MC-18-1834Miami Shores Village
10050 N.E. 2nd Avenue NW
"
Miami Shores, FL 33138-0000
Phone: (305)795-2204
F�ORIOp'
Permit NO. MC-7-18-1834
Permit Type: Mechanical - Residential
Perlillot
Worts Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 7/13/2018 1 Expiration: 01/09/2019
Project Address Parcel Number Applicant
175 NW 100 Street 1131010230320
Miami Shores, FL 33138- Block: Lot: CHRISTIAN LANSER
Owner Information Address Phone Cell
CHRISTIAN LANSER 175 NW 100 Street (305)772-4313
MIAMI SHORES FL 33150-
175 NW 100 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone
SANTOS A/C MECHANICAL CONTRA( (305)450-8238
Tons:
Additional Info: RELOCATE A/C AND NEW DUCTWORK
Classification: Residential
Approved: In Review
Comments: Date Approved:: In Review
Date Denied: Type of Work:
Scanning: 1
Fees Due
Amount
CCF
$3.00
DBPR Fee
$2.63
DCA Fee
$2.00
Education Surcharge
$1.00
Permit Fee
$175.00
Scanning Fee
$3.00
Technology Fee
$4.00
Total:
$190.63
Valuation: $ 5,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC-7-18-68154
07/13/2018 Credit Card $ 140.63 $ 50.00
07/06/2018 Check #: 1555 $ 50.00 $ 0.00
Avauaoie
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.
OWNE S AFFIDAVIT: II� ZAj at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constr ction and zonirlr�!/F1i ermore- 1pociz�he above -named contractor to do the work stated.
July 13, 2018
Ruthorized Sin ner / Applicant / Contractor / Agent
Building Department Copy
1
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Miami Shores Village
g J L 0 2018
Building Department BY
d, G --
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 llzZ ll
FBC20��
BUILDING Master Permit No. F\9-- 4-7-7—
PERMIT APPLICATION Sub Permit No. I el - 8
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING XMECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
11, CONTRACTOR DRAWINGS
10B ADDRESS: I !� "" I D o �`��
1
City: Miami Shores County: Miami Dade Zia: 3� �
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:,, \ Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): <::- iZ l S� Lo�05cyA- Phone#: 3aS jl1Z--�f 313
Address:
^'
City: S:5 5 State: �� Zip:
Tenant/Lessee Name: Phone#:
Email: -5e-A LJ��Co—c;' C-*g
CONTRACTOR: Company Name: ittNM 5 MEL�ll.1C1. Phone#: _S — >t7�%23fS
Address: ,Z $ I 0 S w laµ 4C'S11Yt�t"^
City: M l PtM I 1 . State: Zip: 331 joJ
Qualifier Name: �a %� t"lC r%�_ Phone#: 3D — '-Irsb" �3
State Certification or Registration #: C M L 12-4q 1 c'2 O Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: L City: State: Zip:
Value of Work for this Permit: $ `Square/Linear Footage of Work:
Type of Work: ❑ Addition ( Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: l.b GR11�� N'��-% bV 44-
Specify color of color thru tile:
Submittal Fee $'S0 - (R) Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $ .
Radon Fee $
WA!r
Training/Education Fee $
CCF $
DBPR $ 2 '
CO/CC $
Notary $
Double Fee $
Bond $ TOTAL FEE NOW DUE $ ( 1 U 0 •
(Revised02/24/2014)
J
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 charge
Signat a 1.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
(O day of 120 by
La who who is personally known to
d.
Signature
CONT CTOR
The ff oregoing instrument was acknowledged before me this
(C�+�, day of S — 20 � by
who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: l' �c—
Print: Print:
Seal: ;`+P`��; Notary Public - State of Florida Seal: ;�' w`��; Notary Public - State of Florida
_• : • Commission Ar FF 182380 =• . •_ Commission # FF 182380
My Comm. Expires Apr 3, 2019 z.; My Comm. Expires Apr 3, 2019
'' •°� t• `` Bonded throw NatkMW Notary Assn. •�4f�� t`•%•� Bonded through National Notary Assn
rssrrrr r rrrsassss*s**s*r*rs r r• r * r s r***r*srs**srrrr
771
APPROVED BY �O ` Plans Examiner 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 Uwner — worKers, compensation Insurance Exemmon
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.
Si ature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of 20'
y� rz-
MAHARAI K.GOn(zALEZBywho is pern tawyflMMhy@i oz
EXPIRES: November 2, 2020
«� as identification.BondedThruNotaryPublicUnderwriters
Nota
SEAL: