MC-19-1536Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.. MC-07-19-1536
(� ,� !Lc Permit Type: Mechanical - Residential
NJ u, 1 t!
Work Classification: Addition/Alteration
Permit Status: Approved
Issue Date: 09/09/20 91 Expiration: 02/04/2019
Location Address Parcel Number
1158 NE 99 ST, Miami Shores, FL 33138 1132050180130
Contacts
SUSAN PINNAS Owner SUSAN PINNAS Applicant
1158 NE 99 ST, MIAMI SHORES, FL 331382641 1158 NE 99 ST, MIAMI SHORES, FL 331382641
TWIN ISLAND AIR CONDITION & Contractor
REFRIGERATION INC
DEXTER DOVE
8651 NW 47 ST, FT LAUDERDALE, FL 33351
Home: 9549803669 delaireacl@gmail.com
Description: ADDITIONAL A/C DUCTWORK INSTALLATION Valuation: $ 8,500.00 Inspection Requests:
305-762-4949
TotalSq Feet: 695.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$5.40
DBPR Fee
$4.46
DCA Fee
$2.98
Education Surcharge
$1.80
Permit Fee
$247.50
Scanning Fee
$3.00
Technology Fee
$7.44
Total:
$322.58
Payments
Date Paid Amt Paid
Total Fees
$322.58
Credit Card
08/09/2019 $272.58
Credit Card
07/03/2019 $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 ordirfances 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 zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner C / Applicant / Contractor / Agent Date
August 09, 2019 Page 2 of 2
Certificate of Competency #:
/// City; State: Zip.
�j square/Linear Footage of Work:
D Alteration ❑ New El Repair/Replace ❑ Demolition
tile:
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
BUILDING
PERMIT APPLICATION
BUILDING ELECTRIC [] ROOFING
_ ZI ED
JU 03 19
BY:—
FBC 20
m�
Master Permit No.�&-1 - t g G� �i" 1
Sub Permit No. 1 " 1�% 07 _—I I — 135
0 REVISION (] EXTENSIONRENEWAL
PLUMBING 'j MECHANICAL ❑PUBLIC WORKS Q CHANGE OF CANCELLATION n SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1158 NE 99TH STREET
City' Miami Shores County: Miami Dade ziD'
Folio/Parcet#:11-3205-018-0130 Is the Building Historically Designated: Yes _ NO
Occupancy Type R3 Load: Construction Type: VB Flood Zone X BFE: FFE:
OWNER: Name (Fee simple Titleholder): SUSAN PI NNAS phone#; 305-987-2132
Address: 1158 NE 99 STREET
City: M(AMi SHORES State: FL Zip: 33138
Tenant/Lessee Name:
Email -
CONTRACTOR: Company Nam �N 1 C Ulq U'D f� � liU`vDI L� Phone#:�� `1 ,J 1 v `- 3� `` S
Address: <� J I t\ W _ST cic—e—�----
City: L1 State:- zip: 333 ( 5
Qualifier Name: [. J�� �.`� �%�V _Phone#:
State Certification or R
DESIGNER: Architect/E
Address:
Value of Work forthis
Type of Work: M
--
Submittal Fee $ JOinICI Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $Training/Education Fee $
Structural Reviews $
(RevisedO2/24/2014)
CCF $
CO/cc $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
� � -Z
Bonding Company's Name (if applicable)
Bonding Company's Address
city
State
Mortgage tender's Name (if applicable)
Mortgage Lender's Address
City
State
0
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 f7) 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 Signature
OWNER or AGENT
The foregoing instru nt as acknowledged before me this
r day of V� J 20 b
y
w o is personally know,,nn�tc
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: LV '
• M'i�fG"103959—
Print
Seat:
F� ;; ° ' Bonded Tnru Notary Public Underwriters
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of J��UAI 20 19 by
t�t7�11 who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
»ss*s***s*w*sssssss+• �,� s rsssstr *sxylrsss�ssss»ss+s»sr*ssw+�ssssss+r�R�s».�n�sssssFM��*s�srsss�ss�s�sksa�*
APPROVED BY \IV `/r/AIV 1 Pia?is Examiner
1• Zoning
Structural Review Clerk
(Revised02124J21214)
Tulin Island Air Condition & Refrigeration
July 12, 2019
State of &�, (-D;k
County of
Before me this day personally appeared Dexter Dove who, being duly sworn, deposes and says:
That he will be the only person working on the project located at:
1158 NE 99 STREET, MIAMI SHORES, FL 33138
Dexter Dove
Sworn to (or affirmed) and subscribed before me this 30I k'day of
Personally Known_ �—
Or Produced Identification
Type of Identification Produced
ot..
Notary public - State of Florida
Commission N GG 113923
`My Comm, @rpiros lun 12,2021:gm*dthmugNNalieoalNowyAssn, Print, T4P or of Notary
8651 NW 47171 STREET, LAUDERJ 1ILL, FL 33319
T (954) 980-3669
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-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 co ractor's company for day labor. part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOW—UPD AT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. ,
er
State of
County of Miami -Dade The foregoing was acknowledge before me this l -7
1-Lt day of AV q V 20A.
By S V S 0. ✓l. �L P� vt who is personally known to me or has produced
_FL iv ci Li C-9 Q as identification.
GARY L. FOGAL
Notary: NOTARY PUBLIC
S STATE OF FLORIDA
SEAL: a Comm# GG218519
�� Expires 6/3/2022
l P--2036