MC-12-1714 F
71
Miami Shores Village Q M f � �t3' �h'W8@CIs't
10050 N.E.2nd Avenue NE
q M"
MA Ctass/ AIC Replacement-,
Miami Shores,FL 33138-0000
I
hVc� r� q►i 5� ;°AI PROVED
Phone: (305)795-2204 ;
ate;
Expiration: 0 0$12017
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Project Address Parcel Number Applicant
9005 NE 4 Avenue Road 1132060460030
CHRISTOPHER 8 JESSICA L Cl
Miami Shores, FL Block: Lot:
Owner Information Address Phone Celt
CHRISTOPHER &JESSICA L CURTIS 9005 4 Avenue Road
MIAMI FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 750.00
KINGDOM AIR CONDITIONG INC (305)986-0423
Total Sq Feet: 15
Tons: Available Inspections:
Additional Info:VERIFY THAT DUCT WORK WAS DONE PROP Inspection Type:
Classification:Residential Final
Approved:In Review Review Mechanical
Comments: Date Approved::In Review
Date Denied: Type of Work:
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Invoice# MC-6-16-60270
DBPR Fee $2'25 08/12/2016 Credit Card $259.10 $50.00
DCA Fee $2.25
Education Surcharge $0.20 06/20/2016 Check#:3252 $50.00 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $0.80
Work without Permit Fee $150.00
Total: $309.10
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 in ^'s a urate an at all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the a-na ^ontrac o do t e work stated.
August 12, 2016
Authorized Signature:Owner / Applicaa or / Agent Date
Building Department Copy
August 12,2016 1
Miami Shores VillagePF
CEM
Building p De �rtm- ent JUN 20 016
10050 N.E.2nd Avenue,Miami Shores, Florida 33138 BY: f
Tel:(305)795-2204 Fax.(305)756-8972 -
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 s
BUILDING Master Permit No. j le - i D 4 j
PERMIT APPLICATION Sub Permit No.MCA — t-1 I `j
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING S ] MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP
qoo�: CONTRACTOR � DRAWINGS
JOB ADDRESS: K� /q fK Aw*w 0 �-p`o vS;
City Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 113;L, O� 01j-(4 (10 0 3o Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
�rr__ �"��y,�/_•� {' . ��
OWNER:Name(Fee Simple Titleholder): (..�1 Irl4 I�NI l P .rr2�f 1l.�tCW-hone#: V. 5795•7
Address: 'Jr 4 •
City: D tl ( State Zip:
Tenant/Lessee Name - Phone#: WV10-
Email
CONTRACTOR::Company Name: t r Phone#: Z05-440-3; 9x
Address: �• 0 D cq, vra r
City:_ rWrl D State: .,ar, �--• Zip: ^
Qualifier Name: �+ O�UA/ Phone#: 305 �P�
�y
State Certification or Registration#: Certificate of.Cto�mpetency#: a ��','I
DESIGNER:Architect/Engineer: L t ..J) .i-�' Phone#: 784- 3Tt•
Oq %V-4 nllf, City: p 33 3.2g
Address: � S �� VQ�Ie State: Zip:
Value of Work for this Permit:$ 750 Square/Linear Footage of Work: 15- 1--1"
Type of Work: ❑ Addition El Alteration F-1New [Repair/Replace El Demolition
Descripti n of Work: Y W'6(- jh= `p
•
f ^�h
Specify color o�`cblo►�itlra�u.1t�1 : lS )-A
r ,, s ,
Submittal Fee$ _ ° Pecnit Fed$k Y CCF$ 1~O/CC$
Scanning Fee$ Radon Fee$ DBPR$ �� Notary$
Technology Fee$ (D Training/Education Fee$ Q' 2-0 Double Fee$
Structural Reviews$ Bond$ (2� /
TOTAL FEE NOW DUE$ o v R
(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 `� t 3 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 coristrvctigg and,zoning.
"'WARNING O`'OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENT91t YOUR�'P�ROP�ER°TY-: `If YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
Y0U&.N,QJ4CF OF,COMMLNC
Notice to Applicant: As a condition to the issuance of a building permit with an estim®t0dVal0t*q Pie)#i4g$2ftA&applicant must
promise in gboadfaith4- at a copy of the notice of commencement and construction lien law brochure yvil, e elrvered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencenmet*muW" L,potted at the job site
fQ e�t�x mspmti which occurs seven (7) days after the building perde�tiis`Issued.--/q t4i Absence of such posted notice, the
inspection will not be approved and a reinspecfign fee ivjll e,ch rgefl :t. . "A '• '
a 1 i_.3 6=",
7 1 9• \J b• ■ d1f
y
Signature Signature
cr _ %,
NER or AGENT ^ , 4 CONTRACTOR o
,.,1he•f egoing 1nstru�M ept was acknowledged before me this The foregoing in6trument was acknowledged before me this
0 da�of `. 20 (6 by d?X of 120 , by
/• who i perdonally�Cno�nrn to- �lJ;f who is personally known to
mi�,oc, teas produ edr L°63�'YD'Y4 07-aas me or wt�o his prgducoo
identificatiwa and who did take an oath. identification and who rl take an oath.
e—A r� ^9 R.. .
NOTARY PUN . NOTARY P
Sign:
Print: ,
FIOR^?LOW Print:
Seal: Seal: � W
Jose Ar!lob Formen# .�'��. ,lyse Ankoo Foment
WWS:oc o ff 1 ',c 15tP1i S: 1 �
**�*****�s�*ix*r�' '� r•s � �**2**77*/*Pln�xaminer
��APPROVED BY °� Zoning
Structural Review Clerk
(Revised02/24/2014)