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MC-17-2671Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 290 NE 101 Street Miami Shores, FL 33138-2423 Owner Information Address Permit Permit NO. MC-11-17-2671 Permit Type: Mechanical - Residential Work Classification: Pool Heater PermitStatus: APPROVED Issue Date: 11128/2017 Expiration: 05/27/2018 Parcel Number 1132060134590 Block: Lot: Phone Applicant STEVEN T DOBIE CeII STEVEN T DOBIE 290 NE 101 Street MIAMI SHORES FL 33138- 290 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) HAVANA AIR CONDITIONING, INC Phone (305)558-9136 CeII Phone (512)569-3370 Tons: Additional Info: MECHANICAL WORK/ POOL HEATER INSTAL Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 3 Date Approved: : In Review Type of Work: MECHANICAL WORK/ POOL HEATEF Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $105.00 $9.00 $0.80 $119.60 Pay Date Pay Type Invoice # MC-11-17-65609 11/08/2017 Check #: 14950 11/28/2017 Credit Card Amt Paid Amt Due $ 50.00 $ 69.60 $ 69.60 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 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 AFFIDAVI I .-rtify thal the regoing info constructi• a d - ing. uther %e, I orize the ab Authori . Signature:, icant ation is accurate and that all work will be done in compliance with all applicable laws regulating med contractor to do the work stated. / Contractor / Agent November 28, 2017 Date Buildi 'g Departmen Copy November 28, 2017 1 3Bs' 3-G/Sz BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑PLUMBING MECHANICAL Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 Master Permit No. Sub Permit No. ❑ ROOFING ❑ REVISION ❑ PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: ? l D �� /o / City: Miami Shores Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: NOV 2017 j;Y: GL FBC 2014' Sfi� ()P- nic, 17 - ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION Construction Type: Flood Zone: ❑ SHOP DRAWINGS zip: 33/3f NO. BFE: FFE: OWNER: Name (Fee Simple Titleholder): ��'' /J�1 �r e Phone#:6 1'c/ ---337c Address: c9-ArL' /O / S'' City: ' . (,4L1; S7/-0 Z-. Tenant/Lessee Name: Email: State: 7[ Zip: 3 3/ 3, Phone#: CONTRACTOR: Company Name: County: Miami Dade p Address: if% Ia r 3 Si / City: /7?.91"-P 4 Qualifier Name: State Certification or Registration #: State: /24 CO5�c3T Phone#: 55-1 Zip: 3�l- Phone#:� Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: e3 City: State: Zip: �Value of Work for this Permit: $ ©" ' quare/Linear Footage of Work: Type of Work: ❑` Addition El Alteration Ne ❑ Repair/Replace n Demolition Description of Work: 114 (%/dr%r «L 1.<2eV- . / (7 �-e ti-- -.,Le--57 4-7/ p,—' Specify •color_of colortfiru tile: JO . Submittal Fee $d-w.1.,, �,-�-<Permit Fee $ t05 L, Scanning Fee $ Radon Fee $ 2 • Technology Fee $ Structural Reviews $ Training/Education Fee $ CCF $ x.,..x.-wry- NCO` CC • DBPR $ 2 • Notary $ Double Fee $ Bond $ (Revisedn2/24/70141 TOTAL FEE NOW DUE $ Gq • 6C) 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. Signature Signature OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this j1 day of -au )1 ,20 [7 ,by 1l day of U1j Ly6 1 who is , 20 )) by personally known to (k� who is personally known to me or who has produced Lf k4Iqxthi as me or who has produced -�, "l k 91i as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLI NOTARY PUBLIC: Sign: Print: Seal: DORIS ANAYS MARTINEZ • ,•,, \ •' i ::a'y P e c - State o1 Fiorda •• Cor ss.on : GG 156732 `'..�c Z • My COTT. ExD es Feb 14. 2021 - -► I _ _r �i ***************************A************************************************************* qiCA t) Plans Examiner CONTRACTOR APPROVED BY Sign: Print: Seal: DORIS ANAYS MARTINEZ Notary Pudic - State o' Fio-da Commission # GG 156732 My Comm. Exaires Feb 14.2021 Zoning * Structural Review Clerk