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MC-16-1014 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-257007 Permit Number: MC4-16-1014 Scheduled Inspection Date:April 20,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: KEATING,PHILIP&LISSET Work Classification: A/C Replacement Job Address:145 NE 101 Street Miami Shores,FL 33138- Phone Number (305)336-1715 Parcel Number 1132060131940 Project: <NONE> Contractor: FRIENDLY ROOFING INC Building Department Comments CHANGE OUT TWO AC SPLIT SYSTEM IN AND SWAP Infractio Passed Comments OUT A/C. INSPECTOR COMMENTS False 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 32 of 46 a� Miami Shores Village 10050 N.E.2nd Avenue NE nn Miami Shores,FL 33138-0000 Y - r � 'U Phone: (305)795-2204 " y Expiration: 1011512016 ! Project Address Parcel Number Applicant 145 NE 101 Street 1132060131940 Miami Shores, FL 33138- Block: Lot: PHILIP&LISSET KEATING Owner Information Address Phone Cell PHILIP&LISSET KEATING 145 NE 101'Street (305)336-1715 MIAMI SHORES FL 33138- 145 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 4,500.00 FRIENDLY ROOFING INC W Total Sq Feet: 0 Tons:5 Available Inspections: Additional Info:CHANGE OUT TWO AC SPLIT SYSTEM IN A 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 $3.00 Invoice# MC-4-16-59424 DBPR Fee $2.37 04/15/2016 Credit Card $50.00 $129.24 DCA Fee $2,37 Education Surcharge $1,00 04/18/2016 Credit Card $ 129.24 $0.00 Permit Fee $157.50 Suing Fee $9.00 Technology Fee $4.00 f" Total: $179.24 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 ac ceptirig;.1his 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 ce�all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z ' q ru ore,I autho' bove-named contractor to do the work stated. April 18,2016 OutKo-rized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 18; 016 1 ' �C`` Miami Shores Village A R 15 i� ult ( Building Department BY - - 7 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 9 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 "! FBC 201 C3 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1q5 NE W'i4l JJ City: Miami Shores/- �/County: Miami Dade Zip: '3313A Folio/Parcel#: 16;a32-06 —O/3 — /�y/ /D Is the Building Historically Designated:Yes NO X Occupancy Type: toad: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):!Lkea Phone#: Address: IK /�,6 /o/ r / City: g ( �'>li ceS State: t'6rj a zip. 3313 Tenant/Lessee Name: Phone#: Email: / Q CONTRACTOR:Company Name: �/fndl/� �1L//�,ln/_. Phone#: Address: /M C"16,i��l City: lTJCCc- n State: 06(1 G Zip: .3M3 Qualifier Name: Phone#: State Certification or Registration#: _(fGt.G j l S[�y Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: U A 1161 City: State: Zip: Value of Work for this Permit:$ - r .00- Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition 2/,, l 10 Description of Work: ( a/ 1��/� _�I? ad &f, 11 /AaP actAlk ., L , Specify color of colo/r-tthru tile: Submittal Fee$ v v it Fee$ —2145-0CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 00 TOTAL FEE NOW DUE$ l ! • v (Revised02/24/2014) f Bonding Company's Name(if applicable) Bonding Company's Address City State / Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City Lim ce- State Zipago 4W — 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 sev n (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a rein pection fee will be charged. r Sign Signature OWNER or AGENT CONTRACTOR The f oregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this fG\ day of /i 1't ,20 1 . ./ (- , by f day of X, �i 20 J by Phi i ROSS I( tCQ�'�,'✓� who is personalty known to r.r �� who is personally known to me or who has produced it ( f i�110dr IS L t CQ,4-,S e as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: �r.�.0�'z CeJ,/1 Sign: Prin • cH 7- Print: t iY�r ""•� DIONISIA DREWRY FECHT Seal: Seal ..� � `= Notary Public-State of Florida ,.+qti r ••., AVA(ASHITAI aMAIM Commission dt FF 220831 = �+� MYCOMMISSION tFF243100 My Comm.Expires Aug 8,2019 •, EXPIRES:October 21,2019 •�,q�,�;�' Bonded IVU Wry Pubk Ups **** *�r�xs * *** s•s �►�x* *****�►** ***t ► APPROVED BY � fis Examiner Zoning (�W Structural Review Clerk (Revised02/24/2014) AIC 9j Uc#aac1815584 19515 Carolina Cir, Boca Raton,FL 33434 Phone: (561)674-1478 Fax: (561)826-7139 E-mail:friendlyroofing@hotmall.com Date: 04/13/2016 State of Florida, county of Palm Beach Before me this day personally appeared Adonicam Gomez who, being duty sworn, deposes and says: That he or she wilt be the only person working on the projet located at 10682 NE 11th Court, Miami Shores FL Sworn to and subscribed before me this 13th day of april 2016, by Produced ID- PRINT TYPE OR STAMP NOTORY NAME AYALAS}NTAITELMIYJiH MY CONRNAS M t FF200WO EXPIRES:Oct9 21,2019 Bmubd Thm NMmp PUe WWdWM�018 `$ •SES G Miami shores Village IRON Building Department 10050 N.E.2nd Avenue � R1Ap' 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. L NING BELOW YOU ACKNO EDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS TS. Owner State of Florida County of Miami-Dade �7 The foregoing was acknowledge before me this 7 day of �( ,200. By P l I i yO 1&.5-sell k ctii,�who is personally known to me or has produced -TL 7C t V2 v1f s L CA k s C assiidentification. Nota4r" DJO SIA OREWRY FECFiT SEAL: Notary Public-State of FWW COMMISS(on#FF 220831 My COMM.EWM A a a.2012 IN NyAaSn t yl* 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): A__ o' 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❑ ARHI Sheet Attached:YES ❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT , '? -I'C•L c, S MANUFACTURER qvc, 1S q Q AHU or PKG.UNIT MODEL# COND.UNIT MODEL# IL461 ) i 6. KW HEAT Iw`L% 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 G EER/SEER YES REPLACING DUCTS YES YES REPLACING THERMOSTAT YES YES NEW 4"CONCRETE SLAB YES YES NEW ROOF STAND YES O YES NEW RETURN PLENUM BOX YES O 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection(Fuse/Breaker Size): 3. Voltage of Circuit(208/240/480): G'9; 4. Size Disconnecting Means: )CJ r ` Contractor's Company Name: E; ittA k eCc-4-1, IAC- -(-"V'L phone: State Certificate or Registration No. Certificate of Competency No. Signature Date: (Qualifier's signature) (Revised02/24/2014) yta, Miami Shores Village Building Department ..,. „�.� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 aim Tel:(305)795.2204 �OR� 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. L� Job Address(where the work is being done): G 101st- <S+- 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 D/�ARHI Sheet Attached:YES ❑ NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT L MANUFACTURER UV ►-� (p AHU or PKG.UNIT MODEL# Pt V 3 G.1cJ AA COND.UNIT MODEL# 61 I G KW HEAT 9, c..R/ 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 1 ';.A� YES 44& REPLACING DUCTS YES dw YES REPLACING THERMOSTAT YES YES NEW 4"CONCRETE SLAB YES YES NEW ROOF STAND YES YES NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurren"rotection ( us Breaker Size): 3. Voltage of Circuit 08/1140/480): r� 4. Size Disconnecting Means: ` ''�)q�(V^ Contractor's Company Name: '� � ' (-�l^� 2 Phone: ��" �(` State Certificate or Registration No. Certificate of Competency No. Signature Date: (Qualifier's signature) (Revised02/24/2014)