E l (,- h itc , City: i"� l_Q�'1/1 t CYC State: .– Ziip1:�/��T— Tenant/Lessee Name: r c Phone#: Email: � 6 -) O� ►�-(� �l/� ria I - oyvl J v CONTRACTOR: Company Name: �/�'/� /�G ���P � � ��' Ph ne# Address: City: i State: Zip`: Qualifier Name: pd�rZ Phone#: State Certification or Registration #: lel OY Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work, -for this 'Permit: Square/Linear Footage of Work: Type_of_Work: ❑ Addition Alteration ❑ New ,� Repair/Replace ❑ Demolition Specify color of 'co/or�thru'tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Permit Fee $ cL A V iV Radon Fee $ _ Training/Education Fee $ CCF ,,, CO/CG'$, DBPt $ .rr Notary $4 Bond $ TOTAL FEE NOW DUE $ �� J Q 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 charge Signature OWNER or AGENT The foreping instrument was acknowledged before me this J %� 7 -day of JIL4A`t 20 1 5 by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: f d �L.z-dL� Seal: ALFREDO My Comm: Expi► APPROV D BY� Commis " n (Revised02/24/2014) d. Signature CONTRACTOR The f+oyrggoing instrument was acknowledged before me this 6 f'� day of Mlk?k- 20 by h l f tA2 Do K,6V9 X Lk-Vvho is personally known to has /���' o ^ `� ��� �x.►�h�n' me or who produced as identificatiori and Who did talo a aan o~athI.111=--� NOTARY PUBLIC: Sign: ONELIO SANCHEZ Print: STATE OF FLORIDA Seal: W.., Comm* FF078789 Fires 3/26/2018 V Pla xa iner Zoning 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. 1 Job Address (where the work is being done): ti N GLS M(�Ml 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 ❑ i UNIT BEING REPLACED DATA NEW UNIT CN 1 i L MISS, MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT rA%-\ '41- ��� ly ��X 140 z JLr 1W /4 P� /ski (-SX I o 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 Signature to.,° i-Am/,)al7ma1 Kation No. Certificate of Competency No. Date:. (Qualifier's signature) 2 Artic breeze and Air Conditioning 9971 SW 45' St Miami, FL 33174 786-853-2680 Date: June 15'h, 2015 State of Florida County of Miami -Dade Before me this day personally appeared Ricardo Rodriguez, who, being dully sworn, deposes and says: That he will be the only person working on the project located at: 10634 NE I P Ave, Miami Shores, FL 33138. Sworn to Or Affirmed) dtih subscri Lo •••,µY P�I �P '�;6s AlFRE00 VII.IOlRO Notary Public • State Of Florida ,4- ��? My Comm. Expires May 21, 2017 ��'• IFOF �� ;:••• Commission # FF 020511 me this 15'' day of June, 2015 by Ricardo Rodriguez, Personally known OR Produced Identification Type of Identification produced �_L Zt4p_,, e �_ 36 2 -; 3�-t�-,9- 22f o Print ype 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: 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 -rime 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: C/ Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this ) day of _� 1,/�k , 20 By nAb`n,`b i who is personally known to me or has produced as identification. Notary: �` l�l� '�""Y "�~''•, ALFREDO V11.1.0V11.1.01.061V11.1.01.061O �ice° Notary Pub ie - State aft Florida SEAL: My Comm: Expires MAY41, 2017 °..�� •' Commission N FF 020511 l' �-� v \-j wog COs 106 it y �1/Cw- ",OPV WIc r ec - .�� %007 o f•.... • . 0000 0000.. 0000 .. ... •• . 00.0.0 �lu;,rr n Jy � 0000.. •••�/ w • • •••*•o•o•o • • •••••• • 0 • ELECTRIC SCHEDULLI 120/240 100A CKT Ila IlDescription C.B Pole CKT Description C.B Pol New Microwave 20 1 2 Range 50 2 1 b Small Appliance 20 1 3a Small Appliance 20 1 4 Range 50 2 3b General lighting 20 1 5a General lighting 20 1 6a General lighting 15 1 5b JlDryer 30 2 6b General lighting 15 1 7a Drver 30. 8a Dish Washer 20 1 7b General lighting 15 118b General lighting 15 1 9a General lighting 15 1 10a Refri 20 1 9b General lighting 15 1 10b Water/Heater 30 2 11 a lGeneral lighting 15 1 12a Water/Heater 30 11 b Generallighting 15 1112b General lighting 15 1 ec - .�� %007 o f•.... • . 0000 0000.. 0000 .. ... •• . 00.0.0 �lu;,rr n Jy � 0000.. •••�/ w • • •••*•o•o•o • • •••••• • 0 • . . ... . . . ... . ..... .... x F,. • • • • • • • • • .NWa.<£FFk'akgF§C1:piKs;'e3. rent design drawing ID number: 0000-8541-1508 (EA cannot accept any liability for the accuracy of measurements or furniture layout. Prices in this program are for products you collect from IKEA, )ke home and assemble yourself. All requested delivery, assembly and installation services are charged separately and not included in the price. Ithough we do try to ensure that the information in this program is correct, we apologise for any product alterations that may occur. All prices are alid until June 30, 2015 JUN; 12 2015 rPERM17 #: MIAMI SHORES VILLAGE - APPROVED BY DATE ZONING STRUCTURAL ELECTRICAL PLUMBING 4z-, MECHANICAL BLDG, �711j . SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONm f t 1` F , i i rent design drawing ID number: 0000-8541-1508 (EA cannot accept any liability for the accuracy of measurements or furniture layout. Prices in this program are for products you collect from IKEA, ike home and assemble yourself. All requested delivery, assembly and installation services are charged separately and not included in the price. Ithough we do try to ensure that the information in this program is correct, we apologise for any product alterations that may occur. All prices are alid until June 30, 2015 rent design drawing ID number: 0000-8541-15ub A (EA cannot accept any liability for the accuracy of measurements or furniture layout. Prices in this program are for products you collect from IKEA, ike home and assemble yourself. All requested delivery, assembly and installation services are charged separately and not included in the price. ]though we do try to ensure that the information in this program is correct, we apologise for any product alterations that may occur. All prices are alid until June 30, 2015 'rent design drawing ID number: 0000-8541-1508 <EA cannot accept any liability for the accuracy of measurements or furniture layout. Prices in this program are for products you collect from IKEA, 3ke home and assemble yourself. All requested delivery, assembly and installation services are charged separately and not included in the price. Ithough we do try to ensure that the information in this program is correct, we apologise for any product alterations that may occur. All prices are alid until June 30, 2015 .. .. . . . .. .. . • .;. see a C •♦ • • • •• • �""� �.r w • ••• • • • 4•• • • • Awl 'rent design drawing ID number: 0000-8541-1508 <EA cannot accept any liability for the accuracy of measurements or furniture layout. Prices in this program are for products you collect from IKEA, 3ke home and assemble yourself. All requested delivery, assembly and installation services are charged separately and not included in the price. Ithough we do try to ensure that the information in this program is correct, we apologise for any product alterations that may occur. 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