MC-14-2158Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-231648
Scheduled Inspection Date: April 22, 2015
Inspector: Perez, JanPierre
Owner: ,
Job Address: 1090 NE 92 Street
Permit Number: MC -10-14-2158
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Miami Shores, FL
Project: <NONE>
Contractor: AA MASTERS MECHANICAL AIR MOVING AND ENGINEERIN
tiunamg uepanment comments
LEGALIZING AN A/C REPLACEMENT
Phone Number (305)987-0644
Parcel Number 1132050270410
INSPECTOR COMMENTS False
Phone: (305)559-7004
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-231307. CREATED AS
REINSPECTION FOR INSP-220804. no one home stands ok but need
to revise plans to show access door in garage
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
April 21, 2015 For Inspections please call: (305)762-4949 Page 7 of 27
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
Miami Shores Village
Building Department A��° 201
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 LBY,
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 0a
FBC ZV1
Master Permit No.
P
Sub Permit No. MCI
❑ ROOFING EVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
OWI
Add
City
Tenant/Lessee Name:
Email:
Construction Type: Flood Zone:
BFE: FFE:
CONTF
Addre!
11)
City: /A e I State: A iL Zip:
Qualifier Name:
State Certificatic
DESIGNER: Architect/Engineer:
Ad
Certificate of Competency #:
Value of Work for this Permit: $ 300 Square/Linear Footage of Work:
State: Zip:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Permit Fee $ 3S� CCF $.
Radon Fee $
Training/Education Fee $
DBPR $
CO/CC $
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 b4approved and a reinspection fee will be charged. /
Signatu
OWNER or AGENT/ // CONTRACTOR
The foWgoing instrument was acknowledged before me this
day of�� Ll 20 , by
�/si � .f /Li7JJ , who is personally known to
me or who has produced 01, as
identification and who did take an oath.
NOTARY PUBLIC:
MAGBtE GARCIA
MY COMMISSION ii FF 0480
EXPIRES: October 20, 2017
B=WTWWXyftWW*WftS
APPROVED BY
(Revised02/24/2014)
The foregoing instrument was acknowledged before me this
day
of 20 by
who is personally known to
me or who has produced
identification and who did take an oath.
as
NOTARY PUBLIC:
Sign(Z0,1
Seal:1"-... MAWEGARCIA
='1 � a MY COMMISSION 3 FF 048823
EXPIRES. October 20, 2017
Tem ray r Undewdlem
P ns Examiner Zoning
Structural Review
Clerk
w
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
BUILDING
PERMIT APPLICATION
F-JBUILDING ❑ ELECTRIC ❑ ROOFING
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING >ECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION_ Ej-SHO- P�''�
CONTRACTOR DRAWINGS
JOB ADDRESS: I ®C)U me el p- !07
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):_ �% FV i � P)/SCQC�.—Phon OS99 -)7- ,�
Address: 1090 A)� 4? �� /�
City: �'1 /A/� j Sp%Z E State: Zip: 3
Tenant,/Lessee Name: Phone#:
Email: oe-
t
CONTRACTOR: Company Name: JUAC7rCX.5"- ASL ,Phone#: "7F& 791PVJ,30
Address: %' �J ®� �!" f��� C e:
City: f A- M / State: �= Zip: /2,4 ®G
Qualifier Name: Jam' y -C �� �� �'� > Phone#:
State Certification or Registration #: % to Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: h -1, City: State: Zip:
Value of Work for this Permit: $ U(I (/ t' �.. Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Re air/Replace
Description of Work: LI l
Demolition
G Vim -
Specify color of color thru tile: L�
Submittal Fee $ ° eP rmit Fee $_ AO%O'VCCFS " " s CO/CC $
Scanning Fee $ Radon Fee $ 4 : 2-0 DBPR $ A Notary $ 0
Technology Fee $ Training/Education Fee $ " Double Fee $
Structural Reviews $ Bond $
--P-'Cv "EW TOTAL FEE NOW DUE $
(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
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 begapproved and a reinspection fee will be charged. w
ER or AGENT
The foregoing instrument was acknowledged before me this
(� day of 5e P�r1BE �, 20 by
JoWid a t-6J77Li&r who is personally known to
me or who has produced DL as
identification and who did take an oath.
CONTRACTOR
The foregoiit"g instrument
was acknowledged before me this
_ day of �Zge 20 by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PU IC:
il
NOTARY PUBLIC:
Sign:
Sign:
7
Print: %��
Print:
Seal:
Seal:
'hUMQARC1A
W OOhI1 MION W0480
EXPIRES: October 20, 2017
APPROVED BY
Plans Examiner
Structural Review
(Revised02/24/2014)
L t:4j#
ON tq
Zoning
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): logo AX
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'fn 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 Comp
State Certificate or
Signature
(Revised02/24/2014)
Name:
(Qualifier's signature)
&k- tit
Phone:
Sr
Z 24 Certificate of Competency No.
Date: /0 f'01A
M
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
AHU or PKG. UNIT M DEL#
COND. UNIT MODEL# &Q-jC-0j,,0jA2,
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
YES
YES
NO
REPLACING THERMOSTAT
YE
O
YES
NO
NEW 4"CONCRETE SLAB
N
YES
NO
NEW ROOF STAND
YES
YES
NO
NEW RETURN PLENUM BOX
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 Comp
State Certificate or
Signature
(Revised02/24/2014)
Name:
(Qualifier's signature)
&k- tit
Phone:
Sr
Z 24 Certificate of Competency No.
Date: /0 f'01A
M
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. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, y2u may be
personally liable for the worker compensation iniuries 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.
Print Na
Signatur
State of
County of Miami -Dade)
Sworn to and bscribed
day of
Owner
By
(SEAL)
Type of Identification
before me this 3
, 20_L_q__' -
OAtiC1A
3SI1 1 M FF 0483
EXPIRES: Oct 5 u .201 e16
Print Nam
Signature:
Vnntrartnr
State of Florida )
County of Miami -Dade )
Sworn to and s bscribed before
day of 00/ E r/ .2(
By
of Identification
this
MI11 MEG1AROA
My COMMISSION t FF 048923
�{+IR€S• nctnher 20, 207
Boaaed 7h- Worry PW- U'*Mk'