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MC-16-2364 MC4 2,364 Miami Shores Village Felt3t�p#3:�C�►> tcal Reai � ial 10050 N.E.2nd Avenue NE $ C �� '# SSIfc�t7 .lJ# �ttfln� � `• ""'�' Miami Shores,FL 33138-0000 y Att'� 1 APPR� �' Phone: (305)795 2204 gxi yate „ 1312 Expiration: 04/11/2017 Project Address Parcel Number Applicant 480 NE 103 Street 1132060170710 GEORGE M SCOTT JR Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell GEORGE M SCOTT JR 480 NE 103 Street (813)362-9468 MIAMI SHORES FL 33138-2457 480 NE 103 Street MIAMI SHORES FL 33138-2457 Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 PROSERV AMERICA LLC (954)450-5323 (954)557-2887 Total Sq Feet: p Tons: Available Inspections: Additional Info:REPLACEMENT OF A/C DUCTS Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work: Underground Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# MC-8-16-61082 DBPR Fee $2.00 08/23/2016 Check#:2543 $50.00 $91.90 DCA Fee $2.00 Education Surcharge $0.80 10/13/2016 Check#:2606 $91.90 $0.00 Permit Fee $122.50 Scanning Fee $9.00 Technology Fee $3.20 Total: $141.90 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 AFFIDAcy II oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and ijniT#u thorize the above-named contractor to do the work stated. G October 13,2016 Auth ri tura:Owner / Applicant / Contractor / Agent Date Buildi partment Copy October 13,2016 1 \� Miami Shores Village Building- Department f� 2'U16 [B l 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 I. Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 / - - FBC 20 (14 BUILDING Master Permit No. -2?-34 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION DRENEWAL ❑PLUMBING ZIMECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 11 So Nc 1103 ST City: Miami Shores County Miami Dade Zip: Folio/Parcel#: I s 32.0fO—®lis 0 1 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER:Name(Fee Simple Titleholder): orgf— M 0,C' T r, Phone#:� 9ye Address: z/W NEN (®3 S;r City: Miami Shor-es State: TL_ Zip: 33138 Tenant/Lessee Name: Phone#: Email: _W14 CONTRACTOR:Company Name: �' �oscxy rtC-et L L r_ Phone#: b-511) y50-53Z3 Address: 0:5b SCS ( (0'_1 Ay"Of, ' City: � 1 bto Vf_ iii fres State: T° L- Zip: 3'-102_4 Qualifier Name: MaAyt. 60y rcc @''o' Phone#:(3 State Certification or Registration#: ��4 ®(� q Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Z, -5'®t0 . Square/Linear Footage of Work: Type of Work: El Addition F-1tion ❑ Alteration New Repair/Replace ^ ❑ Demolition Description of Work: LOL4G�CI11- _L ®k A C -POC rS Specify color of color thru tile: Submittal Fee$ Permit Fee$ �� CCF$ �' 'A Q CO/CC$ Scanning Fee Radon Fee$ C-Q) DBPR$ 2 Notary$ Technology Fee$ ° 2-0 Training/Education Fee$ 0' E:o Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I ° 0 (Revised02/24/2014) �Bunding Company's Name(if applicable) Sint-Ve J1 _nSyrA/1cc' CO Bonding Company's Address Q,_44-i III —r.A►I S t'4-p— 320 City -AV i—I i n State TjAI- p Zip �'J Mortgage Lender's Name(if applicable) A /� Mortgage Lender's Address 'v /I City f 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 Signat e Oti ER rAGENT i CTOR--> The forego Ing,iristru t was ack owledged before me this The foreggiing nstrume t was ack wledged befor me this day of 20 4� , by -'—da f 20 by who is personally known to U who is Pers allyown to me or who has produced FhL0 Ste-31b J4-0(F4'- s moor who has produced as identification and who did take an oath. identification and wh did take an oath. NOTARY PUBLI NOTARY P LI Sign: Sign: Prin . Print: Seal: Notary Public State of Florida Seal: Notary Public Stets of Florida :` Tamara Rubio•Urquiza Tamara Rubto-Urquiae MY Commission FF 975769 My CAmmisslon FF 978789 poi' Expires 04109/2020U0%M a© Ex{Nres 04/09/2020 APPROVED BY �I ns Examiner Zoning A ; Structural Review Clerk (Revised02/24/2014) i INVOICE A/R AND HEAT Date Invoice# 8/15/2016 9110 833 SW 167 Avenue,Pembroke Pines,FL 33027 Dade:(305)374-1060 Broward: (954)450-5323 www.ProservAmerica.com Ship To: GEORGE M.SCOTT,JR. (813)362-9468 480 NE 103 STREET MIAMI SHORES,FLORIDA 33138 Technician Rep Tech Time TOMMY JDU JDU Description Quantity Price Each Amount 10 NEW DUCTS 1 3,500.00 3,500.00 State of FLORIDA) County of BROWARD) Sworn to(or affirmed)and subscribed before me this day of AUGUST,2016,by MANUEL R.BARRERA,who!1spersonall knoby me. The undersigned Notary 01-rin aa,acknowledges that HE execu d' p S aV001 � it Tamaubein iss M� 4io312020 978788 e 13 er Notary Pu c,as to Q6nif to'tokj Signature. State of FLORIDA) County of MIAMI-DADE) Sworn to(or affirmed)and subscribed before me this day of AUGUST,2016,by GEORGE M.SCOTT,JR.,who provided FDL#: as Identification.The undersigned Notarytublic of the State of Florida,acknowledges that HE/SHE executed i, proving a/c model and price of unit being installed. Q� Notary Public State FloridaGEORGE ,JR.,Owner TOfnare�u61�UP uqt® e►►► Exy 0012 99 0 Notary P to s i ature. Upon signing this receipt,cus omer is fully satisfied. Total $3,500.00 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD Qy CACO26413 The CLASS AAIR CONDITIONING CONTRACTOR `~ Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 BARRERA, MANUEL RAMON v � a PROSERV AMERICA LLC 14842 SW 42 CT MIRAMAR FL 33027 ISSUED: 08/03/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1608030001310 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-8314000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 IIDBA; Receipt#:183 CONTRA TR Business Name:PROSERV AMERICA LLC Business Type: Owner Name:MANUEL RAMON BARRERA (QUALIFIER) Business Opened:12/20/2010 Business Location:833 SW 167 AVE State/COuntylCert/Reg:CACO26413 PEMBROKE PINES Exemption Code: Business Phone: Rooms seats Employees Machines Professionals 3 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 1 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements.This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: PROSERV AMERICA LLC Receipt #WWW-14-00125164 833 SW 167 AVE Paid 08/03/2015 27.00 PEMBROKE PINES, FL 33027 U.S.A. 2015 . 2016 �_��- A G 2 3 2816 G) CO M . . • f f . . BY: -- . . • . . . . . . . • . ... . ... . m rp ... . cc 19 00 T C7 °p co (' y C CP cp ® nCiN r� - v '�