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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'