MC-15-1195 Aor7' 21
Inspection Worksheet
Miami Shores Village ^� I
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-235028 Permit Number: MC-5-15-1195
Scheduled Inspection Date: February 03,2016 Permit Type: Mechanical - Residential
Inspector: Perez,JlanPierre Inspection Type: Final
Owner: MSM REALTY ASSETS LLC, MSM Work Classification: Addition/Alteration
CCAI Tv AQQCTQ t 1 P
Job Address: 131 NE 93 Street
Miami Shores, FL 33138- Phone Number (305)335-3515
Parcel Number 1132060133020
Project: <NONE>
Contractor: MG EXCELLENCE SERVICE CORPORATION Phone: (786)247-7067
Building Department Comments
NEW DUCT DUE TO BATHROOM REMODEL Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
February 02,2016 For Inspections please call: (305)762-4949 Page 4 of 42
Permit NO, MC-6-15-1X19
Miami Shores VillageP+ l7Ttil'Tit — e.,1Nehaica -Residential
10050 N.E.2nd Avenue NE
Work Classifica6bn Addition/Alteration
Miami Shores,FL 33138-0000 Per
ROVet)"
Phone: (305)795-2204 e� �PP
oRtoA
Issue date.512?12015 Expiration: 11/238201
Project Address Parcel Number Applicant
131 NE 93 Street 1132060133020
Miami Shores, FL 33138- Block: Lot: MSM REALTY ASSETS LLC
Owner Information Address Phone Cell
MSM REALTY ASSETS LLC 131 NE 93 Street (305)335-3515
MIAMI SHORES FL 33138-
10155 COLLINS AVE
BAL HARBOUR FL 33154-
Contractor(s) Phone Cell Phone Valuation: $ 400.00
MG EXCELLENCE SERVICE CORPOR (786)247-7067
Total Sq Feet: 00
Tons: Available Inspections:
Additional Info:NEW DUCT DUE TO BATHROOM REMODEL Inspection Type:
Classification:Residential Final
Approved:In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work: Underground
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Invoice# MC-5-15-55630
DBPR Fee $2.25
DCA Fee $2.25 05/27/2015 Credit Card $ 115.10 $50.00
Education Surcharge $0.20 05/19/2015 Credit Card $50.00 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $165.10
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 zonin thermore,I authorize the above-named contractor to do the work stated.
May 27, 2015
Authorized Signature: ner / Applicant / Contractor / Agent Date
Building Department Copy
May 27, 2015 1
4
Miami Shores Village ;?TrxVFD
Building Department MAY 19 2015
10050 N.E.2nd Avenue,Miami Shores, Florida 33138 BY'
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.2C I t3 " G7 2—
PERMIT APPLICATION Sub Permit No.q�f dS I1��
❑BUILDING r-] ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING I'm MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
\ p CONTRACTOR DRAWINGS
JOB ADDRESS: ) l� -3zzr
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood/Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): r�S� C,4.S Phone#:
Addre D 1 15 E� CC)I 0S Jftv JOOLI
City: y State: Zip: 33/
Tenant/Lessee Name: Phone#:
Email: /
CONTRACTOR:Company Name: T S Phone#:
Address: o W s 1
City: State: Zip:
Qualifier Name: t /1 Cs9�®C� Phone#:
State Certification or Registration M / O Certificate of Competency#: e
DESIGNER:Architect/Engineer: ® �� G(:C-C- Phone#: -S-15 c/
Address: SJ z— cSzAi / ,S- y City: ULChn State: F4 Zip:'3�
Value of Work for this Permit:$ 410 1 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration _t!] New ❑ Repair/Replace ❑ Demolition
Description of Work: 4
Specify color of color thru tile: �y
Submittal Fee$ (jo Permit Fee$ ® L V CCF$ Q ka-CD CO/CC$
Scanning Fee$ -00 Radon Fee$ DBPR$ 2-. Z-5 Notary$
Technology Fee$ ®• Training/Education Fee$ •'�.� Double Fee$
Structural Reviews$ Gam' Bond$
TOTAL FEE NOW DUE$ D '57- Q':5
a�Q
(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 an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of su posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signe Signature
--------------
OWNER or AGENT CO RA
The foregoing instrument w acknowledged before me this The foregoing instrument as a owledged before me this
day of 20 l� , by day of 20 /, by
m who i ersonally know f 1cfo- w is personally kno to
me or who has produced as me or w a roduced as
s
identification and who did take an oath. ide icnand o did-take an oath.
e
NOTARY PUBLIC: J�OfI �LI
c1Q
Sign:
Print: � t:
Seal: ft&� NOtory Punic Stzfe of Florid8 � °`� Seal:
Eiie8er PiacereS
My Com.wn sin,.CE 884650
q p Expires 03/1712017 X01 f0fille§Wle of MOng8
*>k**x***** ******* *w**** s* *** * ** w ********** *** **** * *A*
i `ciF dt ��A9I19/3�'d9
APPROVED BY v Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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SEC.TYPE O BUSINESS j5' MENT RECEIVED
OWNERMECELLENT SERV{G.ES CO,P 196E MECHANIC r. BY TAK COLI.EsTOR
OW
C IVTRAGTOR 46.00 09/ ',.,,'12014
,kCAC1816. , r02�11M005 + 5
j pt Is not Acanse.
f:. Tax Rett only cc ;taYmeF3be Local -s'
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t1is L ocap � ,, '
hermit.or.a cern icatron of taFfi rid®�s qus(a cations,tea o b�tnes nthe burin k with any 94!L s
or nongov reme tai regulgttiry;lim and req ilremaMs'ti oh apply
x The fCEt: tPF NO above}tmt be displayed on all commercial vehrcles,�N►iaq�i,Aada°Cpde Sec 8$ri
morei ormtttion,vmltu sv miamidade gc'v Yo Tt",^#,
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JEFF AT IVATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW•'
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 1/12/2014 EXPIRATION DATE: 1/12/2018
PERSON: GARCIA MICHEL
FEIN: 205418978
BUSINESS NAME AND ADDRESS:
M G EXCELLENT SERVICES CORPORATION
380 W 84 ST
HIALEAH FL 33012
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL LICENSED PLUMBING LICENSED ROOFING HEATING,VENTILATION,
CONTRACTOR CONTRACTOR p�CONTRACTOR AIR-GOND
mt arm��aoom0 4e aittWerNb o�aPP ro CMpU�as ea�12�,R:9�CQr�Caten aeTxnon eapt�...ePVen�Nmwn ttw spa
ottha bwNeaa orhade Baud on Ms natloa of ehotloa to 6e'elmmpt Pareuent to CMpbr440.�(791 R.&,-Notbeaof eteatlan to�e exempt end oeNemtea of
etaotlon to t»exempt shell M aub sotto revooetlon K at siipHma af0er.9ia Bea atlromfka«the bwenoe otcro oallbata,fha vaeoa,nmed�aro�tloe ars
-rsranmta no bn8®r meats tlu req�rementa etMb aeetlen ter baunw of a oa�lBbs9a.TM AapartnroM Mail rwob h oerBflmte.at ary time ter k@i,e ot1M'
pareeeaameE on the oertlfloete to meet tsa regaUamenb et Uh ceotlen.
DFS-F2•DW0.252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07--12 QUESTIONS?(860)413.1504
https://apps8.fldfs.com/erreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER6... 5/19/2014
M.G. EXCELLENT SERVICES CORP.
Michel Garcia
360 W 64 ST
HIALEAH, FL, 33012,
MAY 13f 2015
STATE OF FLORIDA
COUNTY OF MIAMI-DADS �4&g-C
BEFOREMETHISDAYPERSONALLYAPPEARED �C/V�Q &WHO,
BEING DUL YSWORN, DEPOSESAND SA VS.-
THIS
S.THIS LETTER WILL CONFIRM THAT WE SHALL NOT EMPLOYANY WORKERS
ON THE FOLLOWING LISTED PROJECT AT 131 NE 93 ST, MIAMI SHORES, At.
33138. OTHER THAN MYSELFAND PROPERLY LICENSED AND INSURED
SUBCONTRACTORS. IFANY SUBCONTRACTORS SHOULD BE HIRED THEY
WILL REGISTER ALL PROPER LICENSEAND INSURANCE WITH THE CITY
UNDER SAID PERMIT,
SWORN TO D BSCRIBED BEFORE ME THIS DA YOF Ham
2015, BY
PERSONA LL Y KNOWN
OR PRODUCED IDENTIFICATION
' TYPE OFIDENTIFICATION
of Flofide
Hei 1 a x
ni ion EE 198011
s X2812018
or
PRINT, TYPE O MP NAME OF NOT
RY
4.
5tts
sell amm Miami Shores Village
Building Department
lOR>� 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..
Therefore,you 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.
Owner Contractor
Signature. r Signature: ��✓
State of Florida State of Flori
County of Miami-Dade County of Mi -Dade
The forego' g yas acknowledge be f a me this The foregoingwas acknowledge before me this
day of C,,- ,20�e�� day of 20 W' .
By. S l i By
who is pe o me or has produced who i rsonally kno me or has produced
as identification. as identification.
NotaO. F�8 � Notary: Nc s ®of ode
SE p sisal are SEAL: easel A
• ARy Com n EE 1 11 My coma 'mEE 19801
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