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MC-12-1872 A Miami Shores Villages Building Department I ocI 0 9 202 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 j Tel:(305)795.2204 Fax:(305)756.8972 j INSPECTIONS PHONE NUMBER:(305)762.4949 FBC 201 �-- - BUILDING Permit No. PERMIT APPLICATION Master Permit No. 77? Permit Type:MECHANICAL JOB ADDRESS: 10 G 4 7 N, City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Z 19 P y Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): �fT-6�r-ujya�_ Phone#: Address: City: State Zip: Tenant/lessee Name: Phone#: Email: yy I n CONTRACTOR:Company Name: A a GocA M 2 (haw m� =Phone#. Address 5`J'S-1 4 Z 120 Alj'` 1 City::6,(la.a State: Qualifier Name•c 4 ArdNAr7k. Phone#• State Certification or Registration#: 2:1 CC '5-) C1 1 �� Certificate of Competency#: Contact Phone#:5C'6_8 22)j-2 8 Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ 3 V-W ' SquareAUnear Footage of Work: Type of Work: ❑Address WAlteration` ❑New f L3 epair/Replace ❑Dem lition Description of Woo: �'i l� '°" Q� - a77% -;r;l 4-1a f 4 V;,,a z rn r _-3 ^r r v4-,nee-a-2 t-• � °��—> ��+nx*xxaaxx��xa�x�xx.�+x�a.��x+�xxa��x�xFeesa�x�a �aa�x��a��x�a.xa�+�aax��a*an��ax��axaaa Submittal Fee$ Permit Fee$ ®V OD CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ �V r Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zi 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in c6mpliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE",€-F 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the ab of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature °3ign e Owner/oAgent Contractor The foregoing ins ment was ackno ledged bef e m this The foregoing instrument was acknowledged-before me thi� day of ,20)a;by . Awl raw y of�,201 ,by A wA �rt��1 who is personally knn tt�me or who has prod ced who is ersonally kno t e or who has produced As identification an did take an oath. as identification an cep c oart��W pO NOTAR LIC: NOTAR UBLIC: ptptRES tllsntallce gflldndtl+mughlstSta� e - ClP& Ii/6 ]St"AIR Sign: Stgn: ' �� / C iW � .+5,2015 Print Print Ilr@Nfil a ; RIA C.RODRIGUEZ My Commission Expires: I�+IISSION I iDD 876910 MY Commission Expires: EXPIRES:April 26,2018 �r9 FOFFIO�OV IlWad Wd E;u*Nolmy$rAw +N4R+R4+kYk8MMN+bl d+R�Ybb&bYkk�NkN&kd1+k9N�& hpQrt�Ck44kRkkdd"F&W�a=k�a*4%+kk�WNffi�Yd4d4+N�kk%Rd*N+kN+KANffikrtYN+k+Nk�6d+H•tl4Ma&k+ANIY+P4�F8 APPROVED BY G 6o 2'1=— Examiner Zoning Structural Review Clerk y Revised 3/1212012)(Revised 07/10/07)(Revised O6/10=9)(Revised 3/15/09) naVI.,kg 03ainO3b Sd kV'ldSI© xaviawas bZ0££ ZIT. U IInt g F 0 O $ZIG? 93'LAoa -em P .F� L2Q _0 :.smo .$q 8:6'E8TT ZZO.Z 50 90 9T Boos 0 90 ZT-1. $ Caws i)kt3-. rq— xuxsnaxi BE01 ,axsxoz> ssab LASS PAID Win,FL PERt46tT N0.239 419793-5 THIS IS NOT A BILL—DO NOT PAY 4 8URyn1W# REICAL CONTRACTOR STATE# C C7 CA975L / 438432-7 2775-W 79 ST 8 " 3018 HIALEAH AIR KING MECHANICAL CONTR INC SG'1fPEECHANlCA1 CONTRACTOR WORKER/S L a8 cMV A LWU 2 _ Tw tT E Pati U U Togm coum" Off cats NOR DO NOT FORWARD DOES R E%EOkF!7 THE PEW �'SHY OTHER M csmmx o AIR KING MECHANICAL MO. nu INC CONTRACTOR AUaacn. ANGEL AMARAL PRES =' 3351 SW 137 AVE COLLEcroft MIRAMAR FL 33027 08/31/2012_. 09018018001 040045.00 fta llaaaDla; aaaaa�a��aatlaa��:7s�atliaaaaaiatalaiaaaf�laala3 SEE OTHER SIDE E a d •Y Jf3f=P ATwATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION +� ff 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 Jaw, EFFECTIVE DATE: 02/2212012 EXPIRATION DATE: 02/21/2014 PERSON: AMARAL ANGEL FEIN: 850937960 BUSINESS NAME AND ADDRESS: AIR KING MECHANICAL CONTRACTOR INC 3361 S1! 137TH AVE MIRAMAR FL 33027 SCOPES OF BUSINESS OR TRADE: 1- REPAIR SERVICE 2- SALES 3- CORTtFIED AC CONTRACTOR IWORTART: Porsdaet to Chapter 640 . Ord14), F.S., an otliaar of a corporuloa who efects ase®pllon Iron Ibis enaptar by (cling • certllicu6 0l alaGlvn seder this aeetfoo way am raemet baosfin of eempeaattea cadet this eaapter. Pntsnenr to Chaplet 040.0811 21. F.$,. Corttficstes of atecrioa to be esalppt... apply only within the steps of life business or erode listed on the 1161149 of e1e41fea to be ereorpt, Pwsoaat fa C11aptat 440.051131, F.S.• Naticea of election to be axeaapt and eanitiesus of election to oat exempt shall be subject to tesatariee If, at any time liter rbe filing of the notice or she Iacuaace of the certiflcete, she person nomad an the Rowe or eertifloate 11a longer sleets the requirements of this setllon for issuance at a conflieele. The department shell revoke a certtflcate at say time for failere of the person named 04 the cartifiteu to meet toe requirements of ills section. IWC-2132 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01.11 QUESTIONS? (850) 413-1808 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES IMPORTANT DIVISION or WORKERS,COMPENSATION F Pursuant to Chapter 440.05(14), F,S„ an officer of a corporation who CONSTRUCTION INDUSTRY O elect% exemption from this Chapter by filing a Certificate of election W R KERST�OF ENS TION To BE E>t•BAdPT FROM F=t pRIOA L under this section m not recover benefits or compensation under this WORKERS'COMPENSATION LAW may D chapter, EFFECTIVE: 02/22/2012 EXPIRATION DATE: 02/21/2014 Pursuant to Chapter 440.05112), FS.. Certificates of election to be exempt,. apply only within the scope of the business or trade listed on FEIN: 850237960 R the notice of election to be exempt, BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.0503), P.S.. Notices of election to be exempt 33 RING 1I37TM CAt CONTRACTOtl INC end certificates of election to be exempt shell be subiect to revocation *tRA our t 33+ AVE If, at any time after the filing of the notice or the issuance of the MIftAMAR, Fa, x4646 certificate, the parson 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 K flay time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this �• ROaAIR Sd+tVrCE 2• SA69S section, y• C8071plat) AC CONeRACTOR QUESTIONS? (850) 413-1609 CUT HERE • Carry bottom portion on the job, keep upper portion for your records. WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11