MC-15-1940 Inspection Worksheet
Miami Shores Village '
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-240411 Permit Number: MC-7-15-1940
Scheduled Inspection Date: September 28, 2015 Permit Type: Mechanical- Residential
Inspector: Perez,JanPlerre
Inspection Type: Final
Owner: BONAU,JOSE AND MARIA Work Classification: Addition/Alteration
Job Address:1250 NE 102 Street
Miami Shores, FL 33138-2618 Phone Number
Parcel Number 1132050250030
Project: <NONE>
Contractor: J.M.ARCE SERVICE Phone: 305-262-3589
Building Department Comments
INSTALLATION OF 2 EXHAUST FANS&RELOCATE 1 Infractio 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
September 25,2015 For Inspections please call: (305)762-4949 Page 9 of 39
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Miami Shores Villages
10050 N.E.2nd Avenue NE
lip
Miami Shores,FL 33138-0000 , ,
Phone: (305)795-2204
' Expiration: 01/31/2016
Project Address Parcel Number Applicant
1250 NE 102 Street 1132050250030
JOSE AND MARIA BONAU
Miami Shores, FL 33138-2618 Block: Lot:
Owner Information Address Phone Cell
JOSE AND MARIA BONAU 1250 NE 102 ST
MIAMI SHORES FL 33138-2618
Contractor(s) Phone Cell Phone Valuation: $ 1,400.00
J.M.ARCE SERVICE 305-262-3589 (305)720-6248
Total Sq Feet: 00
Tons: Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Approved:In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work:INSTALLATION OF 2 EXHAUST FANS Underground
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# MC-7-15-56557
DBPR Fee $2.25 08/04/2015 Credit Card $116.70 $50.00
DCA Fee $2.25
Education Surcharge $0.40 07/31/2015 Credit Card $50.00 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $166.70
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 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. Fut rmore,I authorize the above-named contractor to do the work stated.
August 04,2016
Authorized Signator • Applicant / Contractor / Agent Date
Building Department Copy
August 04,2015 1
Miami Shores Village RECEIVED
Nt �- Building Department JUL 31.2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 $
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20,/
BUILDING Master Permit No.Rc— LV-- $7�
PERMIT APPLICATION Sub Permit No,�C/� Z,27z/
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING [MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
i CONTRACTOR DRAWINGS
JOB ADDRESS: ,a` `O-2, t-
City: Miami Shores County: Miami Dade zip: /
Folio/Parcel#: Is the Building Historically Designated:Yes NO L/
Occupancy Type: Load: Construction Type: Flood Zone: B F E:
OWNER:Name(Fee Simple Titleholder):_ PbL4�i�' N�4(� phones
Address:
City: State: Zip:
Tenant/Lessee Name: /v A— Phone#:
Email: qf-,e-, log,, &�� LA-4 ctpJ Q e- B U
CONTRACTOR:Company Name: A-`z- 11(C Phone#:
Address: ® r Av- U-)A-
City: " A'1-1 I State: Zip:
Qualifier Name: Nll ® tv, A—,oC=am% Phone#:_30.T-700 62Y 9
State Certification or Registration#: liA&I Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit:$ 0- C Square/Linear Footage of Work:
Type of Work: ❑ Addi n ❑ Alteration ❑ New Repair/Re/place ❑ Demolition
Description of Work:
Specify collarof color thru tile: �y�
Submittal Fee$ �O� l/��Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Educat)on Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$k a C)
(Revised02/24/2014)
f l
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
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 OBT ,FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NbTltE OF COMMENCEMENT."
Notice to Applicant. As a condition to the issuance of a building permit with on 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 Signature a (aj 12 r
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrum t was acknowledged before me this
2i day of c�U L ( ,
201 -) ,by day of 20 / .by
.)CSS 2 C PU ,who is personally known to ,who Is personally known to
�` 1 ifrrr,,,, as me or who has �fe
me or who has produced �--%�/�>�"�r.,, produced SCD as
identification and who did take an oaf. �r''•.��°p'� Identification and who did take an oath.
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NOTARY PUBLIC: _ � �ffi O.�4 NOTARY PUBLIC:
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Sign
Print: ,�����ii�jF�a `\ Print:
Seal: Seal: a°`;��Pve�% LUS FEPXANDEZ
* MY COMMISSJON#EE 838180
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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CERTIFICATE OF LIABILITY INSURANCE
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TM CERTNWATZ IS OMM AS A MATTER OF INFORMATION OPILY ARID COMMNO,1 fS UPON THE CERTIFICATE HOLOM TW
CERTIFICATE DONS NO'T APPOWWW&Y OR NEGATNELY Atm,ECT )OR ALTIER TN&COVERAGE AFFORDED BY THE POLICIES
01M.OW. TIS COWIFICATIS OF RtR+ICE DOER NOT CONSTITUTE A CONTRACT O TWON TW N WJING NUAWAR(B).AUTHORIZED
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MWORTAXIII.fffteemillbabbolderban ADDITIONAI. be sadores& WOUBROGATIONISWAlmosubjeato
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COVERAGES CERTIFICATE NUMBER: REV*=NII R:
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EFFECTIVE DATE- 7 14 EXPIRATIMI DATE 7182MG
PERSON: ARCS JOSE a M
FESH: 851112177
BUSSIESS NAME AND Ate:
J M ARCS SERVICE INC
SW SW 22 ST
MIJAW Fl 33155
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6030 SW 2e Street
Miami,FL 33155
Date: July 30.2015
State of Florida
County of Miami-Dade
Before me this day personally appeared JOSE M.ARCE who,being duly sworn deposes and says:
That he will be the only person working on the project located at 1250 NE 102 St.Miami Shores,FL
33138
Sworn to(or affirmed) and subscribed before me this 3e day of JULY.2011 by JJse,
Personally Known
Or Produced Identification
Type of Identification Produced
���,�; YWAL FADL ON
t*; MY COMMISSION#FF123870
EXPIRES May 16.2018
3eeotas FI ,gym
Print,Type or Stamp Name of
Ingo Run Miami shores Village
L � Building Department
�ORtUA
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 Lawr 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.
Signature.
Owner
State of Florida
County of Miami-Dade q
The foregoing was acknowledge before me this 2 l day of 'SJ ,201 .
ByTcj�— ?�)Q N(--�J '`\ , �►rd►ii(i1i(i
is personally known to me or has produced
Notary:
SEAL:
/Mill III 11\0