MC-18-14 Permitwo. MC-1-1'8-14
�sKoRES
Miami Shores Village Permit Type:Mechanical-Residential
10050 N.E.2nd Avenue NE Work -Classification:AIC Re p I ac e me nt
Miami Shores,FL 33138-0000 Pen 'I't Permit Status:APPROVED
Phone: (305)795-2204
0 Iss us Date: 119/2018 1 Expiration: 07/08/2018
Project Address Parcel Number Applicant
575 NE 95 Street 1132060140760
Miami Shores, FL Block: Lot: THOMAS N CONWAY
Owner Information Address Phone Cell
THOMAS N CONWAY 575 NE 95 Street (786)218-2757
MIAMI SHORES FL 33138-
575 NE 95 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 5,500.00
ACEXTRA INC (786)270-6287
Total Sq Feet: 0
Tons: Available Inspections:
Additional Info:A/C SPLIT SYSTEM INSTALLATION Inspection Type:
Classification:Residential Final
Approved: In Review Review Mechanical
Comments: Date Approved: : In Review
Date Denied: Type of Work:A/C SPLIT SYSTEM INSTALLATION
Scanning: 1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.60
Invoice# MC-1-18-66030
DBPR Fee $2.89
DCA Fee $2.00 01/09/2018 Credit Card $ 159.99 $50.00
Education Surcharge $1.20 01/03/2018 Credit Card $50.00. $0.00
Permit Fee $192.50
Scanning Fee $3.00
Techrl,ology Fee $4.80
Total: $209.99
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Fue!g!gR�autho i the above-named contractor to do the work stated.
I January 09, 2018
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 09, 2018
� �6 40� � �` `� �
Miami Shores Village
FF-CF IVE®
Building Department SAN o3 �a�e
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795-2204 Fax: (305) 756-8972 (�-'/,�1 •`(�'
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201`x'
BUILDING Master Permit No.
PERMIT APPLICATION sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL
❑PLUMBING PM MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 5-75 o a Is S-�
City: Miami Shores / County: Miami Dade Zip:�1 3
Folio/Parcel#: `l-320(-�t51 q- O j Go Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): V10wt'N-s o c-10w r, Phone#: �$� tis -z7§ -
Address: s s
City: V-k-tC.,, k State: Zip: _ _3 1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: N C FX W A INC
Phone#: / 4 13-b2,U
7
Address: ` S VJ S� T�ER,
City: W�0.m/�, State: L Zip: 33
Qualifier Name: A'e; r rvo.& Ze-1-P COy �'��- Phone#:
State Certification or Registration#: CA C. 18 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ C) ,-,( Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ISI New ❑ Repair/Replace ❑ Demolition
Description of Work: A/C- 1,�,,eot_kl0.hi o yy
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ �jti�-� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ 2- DBPR$ Notary$
Technology Fee$ Training/Education Fee$' Double Fee$
Structural Reviews$ Bond$ �--Q
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
inspectiondnstru
and a reinspection fee will be charged.
SignatuSignature
ER or AGENT CONTRACTOR
The fors acknowledged before me this The foregoing instrument was acknowledged before me this
ISS �-u.� 20 (� by _dayof DeUM)2Or 20 j 7 by
C04 wC7�/who is personally known to 4C/✓1 rdo 0? Poor a-,1.9- ,who is personally known to
me or who has produced y�c DL N1111111114,. as me or who has produced rL 0ri"V,"S as
identification and who did take an oatl��` \�Eg••' �li identification and who did take an oath.
NOTARY PUBLIC: :=���o 0�0 , �•a% NOTARY PUBLIC:
Sign: Sign:
Print: ely, ,c MG rCG NESP Print: -?vl"w o l w i ko
Seal: Seal: GUifle=T
Notary Public
State of Florida
My Commission Expires 03/28/2021=
APPROVED BY Y ans Examiner f Zoning
Structural Review 4�' Clerk
(Revised02/24/2014)