MC-15-2892 2L 1S P� Y
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-247884 Permit Number: MC-11-15-2892
Scheduled Inspection Date:June 06,2016 Permit Type: Mechanical- Residential
Inspector: Perez,JanPierre Inspection Type: Final
Owner: , Work Classification: Addition/Alteration
Job Address: 1421 NE 102 Street
Miami Shores,FL Phone Number (305)898-7882
Parcel Number 1132050240190
Project: <NONE>
Contractor: ALISAEZ A/C INC
Building Department Comments
REMODELING AIR CONDITIONING DUCT WORK AND(3) InIctio Passed Comments
EXHAUST FANS FOR BATHROOM INSPECTOR COMMENTS False
Inspector Comments
Passed Iy►
Failed
Correction ❑
Needed
Re-Inspection 1 1��� ®`'
p 4
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
June 03,2016 For Inspections please call:(305)762-4949 Page 1 of 31
� a
Miami Shores Village
10050 N.E.2nd Avenue NE 3 tt ?
Miami Shores,FL 33138-0000 }_
Phone: (305)795-2204r
,,�;. F
Expiration: 07/16/2016
Project Address Parcel Number Applicant
1421 NE 102 Street 1132050240190
Miami Shores, FL Block: Lot: BAY CONSTRUCTION&DEVEL(
Owner Information Address Phone Cell
BAY CONSTRUCTION& 201 S BISCAYNE Boulevard (305)898-7882
-- - ------ - - MIAMI FL 33131-
201 S BISCAYNE Boulevard
MIAMI FL 33131-
Contractor(s) Phone Cell Phone Valuation: $ 3,400.00
ALISAEZ A/C INC
Total Sq Feet: 0
Tons:0 Available Inspections:
Additional Info:REMODELING AIR CONDITIONING DUCT WO Inspection Type:
Classification:Residential Final
Approved:In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work: Review Mechanical
Scanning:3 Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40 Invoice# MC-11-15.67776
DBPR Fee $2.25 01/20/2016 Check#:1006 $163.90 $0.00
DCA Fee $2.25
Education Surcharge $0.80
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $3.20
Total: $163.90
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing informatio ' a ate nd that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above- actor t do the work stated.
' January 20,2016
Authorized Signature:Owner / Applicant / o r / Agent 15ate
Building Department C
January 20,2016 1
Miami Shores Village
Building Department NOV 16 015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION UNE PHONE NUMBER:(30S)762-4949
FBC 20
BUILDING Master Permit N-.,& 4,d 961
PERMIT APPLICATION sub Permit No. 1CC, I S- 2%12�
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL
❑PLUMBING k0ECHANICAL ❑PUBLIC WORKS M CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I 2- , eac—'
City Miami Shores County Miami Dade Zip:
Folio/Parcel#: ��,� Is the Building Historically Designated:Yes NO
Occupancy Type: �y✓i�ad: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):
Phone#: / J
Address:
State: Zip: ?'
Tenant/Lessee Name: Phone#•
Email:
CONTRACTOR:Company Name: Phone#; �Y ��
Address: 120 44491 "Z ser
r gyp;
it
may; / State: -
Qualifier Nam • D Phonek�1
State Certification or Registration#: ` d a .6 Certificate of Competency#:
if
DESIGNER:Architect/Engineer:
Q•� Phone#F%�'! o?/*0
Address: City: State• Zip:
Value of Work for this Permit:$._,• / square/Unear Footage of Work:
Type of Work: ❑ Addition E7AIteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Wor .Y�4�/ /c2. ,C,�4itf[�/ �cl C ( ��z•–
Specify color of color thru tile:
Submittal Fee$ _ Permit Fee$ tr CCF$ OZ• 4 0 CO/CC$
Scanning Fee$ 7a 00 Radon Fee$ DBPR$ �'�� Nary$
Technology Fee S Training/Education Fee$ Double Fee$
Structural Reviews 0 Bond$
TOTAL FEE NOW DUE$ K>
(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 Trp
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$25w,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 an a reinspection fee will be charged.
Signature � Signature
WNERorAGENT - CON CTOR
The foregolA instrument was acknowledged before me this The foregoing in ment wa cknoWledged before this.
day of 20 f by _� -day of 20 ,by
r e��
Or aW 4" e0 ,whoCpersi.nally kno o 6k ci 0-lka �.who is persgnally known to
me or who has produced 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:
i
Sign: Sign:
Print: Print:
Seal: � ~ MY COMMISSION EES72M Seal: '� • MY CoMmIMON 0 EEB72982
EXPIRES February 07,2017 EXPIRES February 07 2017
NO '3668183 oma f40
ss*sss*ss*ssss*sss*sssssss**ss**sss sss***ss1*,s:ss*s sass**s***ss**sss*ssss*sss**ssss**ss***ss**sss**ass***
APPROVED BY V lans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
EST I1AAATE
Amengual ®ectric Inc.
1421 NE 102 ST
Avflisaez Miami Shores, FL 33138
HVAC design-build
786-443-0853
Alisaez AIC
12973 SIN 112 ST 131 Estimate# 2015NCAC15
Miami, FL 33186 Date 10/27/2015
Done: 305-677-9556
Email: alisaez@aol.com
Fax: 306-677-2294
Description Total
Remodeling HVAC $3,400.00
AS PER PLANS Project#15-0301 Dated 04/22/15.WWhitelocke&
Williams,Consulting Engineers LLC
Includes new Ductwork as per plan and new exhaust fans and Vents
in Bathrooms. Items not shown on plan but included in budget are
New white Diffusers throughout.
NOT INCLUDE[) $0.00
Any deviation from the plans above will create a difference and will
void this estimate.
Actual Permit Costs From Proper authorities.
It does include standard 3/4"from unit to 2".
Subtotal $3,400.00
Total $3,400.00
By signing this do ment,the customer agrees to the services and conditions outlined in this
document.
Amengual 13 ric Inc. DIfte
Page 1 of 1
Miami Shores Village
dam.-
Building Department
�OR10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exem tion
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 YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature: ,
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this. day of � ,20 0 .
By� who P* jwnaWy known a or has produced
as identification.
N;1407)
I'
64
MY COMMISSIONS EE872882
EXPIRES February 07,2017
&0153 F S Oe.00m
f'/'41isaez
HVAC design-build
12973 SW 112 ST. 131 Miami, FL 33186. Ph: 305-677-9556 Fax: 305-677-2294—alisaez@aol.com
November 16, 2015
State of: Florida
County of: Miami -Dade
Before me this day appeared Hector Oscar Arballo who, being duly sworn
deposes and says:
That h willbe the only p�erA on working on tth roject located at
-i Miami Shores FL 33138.
�Sw�o�rn. to (or affirmed) and subscribed before me this _day of
ML-L-NAG 2_ , 2015, by 9=Tc, nswe IL UVW5
Personally kn
OR produce Identification
JPS Type of Idgrtification
produced
Print, Type or Stamp Name of Notary
a' No Notary r'ublic State of Florida
Sitxfia Alvarez
C '� My Commission FF 156750
'`.orW' Expires 09!0312018