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MC-14-1546Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 To -- Inspection Number: INSP-216134 Permit Number: MC -7-14-1546 Scheduled Inspection Date: October 15, 2014 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: REID, LISETTE Work Classification: Addition/Alteration Job Address: 290 NE 95 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: MANCO AIR INC. Building Department Comments Phone Number (305)632-5357 Parcel Number 1132060133700 Phone: 305/409-7719 CHANGE CONDENSING AND HANDLER Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re -inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. October 14, 2014 For Inspections please call: (305)762949 Page 9 of 40 7 `� �? 3 5 �-'� �� S� 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 VFX JUL I I Z014 BY: FBC 20 Master Permit No. Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: o lo A4 E. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: // Construction Type: �f� ,, Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): I SqT� 7' 46 Sl- � oo`�L gvmley Phone#:L—?e--43a - `357 Address:��ii��fU AI,C- . x'!he 57 S, f City: _/_[ice+nl� 'S/-)aM-S State: % �-- Zip: /38 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address: 16C11- 1�ku ), City: vkja— Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: Address: t�� ne11: 4ol '7 �- iy of Competency #: Value of Work for this Permit: $ V0 Square/Linear Footage of Work: Type of Work: ❑ Addition b Alterajjon A ❑ New ❑ pRepair/Replace Description of Work: Specify color of color thru tile: :1�- 14T, Zip: 33l(e. ❑ Demolition Submittal Fee $ Permit Fee $ 1 1:V LV V CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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 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 OWNER or AGENT Signature looZ CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �.i� day of ��-� , 20 , by day of Zm�L '20 < I , by J S rjhl �`''� r'� who is personally known to � 1C�lA(Z£� who s personally known to me or who has produced\J r" as me or who has produced as identification and who did take an oath; NOT, Sign: Print Seal: identification and who did take an oath. ►�►►►uirr► r�i NOTARY PUBLIC: s Sign: _ 2016 Print: s LIC11 ° It Seal: ',�,sl EE1130S9: 0F '��+r►rreru►N►�� APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) MiamishoresVillage 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. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore. you may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Print Name: Signature: State of Florida) County of Miami -Dade) Sworn to and subscribed before me this`''�1 day of , 20 l �; .,,-,Ilk ��''• 03 By ca CD Z (SEAT,) .�� b� a. w �, 2,: `' Tvae of Identification produced a�s�• _ Contractor of Florida ) ty of Miami -Dade ) n to and subscribed before me this f , 20 M MANCO AIR, INC 197 NW 104 AVENUE CORAL SPRINGS FLORIDA, 33071 MICHAEL MANNO GONZALES - REID RESIDENCE 290 NE 95TH STREET MIAMI SHORES, FL 33138 Attn: VILLAGE OF MIAMI SHORES Project: GONZALES REID RESIDENCE JUL 2 2 2v Invoice DATE 7/22/2014 Invoice # 7222014-001 Customer ID REID-001 Due Upon Receipt Prepared by: MIACHEL MANNO Description AMOUNT NEW A/C CONDESOR AND HANDLER WITH TWO NEW DROPS $4,500.00 TOTAL DUE $4,500.00 If you have any questions concerning this, invoice do not hesitate to contact us at any of the numbers listed above. Make all checks payable to the order of MANCO AIR, INC. unless otherwise noted above. WE THANK YOU FOR YOUR BUSINESSI