MC-15-2987 Permit No, M -1 '
Miami Shores Village Pttft �11Ca)--ReSatal
10050 N.E.2nd Avenue NEW /
Miami Shores,FL 3313&0000 f ' � cttn
., _ Fef wt StalttS.APPAMC
Phone: (305)795-2204 ,
issu bate 12171201Expiration: 06004/2016
Project Address Parcel Number Applicant
1094 NE 91 Terrace 1132050010380
Miami Shores, FL 33138- Block: Lot: WATERSEDGE SHORES LLC
Owner Information Address Phone Cell
WATERSEDGE SHORES LLC 1094 NE 91 Terrace (305)336- 100
MIAMI SHORES FL 33160-3313
72 GOLDEN BEACH Drive
GOLDEN BEACH FL 33160-
Contractor(s) Phone Cell Phone Valuation: $ 4,500.00
ARTIC BREEZE AIR CONDITIONING C (305)485-4085
_... __ .. _.__... . _. ._ Total Sq Feet: 0
ti
Tons:5 Available Inspections:
Additional Info:REPLACE THE A/C Inspection Type:
Classification:Residential Final
Approved:In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work: Underground
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00
Invoice# MC-11-15-57897
DBPR Fee $2.25 11/30/2015 Credit Card $50.00 $115.50
DCA Fee $2.25
Education Surcharge $1.00 12/07/2015 Credit Card $ 115.50 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $4.00
Total: $165.50
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 certi it that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. F t r ore,1 authorize the above-named contractor to do the work stated.
December 07,2015
Authorized Sig re:Owner / Applicant / Contractor / Agent Date
Building Department Copy
December 07,2015 1
Miami Shores Village
• Building Department NUv 0
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 ."O,�
INSPECTION LINE PHONE NUMBER:(305)762-4949 '-[ {
FBC 20 1 `4
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit Nb. (0 o ! P-�a
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: (� `! A/LL 2 I R Iz
City: Miami Shores Countv: Miami Dade _dip _ 3/ 39
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): C, A2 V h7 �.13 h✓l e,x" Phone#- -30S — 3 0 0
Address[ Z ���i /cYcyJ &a C k
/
City: 6 r, !Q e.r/ l3,1e a c 4 —State: /
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: G 1GLi eW PhPhone#: ��V;(-3'
Address: ;5,io
City: -t State: Zip:
Qualifier Name: C- a Phone#:
=State Certification or Registration#: �� Certificate of Competency#:
f I
DESIGNER:Achitect/Engineer: Phor)e#:
I
Address: City: State: Zip:
�o o a
i7elu�°f for this Permit:$�� Square/Linear Footage of Work:
T p6°01,Wor : ❑ Addition Alter
t* n [:1New [Repair/Replace ❑ Demolition
9 r.D�es�ription'�Sf Work; 4�1 /7 e-e �fL
A
Specify color of color thru tile:
Submittal Fee'$' Permit&$ ���v CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ S �
(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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature V Signature
OWNER or AGENT CONTRACTOR
,'7�
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of / /L'� ,� 20 / 5 byp��Jclay of �v�-- 20 J5 , by
d fV%li� !�0A,1Df�/ ,who is personally known to Ki e-aa /fJ�0���Ve$ ,who is personall no V$o
me or who has produced 6cW,,5as me or who has produced L G���f � n r W
T �
identification and who did take an oath. identification and who did take an oath. It
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: ., AMPBEII Print: i
• Y - tib o1 Florida r.°'" "�e;.,• •�.
Seal: r My
M.Eltpkilit iDEf.30,2018 Seal( _ .�S Notar y
% o�F�.••' Cofini>�titkn A►#Fti►9169 v aQ_ My C"" •.;oh •5�;:
k ok 7k*#ok k k#k+kk##k#&k k k k k k k+k*&$k 8t,k k ek ek ak k k k k k k eP*Ians
APPROVED BY Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
019"
Local Business Tax Receipt
Miami—Nde County, State of Florida
-THIS IS NOTA BILL - DO NOT PAY
6258297 LB
BME/ C
BUSINESS NAI.00ATION RECEIPT NO. EXPIRES
ARTIC BREEZE AIR CONDITIONING CORP RENEWAL SEPTEMBER 3Q, 2016
9971 SW 4 ST 6522883 Must be displayed at place of business
MIAMI FL 33174 Pursuant to County Code
Chapter 8A-Art.9&10
OWNER SEC.TYPE OF BUSINESS
ARTIC BREEZE AIR CONDITIONING 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED
CAC18168M BY TAX COLLECTOR
Worker(s) 1 $75.00 07/14/2015
CHECK21-15-091612
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 meat comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec Ba-27&
For more information,visit www mmmidade aovkaxooilactor
'Artic Breeze Air Conditioning
Ricardo Rodriguez
Date:
Stare of
County of OM l - DA DE
Before me this day personally appeared ROEX CLOD-16UT'I?� who, being duly sworn,
deposes and says:
That he or she will be the only person working on the project located at: M4 Nth
Sworn to(or affirmed)and subscribed before me this af) day of
206 . by & MID �QUi6uff-27
Whop
N VINET CAMPBELL Personally known
. aay Public-Bta,at
MY Comm.Expires oa jk all
Commission#t FF 1?3109
OR Produced IdentificationR, MUEaS�; I k��
Type of Identification Produced
CAMPBELL
. ` State o1 Florida
?" Oe7t 30,20',,c
rr 1?$1 /
Print Typ e or Stamp Name of Notary
SgOREs
• Miami shores Village
Building Department
OR 101 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 BELS YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS. _
Signature: L r"
n
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this Z 6 day ofu e,�iLl-- ,20 1 S .
B ) l l 0 e �o A, who is personally known to me or has produced
Y Y
L /ZS-e Z-'ec.an S F' as identification.
Notary
VOR CAMPBELL
SEAL: _ ft"1h0114-State o1 Florida
My Comm.E ,
OE!$0 2018
"'••F of v.d;••` COMM10110 Off 173169
,SH0 y 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. E�ch 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):
City: Miami Shores Village County: Miami Dade Zip C de:
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#
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 NO
YES NO REPLACING THERMOSTAT YES NO
YES NO NEW 4"CONCRETE SLAB YES NO
YES NO NEW ROOF STAND YES NO
YES NO NEW RETURN PLENUM BOX YES NO
1. Minimum Circuit Ampacity(Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit(208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: 'PP iw ts-4 -1/1 Phone: MOPS,
State Certificate or Regist ion No. / Certificate of Competency No.
Signature Date: r
(Qualifier's signature)
(Revised02/24/2014)