MC-14-1129 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-213407 Permit Number: MC-6-14-1129
Scheduled Inspection Date: November 24,2014 Permit Type: Mechanical - Residential
Inspector: Perez,JanPierre
Inspection Type: Final
Owner: BOURNE, ROBERT Work Classification: Addition/Alteration
Job Address:490 NE 101 Street
Miami Shores, FL 33138-2449 Phone Number
Parcel Number 1132060170430
Project: <NONE>
Contractor: AIR KING MECHANICAL CONTRACTOR, INC Phone: 305-823-5888
Building Department Comments
MOVE A/C UNIT TO FRONT OF HOUSE RE-CONNECT Infractlo Passed Comments
DUCTWORK INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
November 21 2014 For Inspections please call: (305)762-4949 Page 13 of 44
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Miami Shores Village FP_ CEIVED
Building DepartmentUN 0 2 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No. He, 6z p-1129
PERMIT APPLICATION Master Permit No. j9 Cl 3 _233-3
Permit Type: p �1
MECHANICAL
JOB ADDRESS: I�E 6 7 E 101 5trx\
City: Miami Shores County: Miami Dade Zip: .
Folio/Parcel#: 11 —'_3 z®�2 ^ ®1
Is the Building Historically Designated:Yes NO Flood Zone: L)
OWNER:Name(Fee Simple Titleholder): 1ZQb@4a POD
%!nC Phone#: 16CO ;2 3 _J
Address: I q® N eC.
City: 1A aVY1 r'C6 State: L Zip: 6Z�
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 4` mac\ p� Phone#. Al --q S
Address: 11651
City: �AjlQ/ry11 Stater L
Qualifier Name: N��A Ona c o-CnPhone#:
State Certification or Re istration##:CA C 0 15�!9 4 5 Certificate of Competency#:
Contact Phone# "� 3 5 90 Email Address:_8 QX' ® VOCon
DESIGNER:Architect/Engineer: Phone#:
A�
Value of Work for this Permit:$ Jt, !SX)O_ Square/Linear Footage of Work: 100
Type of Work: ❑Address j&Uteration ❑New ❑Repair/R lace ❑Demolition
Description of Work: 1 Lc_) (t
ee
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ a �✓
Bonding Company's Name(if applicable)
3onding Company's Address
-ity State Zip
Mortgage Lender's Name(if applicable)
ftrtgage Lender's Address
-ityState Zip
kpplication is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commence,
)rior 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,
understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES
30ILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC.....
JWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with al
tpplicable laws regulating construction and zoning.
'`WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OI
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TC
YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUI
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OI
COMMENCEMENT."
Votice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500,the applicant must promise i,
Mod faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property i
subject to attachment. Also,a certified copy of the recorded notice of commencement must be pggted at the job site for the first inspection whic,
)ccurs seven (7) days after the building permit is issued. In the absence ofsuc posted tice, the inspection will not be approved and
•einspection fe will be charged.
XftsignatureSignatur
Owner or Agent Q� AA Agntj pX4+
Che foregoing instrument was acknowled ed before me this l." The fore�joing instrument was ackno ledged before me this
lay of 20 '1 ,by �� " LST he, day of 201 V,by k 6 F[,
who is rsonall known to me or who has produced who is personally known to me or who has produced
personally P P Y
As identi a as identification and who did take an oath.
VOTARY PUBLIC: tea' Na1m PW10 Stam 0t F10dds NOTARY PUB
Crlatisirts C LWn
;�
My COInR1M%n EE119033
E)#u 09/04/2016
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sign: Sign:
Tint: Print:
vly Commission Expires: �� I My Com Sion Expi
�afoa
21,20u
kPPROVED BY Examiner Zoning
Structural Review Clerk
Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
I�
5t►OR�,S D
Miami Shores Village
Building Department
d
�ORi p 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): ±!!fjO
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
ARI(AHRI)DATA SHEET REQUIRED
Change Disconnecting means:YES ❑ NO❑ ARHI Sheet Attached:YES❑ NO❑ Contract Attached:YES ❑
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 YES 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 Compa Name: Phone:
State Certificate or R istratio Certificate of Competency N.
Signature Date:
(Quallflees signature only)
Invoice
ius4 Date: 06/02/2014
REFRIGERATION Invoice No.: 156677
Salesperson: Valdez
HEATING & COOLING Ship By: Local Delivery
LICENSE# CAC067976
3351 SSV 137th Ave
Miami, FL 33027
(305) 823-5888
Bill To:
MEP General Contractors/Robert Boume
490 NE 101 Street
Miami Shores, Florida 33138
Qty Description Unit Price Total
i Relocate Exi ing A/C Unit to the East Side of Address,with a new pad to be $963.00 $963.00
Installed per Gode and Manufacturers Specifications.
t to�ttll dt506rk the spired per Architectural;Crarin >+itl 4 a f#fl $ tl0
duworl arI rnchadrr�al s�cl�onsper plan and to be instal qualr
.. ....,.. ... ..i.. .......:.. v.. .:.e... .:... led
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1 Install new thermostat and control per plans and specifications. $250.00 $250.00
Subtotal $3,513.00
Total Amt $3,513.00
Balance Due $3,513.00
Elieff Signature Print Name
S�oR�s
R,,, v" Miami shores Village
a���
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
17* . g
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 anyperson 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 ERSTAND ITS
CONTENTS.
Owner \; Con ctor
Print Name: u�Ar1�� Print Name:
Signatur . Signature:
State of Florida) State of Florida
County of Miami-Dade) ' I(j County of Miami-Dade) Y
Sworn to and subscribed before me this . Sworn to and 1JV1.VM HIV,Una
p ,o`4p{lY p„
day of (� ,20 day of . ¢, ,.�RC�E, U
p•i MY COMMISSION#FF1190a8
By Y 1111 By oa EXPIRES May 4,2018
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(SEAL) My Commis"EEI M33 (SEAL)
Type of IdentificaJ&QJ&J= Type of Identification produced
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CMEP Fl L4WAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
W`CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAA
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to
be exert from FWda Workers'Compensation law.
EFFECTIVE DATE: 212112014 EXPIRATION DATE: 1/2016
PERSON: AMARAL
ANGEL
FEIN: 650937960
BUSINESS NAME AND ADDRESS:
AIR KING MECHANICAL CONTRACTOR INC
3351 SW 137 AVE
MMAR FL 33024
SCOPES OF BUSINESS OR TRADE:
HEATING,VENTILATION,
AIR-GOND
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