MC-18-3143Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date:11/01/2018
Parcel Number
9632 NE 5 AVE, Miami Shores, FL 33138 1132060170140
Contacts
Permit No.: MC-10-18-3143
Permit7'ype: Mechanical - Residential
Work Clossifrcation: Alteration
Permit Status:
Expiration: 04/09/2019
DAVID ELIAS HALABU Owner DAVID ELIAS HALABU Applicant
9632 NE 5 AVE, MIAMI SHORES, FL 33138 9632 NE 5 AVE, MIAMI SHORES, FL 33138
Other:3052137625 Other:3052137625
AIR SYSTEMS CONTRACTOR INC Contractor
ALEXANDERSANTANA
9300 W FLAGLER ST 202, MIAMI, FL 33174
Business: 3052243972
Description: DUCT WORK AND INSTALLATION OF NEW Valuation: $ 20,000.00 Inspection Requests:
SYSTEMS 305-762-4949
Total Sq Feet: 2,250.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$12.00
DBPR Fee
$10.50
DCA Fee
$7.00
Education Surcharge
$4.00
Notary Fee
$5.00
Permit Fee
$650.00
Scanning Fee
$3.00
Technology Fee
$17.50
Total:
$759.00
Payments Date Paid
Amt Paid
Total Fees
$759.00
Credit Card 11/01/2018
$709.00
Credit Card 10/11/2018
$50.00
Amount Due:
$0.00
Building Department Copy
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 constru and zoning. Futher���rize t e abov��c..�ed con actor to do the work stated.
Owner % Applicant / Contractor / Agent
Date
November 01, 2018 Page 2 of 2
Miami Shores a Villa
�Go g
\d� C T 11 2 8
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
FBC 2r10
y
BUILDING Master Permit No. 94" IQ- I-Jrs�
PERMIT APPLICATION Sub Permit No. KC
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING $ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: G G R 1" E J— A%, qD
City: Miami Shores County:
County Miami Dade Zip 13
Folio/Parcel#:I(- 3� 4 —017 C Is the Building Historically Designated: Yes NO
Occupancy Type: k_ Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):_ DC't/'—A 4'. Phone#: k5'' a V— 76 -
Address:-►l��ix %U S'� �/� �� {^,,
City: I % �'E 5 State: � (, Zip: 3, 03
Tenant/Lessee Na`�e: Phone#:
Email: NAV 1A UL le -AM
CONTRACTOR: Company Name:
-4 C Phone#: e-39' 5 ZzZ% � l 7 Z
Address: h%) ,0 S'Y f Z
City: "% C.1/ State: Zip:
Qualifier Name: ��✓�i�1 Q/ S�� d � Phone#: -5d 5 Z?—/ S 1 ? z
State Certification or Registration #: j 7 Z % Certificate of Competency #:
DESIGNER: Architect/Engineer: _ Phone#:
Address: 3Pg) " City: �,,e.,e / State: ,4-/—z Zip: 3 3 / ? 4
Value of Work for this Permit: $ 219 UD d Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration, ❑ New J ❑ jpair/Replace/ ❑ Demolition
Description of Work: /�G�`� �.UrN ��( (1� Jl7S-
Specify color of color thru tile:
Submittal Fee $� Permit Fee $ti _ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $� 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
Zip
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 V .' / \1 Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of PG`� 20 iy by
--,who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY P BLIC:
r
Sign: Aw
Print:i�-1 /"� ✓
Seal: — - — -
#######
CONTRACTOR
The foregoing instrument was acknowledged before a this
((���p vday of O�� 0 by
f� l/� n nyx �✓l ,snperssoonaall yoknown to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Si n
*;JL:*; MY COMMISSION # GG W602
Print: 20
Seal:
Bonded Thru Notary Public Underwriters
Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
Notice to Owner — Workers' Corn
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:
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;
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 �day of �� , 20191.
By �.1�//f`/��.�1.� who is personally known to me or has produced
as
Notary:
SEAL: / —
�: MY COMMIS$l0N �1203
T�N*aryPifttM omfte►s
Date:
State of 17'e A e
Countyof
Before me this day personally appeared (Ayk' A- VO
who, being duly sworn, deposes and say:
That he or she will be only person working on the project
locate at:
-t G 3 21 /b/ —� ':� / �, A v 0 /yJ e /2c AeY i d/<' S�%�:�_.3 / 32
Contra for signature
Sworn t or affirmed and subscribe befor m this��a
C ) �, Y
of 2018 by -1
Personally kno4�0-
Or produced ide ' ' ation
Type of identification produc
Print type or s M
me of
notary
i`'"�'`' JUAN L CABALLERO
•; ;.; M COMMISSION # GG 211203
•''F�RF��POY' PIR�EµS,:�J�upply2��4�,2=
SWKW .j, Thru "`^vl ruu11G U