REV-16-2863BUILDING
PERMIT APPLICATI
❑BUILDING ❑ ELECTRIC
❑PLUMBING
JOB ADDRESS:
City:
Folio/Parcel#:
Occupancy Type:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION L 49
MECHANICAL
RECEIVED
OCT 20 016
BY. •
FBC 20 (L1
rmit No. 12C— 7 -11? -42?
Sub Permit No.
❑ ROOFING r REVISION ❑ EXTENSI
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION
CONTRACTOR
N I�1RE�TEWAL
12y XE cl .
Miami Shores
❑ SHOP
DRAWINGS
County: Miami Dade
Load:
Zip: 33 (��
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): it l 46 ( /4. LOO V,9E5 gOCU f P 6S Phone#:
Address: a
City: D . 5,AA-oJ State: \ Zip: � k 3y
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address:
City:
P 7 Mi7_F1� LLC, Phone#:
22� /lli 1� c
1 W6 State:
Qualifier Narne: pi i C -K H ETZ et -it R
State Certification or Registration #: CAC 05'4 09
DESIGNER: Architect/Engineer: V`� �kjL C 13_
Address: 1/2 N q Z
Phone#:
Zip:
(305) �ctL—c o
Certificate of Competency #:
Phone#: 191.— 23 1
City: 11 . i(9i-e/) State: Zip.
Value of Work for this Permit: $ 0 Square/Linear Footage of Work:
Type of Work: c5iir Addition ❑ Alteration ❑ New ❑ Repair/Replace
0.4...t—C,.. /'0 cr GT S—i> c
Description of Work:
❑ Demolition
10" ce44,
chi 44.0 ft- a va-dkals,
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
(a5
•
Permit Fee $
CCF $
Radon Fee $ DBPR $
CO/CC $
Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Q -e
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.
Signatur
OWNER or AGENT
The foregoing instrument was acknowledged before me this
/CI day of 5C1)--1k111be( ,20 ((0 ,by
4l 1C weI ()mule), who is personally known to
me or who has produced as
identification and who clid take an oath.
NOTARY PUBLIC:
Print: CJI0,21�5 % C U eJ v6
Seal: GLORIA ANDREA CUER'
! I:Y.°,RES: JUN 21, 2017
? ; St Stc'de insu'n''
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
7gday of ; 12 -ti n' I9c r , 20 IU , by
, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
6CULX2
cjioet' 1G G Ci tom)
'r =}�Rt�4S DO #C
LrL J_
0'\t. •
.
C;' 1ES: JUN 21, 2017
2%n'.". '1 '71:7... I S;at.e ir;7r"nP'
*********************************************************************************iii***** *****************
APPROVED BY
(Revised02/24/2014)
7,4 r)s, miner Zoning
Structural Review
Clerk
Local Business Tax Receipt
Miami -Dade County, State of Florida
-THIS IS NOT A 13111 - DO NOT PAY
5754883
BUSINESS NAME/LOCATION
D 1 METZELAR AC LLC
225 NE 108 ST
MIAMI FL 33161
OWNER
D 1 METZELAR AC LLC
Worker(s)
RECEIPT NO.
RENEWAL
2794148
LBT
EXPIRES
SEPTEMBER 30, 2017
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
SEC. TYPE OF BUSINESS
196 SPEC MECHANICAL CONTRACTOR
CAC054090
PAYMENT RECEIVED
BY TAX COLLECTOR
$75.00 07/14/2016
FPPU04-16-010743
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 holders qualifications, to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ba -276.
For more information, visit www.miamidadeyov/taxcollector
KtN LHVVbU1v,
RICK SCOTT, GOVERNOR
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
CONSTRUCTION INDUSTRY REGULATIONOFESSIONAL I
LICENSING BOARD
10ENSE NUMBER
CAC054090
be CLASS AAIR CONDITIONING CONTRACTOR
lamed below IS CERTIFIED
Jnder the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2018
- ;••:
METZELAR, DICK J �--
DJ METZELAR AC LLC ►'x
225 NE 108TH ST „w,.. '^
MIAMI FL 33161A
k•
0.14, k,
ISSUED: 07/17/2016
fl
;
1/4
DISPLAY AS REQUIRED BY LAW
SEQ # L1607170001023
3/28/2016
.100%
Report Viewer
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 that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 3/23/2016 EXPIRATION DATE: 3/23/2018
PERSON: METZELAR DICK J
FEIN: 579747843
BUSINESS NAME AND ADDRESS:
DJ METZELAF: A/C LLC
225 NE 108 STREET
MIAMI FL 33161
SCOPES OF BUSINESS OR TRADE:
HEATING, VENTILATION,
AIR -GOND
Pustant b Chapter 44005(14), F.S.. an officer Of a ccrperation who et xis exemption fran Ns chapter by fling a certificate d elec5on under this section
may rot recast bencfils ar ccmpesaem under this chapter. Rrsuat b Chapter 440.05(12). F.S.. Certiflrdss Of eledicn to be exempt_ apply criy
widen t e scope d Ula tusiress cr trade listed on the rotce of elector o beexempt. P rsuant toChapter 440.05(13). F.S., Notices d election to be
exempt and certificates cf efec5m In ba exempt shed be subject to revocation if, at any lime after the filing d the meteor the issuaxe of the cerlficsee,
the person named on the notice err certificate rolonger meats the rent emacs of Iris section for issuance of acertificate The department shall revckee
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
haps://apps8.fidfs.coon/crreportviewer/reporMewer.aspx?gate=kdvpginc9D7Q3gH6TER6eP1KMZ%2FSz5bXKYfBxkrekeESoPVy1v4NPOPN42XeirDRGXVW I... 1/2