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MC-15-817Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FIL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-232055 Permit Number: MC -4-15-817 Scheduled Inspection Date: April 20, 2015 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: CHURCH, MIAMI SHORES BAPTIST Work Classification: Addition/Alteration Job Address: 425 NE 95 Street Miami Shores, FL Phone Number (305)758-0559 Parcel Number 1132060140610 Project: <NONE> Contractor: IGLAIR AIR CONDITIONING Phone: (305)316-8967 tsunamg uepariment comments REPLACE DAMAGED AIR DUCTS, Infractio Passed comments INSPECTOR COMMENTS False April 17, 2015 For Inspections please call: (305)762-4949 Page 23 of 39 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. April 17, 2015 For Inspections please call: (305)762-4949 Page 23 of 39 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Applicant ------------ 425 NE 95 Street 1132060140610 MIAMI SHORES BAPTIST CH Miami Shores, FL Block: Lot: Phone Cell MIAMI SHORES BAPTIST CH 370 GRAND CONCOURSE AVE (305)758-0559 MIAMI FL 33138-2753 Contractor(s) Phone Cell Phone IGLAIR AIR CONDITIONING (305)316-8967 Tons: Additional Info: REPLACE DAMAGED AIR DUCTS. Classification: Residential Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Work: Scanning: 3 Fees Due Amount CCF $3.00 DBPR Fee $2.36 DCA Fee $2.36 Education Surcharge $1.00 Permit Fee $157.50 Scanning Fee $9.00 Technology Fee $4.00 Total: $179.22 Valuation: $ 4,500.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC -4-15-55133 04/15/2015 Credit Card $ 129.22 $ 50.00 04/09/2015 Credit Card $ 50.00 $ 0.00 Ayauable Inspecuons: Inspection Type: Final 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 AFF�bAV'T: certify hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a d zoning ,,aft noGe, I ayithorize the above-named contractor to do the work stated. April 15, 2015 Auth z ii SlgnatIre: Owner / Applicant / Contractor / Agent Build! Department Copy April 15, 2015 101T►TC� PERMIT APPLICATION ❑ BUILDING ❑ PLUMBING ;ELECTRIC MECHANICAL JOB ADDRESS: q'is Miami Shores Village 7APRO CETVV Building Dep artment Zo'S 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 LI3X::A_ Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 �FBC 2010 Master Permit No. 1� o— 1 -0(4 Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS r'niinty* Miami Dade Zin: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder); -'IS9 �� Address: � -7 0 C� r.. is PA 1 0 ®/it' ea (o & S C g� � City: &d a� l .� -,fy � �� 5 State: �� a Zip: Tenant/Lessee LName:% (/14Phone#: Email: �A D 11.c- 5 ffL o1, d -e juL-r CONTRACTOR: Company Name: Z66 G � ` V(ale Phone#: �� Address: �; 2 ?- 4�;'-4 � City: Qualifier Name; �%;� State Certification or Registration #: F Zip: 3 of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $�-e/� � � � w �' ` Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration❑ New Repair/Replace ❑Demolition Description of Work: Specify color of color thru tile: rt Submittal Fee $ V -1V Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) J CCF $ CO/CC $ 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 ER or AGEN The foregoing instrument was acknowledged before me this day of �`�� 20) by �tV IAV NI i1\'A-( k II who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: /'7') ? I r, j Sign!,, Print E OLk L( C (L A q Seal: � '?_p1F APPROVED BY (Revised02/24/2014) Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 /5 by a� �4jf', who is personally known to me or who has produced �'�� 2D�� identification and who did take an oath. NOTARY PUBLIC: Shin. Print: Sea I: WMry Putt Stat9 of Fbfkla�g 8�4� Notary Public State of Florida Pearile Gray : Joanna M Feliciano My Canmlaslon FF 103736 EXPIMS 04/16/2019� oma My Commission FF 082753 NK�a,�\Ians Examiner Zoning Structural Review Clerk 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): ,`�`� T, 1?? 313e City: Miami Shores Village County: Miami Dade Zip Code: 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 ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: ; A/ r -v L �n c,..;, 4 c n A a Phone: 54D!;r-r3 State Certificate or Registration Nd�%9e ) �% 2 Z 5 ?7 Certificate of Competency No. Signature P Date: ° �-�° L S ( aiwees sign e) (Revised02/24/2014) UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # 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 ES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES 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 Means: Contractor's Company Name: ; A/ r -v L �n c,..;, 4 c n A a Phone: 54D!;r-r3 State Certificate or Registration Nd�%9e ) �% 2 Z 5 ?7 Certificate of Competency No. Signature P Date: ° �-�° L S ( aiwees sign e) (Revised02/24/2014) 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. D Signature ORsz;�, Owne State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of 20 %S By i-� \ �A 0 0. 1 `ebJ• �A \ eC who is personally known to me or has produced as identification. SEAL: Notary Public Stabs d Florida Peary Gray '� P� My CcmmLWw FF 103736 0013721 SW 280 TER HOMESTEAD FL 33033.(305)316-8967, CAC1817253 Date: State of: Florida County of: Miami -Dade Before me this day personally appeared ' )o S i A &_ who, being duly sworn deposes and says: The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. �� /Yt� f_t. ;-T P,/ d0ixv� e-; )✓2° r' -S % �� 33/3 6 Sorn to (or affirmed) and subscribed before me this 3� day of .20 5 by TO W,S .3',� Personally know OR Produced Identification �— Type of Identification Produced�— ,'01`idls Print, Type or StWRI�a�o+r� I Yll Poppet I I Lil vl Y ir LIP I6- ; 1,--; J Or *00 COPT RF • MECHANICAL REVIEW 0 PR APR201 0:0 APPROVED DATE :0: •: - y *.* .:- :0