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MC-16-2662Miami Shores Village 10050 N.E. 2nd Avenue N Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Parcel Number Permit NO. MC-9-16-2662 Permit Type: Mechanical - Residential Work Classification: A/C Replacement Permit Status: APPROVED Issue Date: 3/2812017 1 Expiration: 09/24/2017 Applicant 9400 N BAYSHORE Drive 1132050100110 Miami Shores, FL 33138- Block: Lot: AMINE DOUKKALI MARIELA B F Owner Information Address Phone Cell AMINE DOUKKALI MARIELA B ROVITO 801 N VENETIAN Drive (305)992-6776 --- MIAMI BEACH FL 33139- 801 N VENETIAN Drive MIAMI BEACH FL 33139- Contractor(s) Phone Cell Phone ECOZONE MECHANICAL CONTRACTI (305)978-6569 s: 5 Valuation: $ 45,000.00 Total Sq Feet: 4000 Additional Info: INSTALL 2 HVAC SYSTEMS AND MINI SPL Classification: Residential Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Work: INSTALL 2 HVAC SYSTEMS AND MIN Scanning: 1 Fees Due Amount CCF $27.00 DBPR Fee $23.63 DCA Fee $23.63 Education Surcharge $9.00 Permit Fee $1,575.00 Scanning Fee $3.00 Technology Fee $36.00 Total: $1,697.26 Pay Date Pay Type Amt Paid Annt Due Invoice # MC-9-16-61500 09/28/2016 Credit Card $ 50.00 $ 1,647.26 03/28/2017 Credit Card $ 1,647.26 $ 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 and zoninq. Eutheunore, I authofize the above -named contractor to do the work stated. March 28, 2017 Atlfhorized(54n'efure:Ownef / Applicant / Contractor / Agent Building Department Copy 1 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 fall -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: Q��J 1L__ Q AA! Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of N,� . , 20 �. By who is personally known to me or has produced cation. Ell. MAYRAM. BACALLAO Notary:IT COMMISSION # GG 083306 XPIRES: March 20,2021 SEAL: mru Notary Public undwmitm Ecozone Mechanical 840 W. 351h St. Hialeah, FL 33012 Contractors, Corp ecozonemech@gmail.com Office: 305-978-6569 Fax: 786-362-5769 Licensed & Insured Lic#CmC1250125 Date: State of County of Before me this day personally appeared L �`Q� who, being sworn, deposes and says: That he or she will be the only person working on the project located at Sworn to (or affirmed) and subscribed before me this ay off I4 by ' —Q �av'�ef �biec�, Personally knownV OR Produced Identification Type of Identification Produced MARTAI.FUENTES MY COMMISSION # GG 030259 EXPIRES: September 14.2020 Bonded Thru NoWy Public UM-*Tb" or StaVnp Name of Notary ' 1,. Miami Shores Village RECEIVED 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING SEP 11214 !- l FBC 201(4 t Master Permit No. P.,C t w- l q(ol Sub Permit No. M < 14 LUC) Z ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING fo MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ng / v !� r� 5 � ��� 46 /e i City: Miami Shores County: Miami Dade Zip: S I Folio/Parcel#: I I — 3 a d S " 6 f C'> — o 11 (7 Is the Building Historically Designated: Yes X NO Occupancy Type: �ftoad: Construction Type: 4�f g LI- Flood Zone: _ BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address City: Email State: l- L- Zip: J:? l 3 8 60 L /r el CONTRACTOR: Company Name: 114ik44 jo rAt- G,ureaoC7??9S r-60-p Phone#(3-62) 5 78--I:J(-1 Address: 1414 /?'� C"> ST 39 57 . City: H 1 A tea H State: f'-L Zip: 33U ►Z Qualifier Name: ZIQ V I E=,P- /-I,,//�� n"L) Phone#: (3-S-3 `i � `�" 4J6 � State Certification or Registration ##:�1CM C' /?�O) ZSr DESIGNER: Architect/Engin/ '� eer: c /"( C C-) —144 /9 r� Address: qq Value of Work for this Permit: $� 5 c Type of Work: ❑ Addition [Er Alteration 13 New Description of Work: --A✓1 5 V v.4r_ -:� /Q :ertificate of Competency #: o / $554)f .. Phone#: City: State:�Zip:33% 5 S :/Linear Footage of Work: 410�0 D 0-9'e"pair/Replace ❑ Demolition Specify color of color thru tile: 1 S'-4 S • ov Submittal Fee $ J5b PI''n b • Permit Fee $ CCF $ Z CO/CC $ Scanning Fee $ ?) Radon Fee $ 2 DBPR $ 0 3 ' & 3 Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ 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 Zi 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 I . - , Lu , OWNER or AGENT The foregoing instrument was acknowledged before me this _2day of 20J by PA A , , who is personally known to me or who has produced r as identification and who did take an oath. NOTARY PUBLIC: Signatur CONTRACTOR Th oing instr71�10sk4lu(40 nt was acknowledged before this day of by who is personally known to me or who,has produced and who did take a NOTARY PUBLIC: as Seal: Seal: »•"••".,1 VANESSARNERA ,40 ^- Notary Public State of Florida = • MY COMMISSION OFF "9108 C Rodriguez ,% bw EXPIRES: April 17, 2020 My Commission EE 861704 •� • ai• BmIed They Nofrlly PubW IltWN#k 11 *ss**ss**s** APPROVED BY Pins Examiner Zoning 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): -! -ll" N r/ A-N S owl= �/ &- City: Miami Shores Village County: Miami Dade Zip Code: 3 31 '3 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 # KW HEAT 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: _ State Certificate or Registration No. Signature (Qualifier's signature) Phone: Certificate of Competency No. Date: