MC-12-21-3321, 94 NW 95th StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Y , /
IN4
Issue Date: 12/29/2021
Location Address Parcel Number
94 NW 95TH ST, Miami Shores, FL 33150 1131010340090
Contacts
Permit No-, M C-12-21-3321
ermit Type: ,Mechanical - Residential
rkClassi}cat on: Addition/Alteration
Permit Status: Approved
Expiration: 06/29/2022
IMMOBILIEN LLC Owner MAGNUS R & S AIR CONDITIONING LLC Contractor
GARCIA RICARDO FONG SR
7602 NW 2nd Court, Miami, FL 33150 7211 W 24 AVE 2221, HIALEAH GARDENS, FL 33016
Home: 9544106364 gnd2@msn.com magnusairconditioning@gmail.com
Other:7202975338
_•�• N Inspection Requests:
I Description: INSTALL NEW SPLIT SYSTEM A/C UNITS AND DUCT Valuation: $ 7,695.20
\ 305 762 4949
WORK
Total Sq Feet: 224.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.80
DBPR Fee
$4.04
DCA Fee
$2.69
Education Surcharge
$1.60
Permit Fee
$219.33
Scanning Fee
$3.00
Technology Fee
$6.73
Total:
$292.19
Payments
Date Paid Amt Paid
Total Fees
$292.19
Credit Card
12/29/2021 $292.19
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 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 A I VIT: I ce at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating ns�nd �rrSg ,Futhermore, I authorize the above named contractor to do the work stated.
! Applicant / Contractor / Agent
29,
Date
Page 2 of 2
f
Miami Shores Village
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
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 / t7
FBC 20 .1�
Master Permit No. RC-11-19-2844
Sub Permit No. (A C -.123 2-
❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
III pEC 222021 IUI
❑PLUMBING Q MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 94 NW 95th St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3101-034-0090 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Nick Garcia - (mmobilien LLC Phone#:720-297-5338
Address:7602 NW 2nd Court
City: Miami State: Florida Zip: 33150
Tenant/Lessee Name:
Email: gnd2@msn.com
CONTRACTOR: Company NaJne:
Phone#: 720-297-5338
41 6) Phone#:4�25)
Address: t /
City: �� State: / Zip:`+
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: _� City: State:: Zip:
Value of Work for this Permit: $T�� `2;F Square/Linear Footage of Work:
Type of Work: A Addition ❑ Alteration ❑ Neew ❑ Repair/Replace�� ❑ Demolition Q
Description of Work: _S�f'sf�EL�/
Specify color of color thru the:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $ TOTAL FEE NOW DUE $ 29 2 '
(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 val a exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien la rochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of co encem n must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the a sen e of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
i
Signature Signature
OWNER or AGENT C TRACTOR
The foregoing instrume was acknowledged before me this The foregoing in4rume,,�sacknowledged ntwabefore me this
day of 1 iT, " ! , 20 by day o20 -271 by
Nick Garcia who is personally known to who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
p,ttVPa/c ;cRlJiZ
NOTARY PUBLIC: * - ,; ,,575 NOTARY P LI .
,,i23
�iho�aryService3
Sign:�/y „ Sign:
Print: Print: Ji I CPA Ilk' YO-V
Seal: Seal: �►*. ��;,,. Y ILYN BRITO
Notary Public - State of Florida
Commission S GG 910115
My Comm. Exiires Sep R, 2023
Bonded through Nationa:.Notary Assn.
APPROVED BY �_ �_.' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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):94 NW 95TH St
City: Miami Shores Village County: Miami Dade zip Code: 33150
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
rr � *, k'
AHU or PKG. UNIT MODEL #
& %
COND. UNIT MODEL #
G�iCJ
KW HEAT
NOM TONS
y IDrc/
AHU
CU
PKG
1) M.C.A
AHU W CU PKG
AHU
CU
PKG
2) M.O.P
AHU ' CUtQe PKG
AHU
CU
PKG
3) VOLTS
AHU,13OCU_,72CPKG
PKG UNIT /
/
PKG UNIT
EER/SEER
16
YES
NO
REPLACING DUCTS
YES y NO
YES
NO
REPLACING THERMOSTAT
YES X NO
YES
NO
NEW 4"CONCRETE SLAB
YES y 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 M ans: _
Contractor's Company None: jjd vl-- PM% i A7 Phone: '
State Certificate or Re
Signature
Certificate of Competency Ncd
Date:
(Revised02/24/2014)
Magnus R&S Air Conditioning LLC.
Date:
State of Florida
County of Miami -Dade
Before me this day personally appeared Ricardo Fong who, being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at:
ST. Miami Shores, FL 331SO
re
Sworn to (or affirmed) and subscribed before me this 22 day of December. 2021,
by Ricardo Fong
Personally know
OR Produced identification
Type of Identification Produced
� sL. YYEEpNIIYN ANIITTOr
Y ptC�3Fh�f,l� r�°�,
Print, T m jai
.; s or. I
o. n . My Comm. Ec
Bonded throu h N ores Sec +. 1023
S ationai!.otJrY Assn,
its
pIORIDA
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
r 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:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this �� day of 20�.
By i �1���1 Q`� who is personally known to me or has produced
Notary:
V►*J Notary Public State of Florida
Michelle D' Ambar Cruz
Expires OW2312023
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C COPY OF LIABILITY INSURANCE* -,
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
...........................................................................................
BUSINESS NAME:
BUSINESS ADDRESS:
BUSINESS PHONE: ( )
CELL PHONE ( )
Kw
FAX NUMBER ( )
QUALIFIER'S NAME:
STATE ZIP
QUALIFIER'S LIC NUMBER: