MC-17-2459 r a
Permit No. MIC-10-17-2459
�st!O1S o,� Miami Shores Village Permit rype::Mechanical-Residential
4� 10050 N.E.2nd Avenue NE WOrkClaSsifrcation:Pool Heater
Miami Shores, FL 33138-0000 Pen� '
Permit Status:APPROVED
Phone: (305)795-2204
F�oRtoA Ex iration: 05i20J2018
Issue bate: 11/21,12017 p
MEMEEEE�
Project Address Parcel Number Applicant
78 NE 101 Street 1132060131330
Miami Shores, FL Block: Lot: GLENN E BOARDMAN
Owner Information Address Phone Cell
GLENN E BOARDMAN 78 NE 101 Street (303)437-1529
+ MIAMI SHORES FL 33138-
78 N E 101 Street
MIAMI SHORES FL 33138-
Coritractor(s) Phone Cell Phone $ 2,500.00
PARKWOOD POOLS AND PAVERS LL (954)583-3355 Valuation:
-- —� Total Sq Feet: 0
Tons: Available Inspections:
P
Additional Info:POOL HEATER Inspection Type:
Classification:Residential Final
Approved:In Review Review Mechanical
Comments: Date Approved::In Review i
Date Denied: Type of Work:
I
Scanning: 1
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Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF
DBPR Fee $1.80 InvOICe# MC-10-17-65358 '
$2.00 10/13/2017 Check#:3535 $50.00 $61.80 1
DCA Fee $2.00
Education Surcharge $0.60 11/21/2017 Check#:3615 $61.80 $0.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $2.40
Total: $111.80
i
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 informatio is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-nam d co for to do the work stated.
I
November 21, 2017
Authorized Signature:Owner / Applicant / bohtractor / Agent Date
Building Department Copy
November 21, 2017 1
Miami Shores Village � TVED
Building Department ocT i 2ot1
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY.
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 14
BUILDING Master Permit No. �
PERMIT APPLICATION sub Permit No.
MCS 11
DBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL
❑PLUMBING 0 MECHANICAL [:]PUBLICWORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP
��^• C/O)NTRACTO R DRAWINGS
JOB ADDRESS:��C- IDI t / �1'M1 ��yet), Int-3-i'L� 30 F+ oPzc�Z SLk lo
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:_��: [ ���'�7j� Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: n
OWNER:Name(Fee Simple Titleholder): �Illf• �'( �N Phone#:�`U37- 15?_9
Address: 32 Ale- IN c!I �—
City: `CnNWA\ k-I:N, State: r L Zip: _?;3I
Tenant/Lessee Name: Phone#:
Email:��1�`�-IQl'L�1•Lr�'� �ul'Y�1�� ��'�l
CONTRACTOR:Company Name: %*.Wvoa?0.1S a."le paiJorS ur Phone#: q5q-583-3355
` Address: 0101 W. Sunr;&, BIVa , •j �F �•�
City: PA40FAiXPn ^^ State: fz Zip: 33313
Qualifier Name:. �1 i ci AAama Phone#: Q54-5U-3465
State Certification or Registration#: Certificate of Competency#:
."
DESIGNER:Architect/Engineer: ►JCA Phone#:.
Address:' '"" _ - ` "� B City: State: Zip:
Value of Work for,this'Permit:$i CZ 60.'. Square%Linear Footage of Work:
Type of Work: ❑ Addition �1❑ Alteration ® New f;�, ❑ Repair/Replace E] Demolition
Description of Work: �tb( Heade
4s id
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ ` CCF$ CO/CC$
Scanning Fee$ Radon Fee$ 2 " C� DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable) 01A
Bonding Company's Address _
City-. ~ - ( State . Zip
Mortgage Lender's Name(if applicable) AA
Mortgage Lender's Address
City t 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. a
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
n�
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 mastbe po"ste'd dt 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. - " Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged.before�me this
30 s day of t 20 I- by -80 of 20 1* by
JeAn Indr. who is personally known to who is personally known to
me or who has produced delyaA l i ansf.. as me or who has produced as
, i• • s4e an sa an
YMORGAN
io • o8ERYL MORGAN i '
identification and wh idtifitid Jria
�= MY COMMISSION#GG082765
NOTARY PUBLIC: MY COMMISSION#GG082765 NOTARY PUBLIC: oEXPIRES June 28,2021
EXPIRES June 28,2021. t
i
Sign: Sign:
Print: Print:
Seal: Seal:
y
*****(***\**************
APPROVED BY ;:�bExaminer Zoning
Structural Review Clerk
(Revised02/24/2014)