MC-15-2018Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number
Applicant
461 NE 101 Street
Miami Shores, FL 33138-2448
1132060170670
Block: Lot:
LISA AYUSO ALAN CORONADO
461 NE 101 Street
MIAMI SHORES FL 33138-2448
461 NE 101 Street
MIAMI SHORES FL 33138-2448
Contractor(s) Phone Cell Phone
RAINBOW AIR CONDITIONING INC 305-216-4594
Valuation:
Total Sq Feet:
$ 550.00
0
Tons: 0
Additional Info: INSTALL MINI SPLIT OWNER IS PURCHAS
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 1
Date Approved: : In Review
Type of Work:
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.00
$2.00
$0.20
$100.00
$3.00
$0.80
$108.60
Pay Date Pay Type
Invoice # MC -8-15-56672
08/17/2015 Credit Card
08/11/2015 Credit Card
Amt Paid Amt Due
$ 58.60 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Rough Duct
Review Mechanical
Underground
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, PLU ;G, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
» at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
OWNERS AFFI
construction an
Auth
rmore I authorize the above-named contractor to do the work stated.
August 17, 2015
/ Applicant / Contractor / Agent mate
Building Department Copy
August 17, 2015 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
L e
Inspection Number: INSP-241102 Permit Number: MC -8-15-2018
Scheduled Inspection Date: August 19, 2015
Inspector: Perez, JanPierre
Owner: ALAN CORONADO, LISA AYUSO
Job Address: 461 NE 101 Street
Miami Shores, FL 33138-2448
Project: <NONE>
Contractor: RAINBOW AIR CONDITIONING INC
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1132060170670
Phone: 305-216-4594
Building Department Comments
INSTALL MINI SPLIT OWNER IS PURCHASING UNIT
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Inspector Comments
\o1
August 19, 2015
For Inspections please call: (305)762-4949
Page 27 of 39
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
AUG 1 1 2015
FBC 20t4 s 5"
BUILDING Master Permit No. a C %-I'(--2001
PERMIT APPLICATION Sub Permit No. µC— IS - 20 V?
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION D EXTENSION ❑RENEWAL
❑ PLUMBING ( (MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
//Z / ®/ s 2
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): •(ice 47 d 0 Phone#:
Address: ft ( / 146 / b j f
City: (LC 4 1 7 k' State: F1 Zip: ' / 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: /1/4-€iv/3Vk) A -j A (pr1iocr1o'+bid) f, Phone#: 303--47Y-03/ 3
Address: / r ? 4 /"" 7 % 7T 4)
City: 44 P64i"J r L # I11( S . State: `L Zip: 3'10/17
Qualifier Name: _I osE 6. e7 4-(QZ r� Phone#:
State Certification or Registration #: £t63 5--V66 G Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
25-5-0. OD
Value of Work for this Per
Square/Linear Footage of Work:
Type of Work: ErAddition ❑ Alteration ❑ New
0 Repair/Replace ❑ Demolition
Description of Work: anti/ $ f r L Mr - SP -Cr Ow 1,1-4Ct_LIC ftaUe6/ a ZgAi l,11(<E
Specify color of toter thr(U.tile: ` 5n
0®
Submittal Fee $ Permit dee $4, �CiC� w CCF $ CO/CC $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ ' `��
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 . achment Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which curs ays after the building permit is issued. In the absence of such posted notice, the
inspection w' not b approve' d a reinspection ee will be charged.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
1:0 d yof .4 "J ,20! S
Ute. , 0 , who is personally known to
me or who has produced
identification and who did take an oath.
The foregoing instrument was acknowledged before me this
a-
by g day of Oac,2O/s/ , by
—fort= /r who is personally known to
as me or who has produced &b ?/`n �-V3A ° D as
identification and who did take an oath. F ('
NOTARY PUBUC:
NOTARY PUBUC:
Sign:
Print:
Seal:
r(Ai Cey
LAURA FARLEY
MV COMMISSION t FF 188027
EXPIRES: March 16, 2019
10F
APPROVED BY
(Revised02/24/2014)
Bedew TAN Bu* Notary Serves
Sign/
Print: r6'"' �4 C- '41.
Seal:
* * * * * * * * * *
***********
tans Examiner Zoning
Structural Review
Clerk
459F ATWOMER
CHNEF FINANCIAL OfFICEER
PERSONz GONZALEZ
MIN: wow*
NAME AND
RAINEOW AIR COMITIONING INC
•
JOSE
154TO NW 17 CT
MIAMI LAKES FL S3D'0
RSVP= OP
HEATING, VENTILATION,
AfR-COND
OvnerrOlv elaWst 441 Mu). s- arm, ro
ra memo twos Gr moot to etaadtc
et* !mom, w4r,
viegios 1414113,1
%KU* ae env
mow twassd ortiLnit
CiPaSUMIC453 CatiTil4GAT
-it
Local Business Tax Receipt
Miami -Dade County, State of Florida
IS NOTA 61U. - 00 NOT PAY
1482629
stiatieRSS SUVENEN.XSATON
RIECEWT NO.
Nit
COQ INC RENEWAL.
54 77 a 434 1482829
M LAKES R 33016
OWNER
RAINBOW A4R CONDONING INC
Worker(s) 10
=MOMS, WM IMMO
LBT
EXPIRES
SEPTEMBER 30,2015
Must tra aFtPlahred at place a b146040$6
PUI'SUartt to County Cede
Chapter EA - Ari. S & 10
SEC. TYPE OP BUSINESS
196 SPEC MECHANICAL CONTRACTOR
CAC035486
PAYMENT RECEIVED
sif TAX COLLECTOR
S45.00 W/08/2014
CREDITCARD-14-035925
Thk, Local Business Talt Receipt arrly veil= old the Local Business Tax. The Receipt is net a Bahasa.
penu*ra certification cd the bekler's see, to de famines& Helder aunt mem* vilth any orverareestal
or eengsverrementel tegastory laws • • requiem/Juts which ripply to the bailees&
The SEMI NO. above swat be dIsplaved melt cometerchal vehicles - hesmi-eadri Cob See as -Ma.
For ' Wee
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION .
CAC035486 ISSUED: 07/22/2014
CERTIFIED AIR GONO CONTR
GONZALEZ, JOSE R
RAINBOW AIR CONDITIONING INC
IS CERTIFIED under the provisions of Ch.4S9 FS
caL AUG al WIG Litionneatee3
.AUTO O$I Y'-EAACCIDENT
EA AGC $
AUTCi Y:
AGO
EA 7.
Notice to Owner
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
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 officeis 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 B OU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this i day of 7`L 5 , 20 11.
who is personally known to me or has produced
as identification.
By G.t Yo'
Notary:
SEAL:
V G 451
FARLEY
COMMISSION #FF 188027
EXPIRES: March 16, 2019
Bs* ThruBudget Notary Send
Date: 8/6/15
State of Florida
County Of Dade
Before me this day personally appeared Jose Gonzalez who, is being sworn, deposes and says :
That he will be the only person working on the project located at: 461 NE 101 st. Miami shores
Sworn i r affirmed to) d subscribed before me this 6 day of August, 2015, by.
Ir�i r
dS '' ,i2.4 2 -z G
Produced Identification
Drivers License G524-436-33-084-0
Stam name of Nota r
NN Notary Public State
pTeresa Cate of Florida
My Commission EE149599
ESM 11121/2010
-