MC-04-23-848, 9119 N Miami AveMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number Project
9119 N MIAMI AVE, Miami Shores, FL 33150 1132060130070 ONLINE PERMITS
Contacts
CONSTANCE NORTELUS Owner QUALITY AIR SOLUTIONS INC Contractor
9119 N N MIAMI Ave, Miami, FL 33150 WILLIAM TAYLOR
Mobile: 3057640749 simplicity212@yahoo.com 1051 NW 87 ST, MIAMI, FL 33150
Home: 3059797216 Business: 7864869432
Description: exhaust fan Valuation: $ 100.00 Inspection Requests:
Total Sq Feet: 1,800.00 M, wom`
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.30
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$10.00
Total:
$117.90
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$117.90
Credit Card
05/02/2023 $117.90
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
regu*Pn"onstruction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
nature: Owner / Applicant / Contractor / Agent
f
Date
May 02, 2023 Page 2 of 2
BUILDING
PERMIT APPLICATION
❑BUILDING
❑PLUMBING
❑ ELECTRIC
MECHANICAL
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
-A
FBC 2074 �%
Master Permit No. �1c ` 10'I b
Sub Permit No. 1 I1C� V �i� — ?4 T
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �' t►� 1 6cl. k. 1 fit' V�
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): CJ0-k r @b'+e.c. x Phone#: CaA 2W a -'n
Address: Gi (� + -rut �' �.�n-,-►�
City: c� 1�u`oG�u�t Rv State: _ Zip: 2. IzM
Tenant/Lessee Name: Phone#:
Email: S r 4AA,� (r L-c l Z ! 2- ti _ llA_Ln . 0_>'1/U
CONTRACTOR: Company Name: ��� v` -1,1 '12 J a I Wl Wr S Phone#: -7 Ae & 'A -� 2,
Address:
Email: VV'1
11�
W_r IA 0�.�i� 1�ci. `L
Qualifier Name:
State Certification or Registration #: C IV t 1 g 2 ) V Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
—7 �jc " q �6 -4i q -1 --.
Address: City: State: Zip:
Value of Work for this Permit: $ 100, cry Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
Specify color of color thru tile:,
Submittal Fee $ Permit Fee $
Scanning Fee $
DCA Fee $
Technology Fee $ Training/Education Fee $
f4A
CCF $
DBPR $
❑ Demolition
CO/CC $
Notary $
Double Fee $
Structural Reviews $
(Revised04/05/2022)
P&Z Review $
Bond $
TOTAL FEE NOW DUE $ I I 1 • ft
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
State 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 charged.
Signature I Signature r� ��'` xy-)
OWNER or AGENT CONTRACTOR
The foregoing instrume t was acknowledged before me this The foregoing instrum nt was acknowledged before me this
! h day of 20 aG, by day of 20 Q� �, by
&)v S',c_ who is personally known to )iUt 1J 1uVK ` l a O (2- , who is personally known to
me or who has produced as me or who has produced TWcl C%20 4`�'� 13 as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: d i,
Seal:
APPROVED BY
(Revised04/05/2022)
identification and who did take an oath.
NOTARY PUBLIC:
Print: 1
Seal:
Plans Examiner
Structural Review
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
2601 BLAIR STONE ROAD
TALLAHASSEE FL 32399-0783
Congratulations! With this license you become one of
the nearly one million Floridians licensed by the
Department of Business and Professional Regulation.
Our professionals and businesses range from architects
to yacht brokers, from boxers to barbeque restaurants,
and they keep Florida's economy strong.
Every day we work to improve the way we do business
in order to serve you better. For information about our
services, please log onto www.myfloridalicense.com.
There you can find more information about our
divisions and the regulations that impact you, subscribe
to department newsletters and learn more about the
Department's initiatives.
Our mission at the Department is: License Efficiently,
Regulate Fairly. We constantly strive to serve you
better so that you can serve your customers. Thank you
for doing business in Florida, and congratulations on
your new license!
db'pr
STATE OF FLORIDA DEPARTMENT
OF BUSINESS AND PROFESSIONAL
REGULATION
CAC1821085 ISSUED;10/11/2022
CERTIFIED AIR COND CONTR
TAYLOR, WILLIAM
QUALITY AIR SOLUTIONS' INC'.
Signature
LICENSED UNDER CHAPTER 489, FLORIDA STATUTES
EXPIRATION DATE: AUGUST '31, 2024
Ron DeSantis, Governor Melanie S. Griffin, Secretary
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
LICENSE NUMBER: CAC1821085 EXPIRATION DATE: AUGUST 31, 2024
THE CLASS B AIR CONDITIONING CONTRACTOR HEREIN IS CERTIFIED UNDER THE
PROVISIONS OF CHAPTER 489, FLORIDA STATUTES
TAYLOR, WILLIAM
QUALITY AIR SOLUTIONS' INC'.
1051 NW 87TH ST
MIAMI FL 33150
ISSUED: 10/11/2022 Always verify licenses online at MyFioridaLicense.com
Do not alter this document in any form.
This is your license. It is unlawful for anyone other than the licensee to use th
document
91:
A13
" 0
i_
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 1/1212023 EXPIRATION DATE: 1/1112025
PERSON: WILLIAM TAYLOR IV EMAIL: WMTAYLOR@BELLSOUTH.NET
FEIN: 830415113
BUSINESS NAME AND ADDRESS;
QUALITY AIR SOLUTIONS INC
1051 NW 87 ST
MIAMI, FL 33150
This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional
Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the
license of the certificate holder, go to www.myfloridalicense.com.
IMPORTANT; Pursuant to subsection 440.05(13), F&, an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or comperissition, under this chapter, Pursuant to subsection 440,05(11), F,S,, Certificates of election to be exempt issued
under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440,05(12), F.&, notices of
ele0on to be exempt and certificates of election to be exempt shall be subject to revocation It, at any time after the tiling of the notice or the issuance of the
corlificate, ft person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall
revoke a certificate at any Urns, for failure of the person named on the certificate to meet the requirements of this section.
State of Florida
County of Miami -Dade I
l bt^�
Before me this day personally appeared t t t� � who. being
duly sworn, deposes and says that he or she will be the only person�orking on the proicct
located at:
9119 N Miami Avenue
Miami Shores, F1, 3�150
Contractor Signature: aTA41
The li���uuu nt was acknowledged before me this l day of 20 40
by fre lion) Ding insW who is personally known OR produced
as identification.#
Sign-
0AYI
Print: --Ai
Seal:
1051 N.W. 87r" STREET 0 MIAMI, FLORIDA 33150 • PH. (786) 48&9432
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.
Signature: ( �ki:A
Owner
State of Florida
County of Miami -Dade �,
The foregoing was acknowledge before me this S, day of R\ Jn +'* .CJ�4 , 20 Z 3 .
BySOFL,IJI-1, who is personally known to me or has produced
as identification.
Notary: Q _
SEAL: — —
<�YP�'. ARLENISSILVERA
_,: :,, MY COMMISSION # GG 950477
Bonded Thru Notary Public Underwriters