MC-16-2458 NY
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3 � .1fl:)t �I � I� ltial
Miami Shores Village
y� 10050 N.E.2nd Avenue NE � ; ,� ca o � � ) 06
Miami Shores,FL 33138 0000 ��:...� '',;'.
Phone: (305)795-2204
OR1�D�' 1'
9113t2b t.B Expiration: 0311 17
Project Address Parcel Number Applicant
390 NE 91 Street 1132060190190
KENNETH WILKINSON
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
KENNETH WILKINSONFL (973)632-2529
Contractor(s) Phone Cell Phone Valuation: $ 3,000.00
COOL FREEZE AC CORP (305)591-9794 Total Sq Feet: 0
Tons: Available Inspections:
Additional Info:NEW A/C DUCT Inspection Type:
Classification:Residential Final
Approved:In Review Rough Duct
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work:NEW A/C DUCT Underground
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80 Invoice# MC-9-16-61229
DBPR Fee $2.00 09/06/2016 Check#:2176 $50.00 $61.80
DCA Fee $2.00
Education Surcharge $0.60 09/13/2016 Check#:3699 $61.80 $0.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $2.40
Total: $111.80
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 information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated.
(j I _ September 13, 2016
AAuthorrzed S nature: wner / Applicant / Contractor / Agent Date
Building Department Copy
September 13,2016 1
Miami Shores Village F,CFT . -
Building Department s zois
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 e;To
FBC 201
BUILDING Master Permit No. 'mac\ -X'A Q=k
PERMIT APPLICATION Sub Permit No. MC ,6 - zi5
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING F� MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: act® i1e7 "i,t -=& .
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): �c� t (�1.�lC�er , ��ic��Qw&u-- Phone#:`2j3)Z4Ro -®b"t0
Address: \aj,_)o
City: P1 cxk, paejabi State: VA Zip: '63
Tenant/Lessee Name: Phone#:
Email: /y
CONTRACTOR:Company Name: n L fj-f e?_P ow, Phone#: 005 567 V
Address: LJ d' S-L 6'�)Ct L. /
City: m ( CI n 1 State: FL Zip: 3 3<
Qualifier Name: y-n 1-0 (20 art Phone#:
State Certification or Registration#: 0 f0 e.�- Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New •® Repair/Replace ❑ Demolition
Description of Work: A\.C_ aL3 C�,
Specify color of�ccolor thru tile:
Submittal Fee$ J� a Permit Fee$ r V CCF$ 00 CO/CC$
Scanning Fee$ �• CO Radon Fee$ DBPR$ 2 ° Notary$0
Technology Fee$�z • ® Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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.
Signatu
40W(&RAGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was a nowledged before me this
day of V'� 20 by day of C�S ,20 1 6 ,by
,who is pe�known to ti)&?,?fwho is personally known to
me or who has produced as me or who has produced as
identificatio an o did take an oath. identification and who did take an oath.
NOTARY P ELIC. NOTARY PUBLIC:
Sign: Sign:
Print: Print•
o '
o �., R000LF0 E SOSA 1
Seal: ;iPa°"�e Seal: W. -
"I
EXPIRES Ssotenmer Ot.2010
Notary Public-State of Florida ,,p?,,M.o'u AM
=• ' My Comm. Expires May 4,2017
Commission# EE 873648
APPROVED BY Va xaminer Zoning
Structural Review Clerk
(Revised02/24/2014)