MCC-19-871Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
726 NE 92ND ST 11L, Miami Shores, FL 33138
r'nntartc
Issue gate:
Parcel Number
1132060440490
Permit NO.: CC-04-19-871
Permit Type: Mechanical - Commercial
Work Classification: A/cReolacement
Permit status: Approved
il`j Expiration:10/16/2019
MEHRDAD FARID Owner FROZE -ZONE CORP Contractor
726 92 11L LUIS CRUZ
75 SW 116 AVE, MIAMI, FL 33174
Business: 3052997259
Inspection Requests:
Description: REPLACING WALL UNIT AC WITHOUT ALTERATION Valuation: $ 150.00 Inspec i 4949
OF AC CASE
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$9.00
Technology Fee
$2.50
Total:
$116.30
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$116.30
Credit Card
04/19/2019 $50.00
Credit Card
04/30/2019 $66.30
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 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.
SignatuX Owner / Applicant / Contractor / Agent Date
April 30, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
❑BUILDINGELECTRIC
❑PLUMBINGMECHANICAL
JOB ADDRESS: ;72 (-' ' v
Miami Shores Village
RECEIVED
Building Department APR 19 223
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 PR
Tel: (305) 795-2204 Fax: (305) 756-8972 I
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20174
Master Permit No. 1\ `cc - nq` 1� 0 , i
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
(NO
Occupancy Type: Load:
Construction Type:
Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): 1At t1r � k c� ilk Lk c
t A �� ��� Phone#:
Address: 7 L E N `�
Uj'2... S �_+�
Q Av 1.--
City: `�. wT i)j C f' S
State:
T Zip: :5
i
Tenant/Lessee Name:
Phone#:
/
Email:
n CONTRACTOR: Company Name:
Address:
City: '64iofl
Qualifier Name: Z—(//S iU ( 11
State Certification or Registration #:
DESIGNER: Architect/Engineer
Address:
Value of Work for this Perrr#)t:
Type of Work: ❑ Addition
Description of Work: _
e %Dli1' C/➢fI' Phone#:
lore -
Zip: _f / 7 c
Phone#4_7 2AL2
Certificate of Competency #: _
Phone#:
l City: `
/0✓4V Square/Linear Footage of Work:
Alteration ❑ New Repair/Replace
Specify color of c1*color thru tile: A"
Submittal Fee $',; Pe_ unit Feet$
..e:•..7+.are.w+.-.var...:..r...ra+.:s-,.H..n.,..»+ian^:�
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
Zip:
❑ Demolition
,+_ AC_ C,4L3-.�-,
CCF $ CO%CC S
DBPR $ Notary $
Double Fee $
Bond $ 11 L
TOTAL FEE NOW DUE $
(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 on 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 f ,/� Signature
OWNER or AGENT CO ACTOR
The foregoing instrument was acknowledged before me this
day of J� �i 20 (ej by
Hv..L�nd� f"poewho is personally known to
me or who has produced EL-DUVW 0 as
identification and who did take an oath.
NOTARY BLIC:
Sign:
Print:
Seal:
###########
APPROVED BY
(Revised02/24/2014)
SINDIA ALVAREZ
MY COMMISSION # GG 238273
EXPIRES: September 3, 2022
The foregoing instrument was acknowledged beforemethis
dayof A' rz- 20 1 by
In iz rr T who is personally known to
me or who has produced OD ( as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: ��✓'w % /.'�—�f r
Print: E,*' r
Seal•.—�—
JAVIER MOREMN
34 * Commission A GG 84583
s My,Commission
gExpires
############## #� ####�I�I�M J 2"1*#### I
#####
Exa finer Zoning
Structural Review Clerk
J
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):
City: Miami Shores Village County: Miami Dade Zip Code: 1
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 ❑
Ldll 44*7a�-
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
Al".
1
AHU or PKG. UNIT MODEL #
S Z
72
COND. UNIT MODEL #��1--
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 M
YES
NO
YES
NO
NEW ROOF STAND
YES
NO
YES
NO
NEW RETURN PLENUM BOX
YES
NO
1. Minimum Circuit Ampacity (Wire Size): J) 44In-1
/71C
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480): ,�) `%�1'Z'� r7
4. Size Disconnecting Means: _
Contractor's Company Name: Phone:
State Certificate or Registratlo o. 5_7C rtl Icate o Competency No. �}%.2
Signature Date:
(Qualifier's signature)
(Revised02/24/2014)
% Ski w ral;a 54a low.
745 North East 91 n Street
Miami Shores, FL 33138
305-759-9069/
E-MAIL spel23@att.net
April 18, 2019
Miami Shores Village
Building Dept.
10050 NE 2' Avenue
Miami Shores, FL 33138
Dear Sir / Madam:
This letter will serve as your confirmation that contractor "Froze -Zone,
Corp." has been hired by the owner of Apt. 11 L, at 726 NE 92 Street,
Miami Shores, FL, and is authorized by the Board of Directors of the Shores
Plaza East Condominium Association to replace A/C wall unit at said
apartment.
Should you have any questions regarding the enclosed, please feel free to
contact the condominium office.
Sincerely yours,
Carlos Talavera
Vice -President
cc: file
\y
M
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 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. /
GV`
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this (� day of �-' ('<-1 - 20�.
By � V-X> Nl%C T4V�J� who is personally known to me or has produced
as identification.
Notary:
SINDIA ALVAREZ
SEAL: ='' MY COMMISSION # GG 238273
EXPIRES: Se tem r
�'FOF F,;gS• P be 3, 2022
Bonded Thru Notary public UnderrvMlers
AIR CONDITIONING & MECHANICAL CONTRACTOR
Sales, Service S Installation
Residential • Commercial
cured True 24/7 Service
Phone: 305-299-7259 E-mail: froze-zone.cp@live.com
Date: q _ ;Z3 ) q
State of Florida .
County of Miami -Dade
Before me this day personally appeared
and says:
Luis Cruz
who, being duly sworn, deposes
That he or she will be the only person working on the project located at:
726 NE 92nd Street Miami Shore, FL 33138 jA CC- ' Oq- ) 9 < �/ 7 j
4 1-2 — Q
Contractor Signature
Sworn to (or affirmed) and subscribed before me this 23rd day of April 2019,
by L01_5 Cr-O -&-
.•'•
;.
RAUI GONZALEZ-ORBEGOSO
Notary Public - State of Florida
Commission GG 304892
°i
My Comm. Expires Feb 24, 2023
Personally know,
OR Produced Identification it DL c6zo- 52►- 65-'4m-1
Type of Identification Produced �� DL
/2c of &02'o4rZ • O t-Iae4QaSo
Print, Type or Stamp Name of Notary