MC-16-2645 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 �C
Inspection Number: INSP-269657 Permit Number: MC-9-16-2645
Scheduled Inspection Date: October 26,2016 Permit Type: Mechanical - Residential
Inspector: Perez,JanPierre
Inspection Type: Final
Owner: ESCOBAR, CARLOS Work Classification: Addition/Alteration
Job Address:362 NE 92 Street
Miami Shores,FL 33138- Phone Number (954)937-1841
Parcel Number 1132060136440
Project: <NONE>
Contractor: PR DEVELOPMENT&CONSTRUCTION INC Phone: (786)853-0420
Building Department Comments
REMOVE AND REPLACE 5 TON A/C UNIT Infractio Passed Comments
INSPECTOR COMMENTS False
TO REPLACE PERM IT#MC1 2-1645
9A1 :
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-267987. seal a/c closet, lock
caps and service unit
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
October 25,2016 For Inspections please call: (305)762-4949 Page 23 of 37
Miami Shores Village
M1iiG 9.ry � :
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204a �
Ex iration: 03/29/2017
Issue' I �"77
p
Project Address Parcel Number Applicant
362 NE 92 Street 1132060136440
CARLOS ESCOBAR
Miami Shores, FL 33138- Block: Lot:
I
Owner Information Address Phone Cell
CARLOS ESCOBAR 362 NE 92 Street (954)937-1841
MIAMI SHORES FL 33138-3134
362 NE 92 Street
MIAMI SHORES FL 33138-3134
Contractor(s) Phone Cell Phone Valuation: $ 4,500.00
PRVDEVELOPMENT 8:CONSTRUCTIO (786)853.0420a Total Sq Feet: 0
Tons:5 Available Inspections:
Additional Info:TO REPLACE PERMIT#MC12-1645 Inspection Type:
Classification:Residential Final
Approved:In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work:REMOVE AND REPLACE 5 TON A/C Underground
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00 Invoice# MC-9-16-61472
DBPR Fee $2.36 09/30/2016 Credit Card $173.22 $0.00
DCA Fee $2.36
Education Surcharge $1.00
Permit Fee $157.50
Scanning Fee $3.00
Technology Fee $4.00
Total: $173.22
In consideration of the issuance to me of this permit, I agree to p orm the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings, tat en's or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done b myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL, INDOWS S,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing in ation is r to and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the abov ed co tr r to do4he work stated.
September 30,2016
Authorized Signature:Owner / Applicant / C ctor Agent Date
Building Department Copy
September 30,2016 1
Miami Shores Village � T � � ,
Building Department s P 2 s o1s
10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 g--
BUILDING Master Permit No. PC '-?- 2- 3 o
PERMIT APPLICATION sub Permit No. M0,j(;-
46
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ( MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 3 G Z N gr
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: �Construction Type: Flood Zone: BFE: FFEE: t�
OWNER:Name(Fee Simple Titleholder): 1. ' �V� �(66 (LPhone#: ��J?/ 1
Address: q2
City: State:, Zip:
Tenant/Lessee Name: Phone#: 95V g3-71 O V I.
Email:
CONTRACTOR:Company Name: FA -D G®df'F°Let-T -rtVLC�-Phone#: -6T3 c X12'0
Address: i®s-Y® LAJ ® J
City: �-,T-.4 H J- State: Zip: I
Qualifier Name: kwni'r-q t, 7 Gq LG4n> Phone#: �� T3 C' Lf
State Certification or Registration#: C(A C Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$� Q Square/Linear Footage of Work: 4�6r'
Type of Work: ❑ A dition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of�olgr`thru tile:
Submittal Fee$ Permit Fee$ A �® CCF$ C<) CO/CC$.
Scanning Fee$ & - Radon Fee$ DBPR$ 2. Notary$
Technology Fee$ Y• Training/Education Fee$ I ' Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014) `� 4l
4
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 wotk 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 and a reinspection fee will be charged.
Signature y Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instru ent was acknowledged before me this
day of Jc��p�w ,20 , by k day of 20J by
Carr/o� Fir ,who is personally known to `,who is personally known to
me or who has produced TL /�t 4,cee5,. as me or who has produced of14 teff`(& ` Ak'mt as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:. , Sign:
Print: it, (0100.7. Print: S rV
Seal: Seal: ' t Notary Public-State of Florida
�'�,r p Raul Valdez ;�, Commlaaloo d!FF 224265
Geo Notary Public My My Comm.Expires Apr 26,2019
State of Florida
mmi F 90873
APPROVED BY 6A Aans Examiner Zoning
NY
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA
DEPARTMENT OF
PROFESSBUSINESS AND
.. IO - _ _
CAC1818264 N4L tEGULATION
tS; UED= ,07/10/2016
CERTIFIED AIR CEaND p'Q
ALCANTARA RUE3f0,Mg�E
PR DEVELOPMENIT_�COI�STF€UCTION INC
IS CERTIFIED under the Provisions of Ch.488 FS.
E)Phmon date:AUGs1.2018
L1607100000M
uWV
Local Business Tax Receipt
Miami—Dade County, State of Florida
HIS IS NOT ABILL—d0 NOT PAY
7193566 T
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
PR DEVELOPMENT&CONSTRUCTION INC RENEWAL SEPTEMBER 30, 2017
10540 SW 60 ST 7475583 Must be displayed at place of business
MIAMI R.33173 Pursuant to County Code
Chapter BA-Art.9&10
OWNER SEC.TYPE OF BUSINESS
PR DEVELOPMENT&CONSTRUCTION IN06 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED
BY TAX COLLECTOR
Worker(s)O EMILIO AMARAL ACEBAL PR@#C1818264 $75.00 07/09/2016
CREDITCARD-16-037584
This Local Busiaess Tax Receipt only confimns payment of the Local Business Tax The Receipt is am a license,
pemdt or a certification of the holder's q�lifiaadons,to do business.Holder must comply with any governmental
or nongovernmental regubnory laws and requirements which apply to the buslmss.
Thd RECEIPT N0.above must be displayed on all commercial vehicles—HAiff"ads Code Sac 8a4AL
For more Information,visit www miamidada ggy/taxcofiector
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JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
**CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW*
CONSTRUCTION INDUSTRY EXEMPTION
This certifies thatthe individual listed below has elected to be exemptfrom Florida Workers'Compensation law.
EFFECTIVE DATE: 8/1812016 EXPIRATION DATE: 8/18/2018
PERSON: ALCANTARA MARIA E
FEIN: 472421568
BUSINESS NAME AND ADDRESS:
PR DEVELOPMENT&CONSTRUCTION INC
10540 SW 60 ST
MIAMI FL 33173
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL LICENSED PLUMBING HEATING,VENTILATION,
CONTRACTOR CONTRACTOR AIR-GOND
pureuagtoChaFBar440.�(44),F.3„an d8ardecorp°raUmtvhoeleda m�emptlontr°m th�drephr 8lhgamtl8c�edele�en undr tlde aedmn
w�t9in�9eec�adih°ddnessa ISRad on$iadelactl°nte hCe Pira dMChapty A40.U6(131.FS,N�sdel�edlm�U°b�
exenptandcertl8cetesdetectl°nmbeexemptsiWl6esuhl�t°rewcaHonlLffiaigr9nreeR�the911ngd@ie atl�elsat�aneedN°certl6ceDe,
tle Person rented m thetntice a mN6e�rolager meeffi the recpdramer�d9da sec6m�r issuance de catlflcds.The slreA rav°kea
DFS-F2-0WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)4134609
httpsJ/appsB.Odfs.con/crreporMiewer/repWiever.aspx?datw--kdvpgjnc9D703gH6TER6ePl MZ°/a21SZ5WCKYfBxkrekOESoPVy1v4NPOPN42XeirDRGXVW I... 112
PR DEVELOPMENT& CONSTRUCTION INC
10540 SW 60 ST
� Miami FL 33173
Phone:(786)853-0514
Phone:(786)853-0420
Gen.Contractor License#CGC1522923
Air Conditioning License#CAC1818264
Plumbing License#CFC1429467
prdevelopmentandconstruction@hotmaii.com
September 212016
State of FLO rLT 1D A
County of H VIrm l — IU41745
Before me this day personally appeared FlAf'L64 ESTLt4 J4CC4't'4A4 who, being duly sworn,
deposes and says:
That he or she will be the only person working on the project located at: 36z NE q Z S J
MiAMi S'µo-tFs , FL- 3113Y
Sworn to(or affirmed)and subscribed before me this ay day of 20
Personally Know W
Or Produced identification �qYf c �(cV � �Cx l\y -
Type of identification produced `4{
KRISTIAN CASTILLO
i� Notary Public-State of Florida
� Commission#F FF 224283
My Comm•Expires Apr 26.201
II.111N
Print,Type or Stamp name of Notary
Page 1 of 1
agaM Miami Shores Village
Building Department
tpR>�uP► 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
Notice to Owner —Workers' Compensation Insurance Exemption
11000221221111M WE,:22'222
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 fill-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: it
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this ?_Z_ day of I& 20-L(1-0 -
B G_x
0-L(1-0 .BYx X25 T 15co J_XX 1/- who is personally known to me or has produced
ler It<-tY7 as identification.
�a0''°a Raul Valdez
`�, Notary Public
Notary: SM of Fk&a
SEAL: MY Conu*sion Expires 8111119
Commbsion No.FF 9N737