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MC-19-1353Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit No.. MC-06-19-1353 Permit Type: Mechanical - Residential Work Classification: A/C Replacement Permit Status: Approved Issue Date: 06/19/2019 1 Expiration: 12/09/2019 Location Address Parcel Number 9730 NE 5 AVE, Miami Shores, FL 1132060171470 Contacts JOHN & MARIE PERIKLES Owner JOHN & MARIE PERIKLES Applicant Other:7862360254 Other:7862360254 PRIME AIR SERVICES CORP Contractor BERNARDO DEJESUSPLA 30120 SW 156 AVE, HOMESTEAD, FL 33033 Business: 7863081422 Description: INSTALL 2 HIGH EFFICENCY A.0 UNIT DUCT WORK. Valuation: $ 17,800.00 Inspection Re nests: 305-4949 TO RENEW EXPIRED PERMIT MC-9-15-2368 Total Sq Feet: 4,073.00 Fees Amount 100% Permit Renewal Fee $573.00 Application Fee - Other $50.00 Total: $623.00 Building Department Copy Payments Date Paid Amt Paid Total Fees $623.00 Credit Card 06/19/2019 $573.00 Credit Card 06/12/2019 $50.00 Amount Due: $0.00 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,pw-required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWN�RS AFFIDAVIT: I certify that all p6 foiegoing information is accurate and that all work will be done in compliance with all applicable laws regulaiing,constryction and zoning. Futh rmore, I authorize the above named contractor to do the work stated. Signature: Owner / Contractor / Agent Date June 19, 2019 Page 2 of 2 Miami Shores Village JUN 2 019 Building Department BY:.��• 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 20 BUILDING Master Permit No. fL(- IC 1 " Z 3,6 (-1 PERMIT APPLICATION Sub Permit No. I C Ub Iq -• S3 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1-� `� � j� �(✓ 0 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: t' M z2 (o b A 1 I -A —10 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: r � OWNER: Name (Fee Simple Titleholder): I ne#: Address: S}n City: NAN k t," © Vf State: Tenant/Lessee Name: Phone#: Email: {� 1 CONTRACTOR: Company Name: 1 'Ar Phone#: Address: --t'D City: tf V-^ State: ' Zip: Qualifier Name: f"yy Q k"\ Phone#: State Certification or Registration #: �''�C �1 Z) Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: � City: State: Zip: Value of Work for this Permit: $ --8� 191B4�C%a::�Square/Linear Footage of Work: Type of Work: ❑ Addition ❑�j� _Alteration ❑ New. I ❑ Repair/Replace / , /❑ Demolition Description of Work: 2-/- / cljr7` l.12 3�eai2- % b Re=m Specify color of color thru.tile: Submittal Fee $S6 I� .Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ CJ� (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 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 reirlsaection fee will be charged. Si ture t,.. Signature OWNER or AGENT CONTRACTOR The foregoing instrum nt was acknowledged before me this day c �^-� 20 by who i p sonally know �to me or who has pr ddced as identification ad w6 did take an 'ARY PU Sign: Print: The foregoing instrument was acknowledged before me this day of �,u�-e- 20_ `---,-by' w �personally p.to me or who has pro uced as i cation and irho did taWbn oath. OTARY P Print: Seal: ap�;0. ��`•;�� LORETTA COMES Seal: t �'`;'Pu�;, LORETTA COMES * * MY COMMISSION t FF V4664 * * MY COMMISSION: FF 9W64 EXPIRES: March 21, 2020 EXPIRES: Match 21, 2020 Baededihru9t4 tNoNrySuft �Ae., 0', BmWThruBudget NoorySenim i APPROVED BY , Plans Examiner Zoning YiV Structural Review Clerk (Revised02/24/2014) Prime Air Services Corp. 30120 sw 156 ave Homestead FI.33033 8/28/18 State of Florida Miami Dade County Before me This day appeared Bernardo Pla who, being duly sworn deposes and says That he will be the person working on the project located at: 9730•ne5th ave rd,.—ffla i%Shores ti Contractor Sworn to (or Affirmed) and subscribed to me thiAay of Ak pAkuf) By %EVArdD fiA, Personal Or p odoced identification LORETTA COMES Notary * * MY COMMISSION #FF95M EXPIRES: March 21, 2020 Bonded Thor Budget NobrySerrires 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. 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; The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 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 CONTENT.- Signature: Owner l State of Florida County of Miami -Dade The f�regoing was acknowledge before me this �1" _ day of By. Notary: SEAL: LORETTA COMES MY COMMISSION i FF 98a664 a EXPIRES: March 21. = who ' rsonally kno me or has produced as identification.