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MC-18-1117Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Perm 11 Permit NO. MC-4-18-1117 Permit Type: 'Mechanical- Residential Work Classification: Addition/Alteration Permit. Status: APPROVED Issue Date: 7/9/2018 Expiration: 01/05/2019 Parcel Number Applicant 1421 NE 103 Street Miami Shores, FL 33138-2625 1132050310150 Block: Lot: VILMA QUINTANA Owner Information Address 1421 NE 103 Street MIAMI SHORES FL 33138- 1421 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone TEST AND BALANCE AIR CONDITION (305)218-1798 Cell Phone Phone Cell Valuation: Total Sq Feet: $ 11,975.00 0 Tons: 3 Additional Info: NEW A/C 3 T UNIT NEW WH NEW DRYER E Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 1 Date Approved: : In Review Type of Work: NEW NC 3 T UNIT NEW WH NEW DF Fees Due CCF DBPR Fee DCA Fee Education Surcharge Penalty Fee Permit Fee Scanning Fee Technology Fee Work without Permit Fee Amount $7.20 $6.29 $4.20 $2.40 $100.00 $419.13 $3.00 $9.60 $419.13 Total: $970.95 Pay Date Pay Type Invoice # MC-4-18-67322 07/09/2018 Credit Card 04/26/2018 Check #: 1161 Amt Paid Amt Due $ 920.95 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Rough Duct Review Mechanical Underground 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 toning. uthermore, I authorize the above -named contractor to do the work stated. thorized Signature: Owner / Applicant / Contractor / Agent July 09, 2018 Date Building Department Copy July 09, 2018 1 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC 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 ❑ ROOFING PLUMBING MECHANICAL PUBLIC WORKS JOB ADDRESS: Master Permit No. Sub Permit No. RECEIVE APR 2 6 2018 FBC 20r4 rig-Lttq. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF CONTRACTOR `L-7A ‘D-Y-c4- City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: ❑ CANCELLATION ❑ SHOP DRAWINGS Zip: J5\V BFE: FFE: OWNER: Name (Fee Simple Titleholder): V \\Ma Qv \ Phone#: Address: ILZ� cam\ 1 1::) City: I— \ \ LM � \ JY�©� 5 State: ` --' Zip: J 13e) Tenant/Lessee Name: Phone#: Email: a CONTRACTOR: Company Name:7--P **a\ay.-‘ .T\v Phone#: Address: 2,-1-3 v J 7 1 t-1/4- .A\J to . City: \ a KAV\ t A State: Ft Qualifier Name: i t_ � *� }YA\i �c. �7 Phone#: State Certification or R stration #: ('J\( \ £� \ 5 - I v Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: l (/ 9 --S i M City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration o ❑ New t' Description of Work: ) 3 if vt i .1,(12-ik 7" ,,W-6 kvii Specify color of color thru tile: 1 C4 I cl . (3 Submittal Fee $ Permit Fee $ 147731, ? CCF $ Scanning Fee $ Radon Fee $ 4 • 7-0 DBPR $ ,( • c;9 ! I Technology Fee $ Training/Education Fee $ Double Fee $ 4 l • ( 3 Zip: ``—kZ ❑ Dem lition Structural Reviews $ (X . GC) (Revised02/24/2014) Repair/Replace CO/CC $ Notary $ Bond $ TOTAL FEE NOW DUE$ 4- •(72-V c1Zs7'RS Unding 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 OWNER or AGENT The for going instrument was acknowledged before me this day of _Pk& , 20 \Cif) , by \\rna QU1inbr+G, who sonally known to me or who has produced identification and who did take Sign: Print: Seal: ********************************** ******** APPROVED BY as The foregoing instrument�1was acknowledged before (mme this l \ day of )`k—�C\ , 20 t , by \; �k& (, wh personally known to me rWho has produced as identification and who did take an o NOTARY PUBL Sign: Print: Seal: 0 P9ns Examiner Zoning (Revised02/24/2014) Structural Review Clerk