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MC-15-2775 v Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-246965 Permit Number: MC-10-15-2775 Scheduled Inspection Date:April 20,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPlerre Inspection Type: Final Owner: DOWSON,ALFRED&NANCY Work Classification: A/C Replacement Job Address:289 NE 102 Street Miami Shores,FL 33138-2426 Phone Number Parcel Number 1132060134970 Project: <NONE> Contractor: DEDICATED COOLING LLC Phone: (786)326-0911 Building Department Comments A/C CHANGE OUT 5 TON Infractio Passed Comments INSPECTOR COMMENTS False V' 2b Inspector Comments Passed Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 19,2016 For Inspections please call: (305)762-4949 Page 7 of 46 t Miami Shores Village 10050 N.E.2nd Avenue NE r .... yw Miami Shores,FL 3313&0000 Phone: (305)795-2204 Z.—Op Expkation: 0 /02/2016 Project Address Parcel Number Applicant 289 NE 102 Street 1132060134970 ALFRED 8 NANCY DOWSON Miami Shores, FL 33138-2426 Block: Lot: Owner Information Address Phone Cell [.ALFRED&NANCY DOWSON 305 NE 91 ST MIAMI SHORES FL 33138-3129 Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 DEDICATED COOLING LLC (786)326-0911 y y Yw w mm Total Sq Feet: 0 Tons:5 Available Inspections: Additional Info:A/C CHANGE OUT 5 TON Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# MC-10-15-57615 DBPR Fee $2.00 11/04/2015 Check#:3135 $91.90 $50.00 DCA Fee $2.00 Education Surcharge $0.80 10/30/2015 Check#:3126 $50.00 $0.00 Permit Fee $122.50 Scanning Fee $9.00 Technology Fee $3.20 Total: $141.90 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,PLU ING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAV ce ' th a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction n uthorize the above-named contractor to do the work stated. November 04,2015 uthorized Signature:Owner cant / Contractor / Agent Date Building Department Copy November 04,2015 1 0 IF Miami Shores Village ED Building Department OCT 9 0 2015 t1 g p l `(G 10050 N.E.2nd Avenue Miami Shores Florida 33138 CC , �7 Tel: 305 795-2204 Fax: 305 756-8972 7�. INSPECTION LINE PHONE NUMBER: 305 762-4949 NUMBER:(305) FBC 201 BUILDING Master Permit No. fqc i's' 2,*gs- PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING EgMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP �J CONTRACTOR DRAWINGS 10B ADDRESS: (�. �� I O�e � T City: Miami Shores ,� '1County: Miami Dade Z113: Folio/Parcel#:_ 11 3 2 1 /0 V !313 ,4:1 •1 0 Is the Building Historically Designated:Yes NO X_ Occupancy Type: Load: AA Construction Type: Flood Zone: BFE: (�/ FFE: /� OWNER:Name(Fee Simple Titleholder): �1 /y� Jl� Phone#:*� 010 S; �b Address: A�i� 1 PC I'0� Ca I City: M 1 H I � State Zip: // 3 b Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: . L W®L I Phone#: 7 No •' '32&" 09 Address: �4 OW 114- QJ City: W, r State: i' L Zip: 33 y t 6 Qualifier Name: u 0 k_7_ p p Phone#: blo - 3 26 0111 State Certification or Registration#: CA C t -1 1 0 1 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address City: State: Zip: Value of Work for this Permit:$ ®� 0 Square/Linear Footage of Work: Type of Work: ❑ AddPC- ❑ AIltrtatlion 1r_C❑ NewRepair/Replace ❑ Demolition Description of Work: 1. k A`—'b L 00-F R�0 Specify color of color thru tile: 6' Submittal Fee$ Permit Fee$ 0t CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ .� (Revised02/24/2014) 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 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 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 a reinspection fee will be charged. Signature Signature OWNER or AGENT - CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of-� ,20 ,by day of 20 j,by Db W0 U.who is personally known to t.l S (I who is personally y known to me or who has produced L DPJ Ut�UW me or who has produced�0tllt CP �Q luktC as identification and who did take an oath. identification and who did take an oatr-Vu NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print Print: L (�1�1._)G 1— ` ��Y rux Seal: ;� Sindia Alvarez My Commission FF 158750 Seal: o� Expires 09/0312018 �'tyjr,_ of A � '� MONICA L SANT�A W COMMOSIGN 0 FF 908293 �r*+r****�r•�e*e*ssea�*�►a�*se�xe:s*srs•*+rss**.•••***•*ase**�r•eaee* r�`o ►x�o1�*i�'��+� r�►�+��e *•�x***as**s*sus APPROVED BY ti / oan �lans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department .■■. nm 10050 N.E.2nd Avenue Miami Shores, Florida 33138 �rpR�p► 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):_ Z C69 W� I OZ. 1 City: Miami Shores Village County: Miami Dade Zip Code: 7 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 ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL# COND.UNIT MODEL# (, 0(n 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 O YES NO REPLACING THERMOSTAT YES-60 YES NO NEW 4"CONCRETE SLAB Lyrz NO 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): LO 0 3. Voltage of Circuit(208/240/480): 4. Size Disconnecting Means: ,�1p 7 Contractor's Company Name: t LA T EQ a`� L i 0 Phone: 7 I a - 3/� S I I State Certificate or Regi ration No.CAL f�� 10 Certificate of Competency No. Signature (Qualifier's signature) (Revised02/24/2014) Local Business Tax Receipt MT Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6939145 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES DEDICATED COOLING LLC RENEWAL SEPTEMBER 30, 2016 8964 NW 174 LN 7214950 Must be displayed at place of business MIAMI FL 33018 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED DEDICATED COOLING LLC BY TAX COLLECTOR Worker(s) ) CAC1817017 $75.00 07/08/2015 CREDITCARD-15-034462 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT ND. above must be displayed on all commercial vehicles-Miami-Dade Code Sec Ba-276. For more information, visit www.miamidade.gov/taxcollector soon n Miami shores V � a Building Department tpR ► 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 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 CKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. i Signature: Owner State of Florida County of Miami-Dade ��ll The foregoing was acknowl`e�dgge,before me this c30 day of Q0100aNE�V— ,20 Bywho is personally known to me or has produced as identification. Notary: �� Notary pubtc State of Ronda Sindia Alvarez SEAL: asfosl2oas1587so a DEDICATED COOLING, I.I.C. 8964 NW. 174 LN. Miami, FL. 33018 786-346-4571 Licensed & Insured Mechanical Contractor CAC 1817017 Thursday, October 29, 2015 State of Florida County of Dade Before me this day appeared Luis Perez who, being duly swom, depose and says: That he will be the only person working on the project located at 289 NE. 102 St Miami Shores, FI. 33138 Affirmed and subscribed before me is day of Thursday, October 29, 2015 by Personally Know Produced Identification Type of Identification Produced u►ii++ea Stamp of Notary ,••4M1 S/p •., C,P�ust 21, 'O�W T. • 4W ca f #FF 131781ou :Q� �9`•;be,,e�rded taro m;:Qom,; i00