MC-17-2646�sH°Rsy Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
lORio
Permit NO. MC-11-17-2646
Permit Type: Mechanical - Residential
Per it Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 12/28/2017 j Expiration: 06/26/2018
Project Address Parcel Number Applicant
129 NW 96 Street 1131010250100
ERIK SACCOMANI
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
ERIK SACCOMANI 129 NW 96 Street
MIAMI SHORES FL 33150-
129 NW 96 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone
MDS ENGINEERING CORP (786)436-7062
Valuation: $ 2,000.00
Total Sq Feet: p
Tons:
Additional Info: NEW DUCTWORK FROM EXISTING UNIT NEW
Classification: Residential
Approved: In Review
Comments: Date Approved:: In Review
Date Denied: Type of Work: NEW DUCTWORK FROM EXISTING l
Scanning: 1
Fees Due
Amount
CCF
$1.20
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total:
$160.45
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC-11-17-65579
12/28/2017 Credit Card $ 160.45 $ 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 th foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and z"gA Futhermore, I ay�l orize the above -named contractor to do the work stated.
December 28, 2017
Authorized Signature: Owner /- Ap�py
icant / Contractor / Agent uaie
Building Department C
December 28, 2017 1
BUILDING
PERMIT APPLICATION
❑BUILDING
❑ PLUMBING
❑ ELECTRIC
MECHANICAL
Miami Shores Village
Building Department RECEIVED
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20"
Master Permit No. /` 6l7 ¢&3
Sub Permit No. t ` 1(_ 1---4 Z(W1((9
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
❑ CANCELLATION ❑ SHOP
DRAWINGS
JOB ADDRESS: 179 Nvi I v fh S -
City: Miami Shores` County: Miami Dade Zip: 33 is
Folio/Parcel#: I , — -3 I 0 1 O2S` O 1 a0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone
OWNER: Name (Fee Simple Titlehool�d/er): � i 9 So GCy h Mcc
Address: 1 LCi N tlU Ito 4X si -
BFE: FFE:
Phone#:JUto - t-7S 31M
City: M I State: Zip: 33 1 SO , i
Tenant/Lessee Name: Phone#: ��� ' 9-7 S3 `l 3
Email:
CONTRACTOR: Company Name:
Address: � 5b &,
A 175 G✓► 1'?Cer;:Z &OJ/
37i✓►Li /��� ,
- Phone#:
/ � 6�36 �6, Z
City: / " ►jGt�'�^ t
State: J
Zip:
Qualifier Name: ,"rin aid 0
nn
L� ,(,ty7I
Phone#:
State Certification or Registration
#: GAG I2$d f S 0
Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address:
City: State:
Zip:
Value of Work for this Permit: $
(v�'y Square/Linear Footage of Work:
Type of Work: ❑ Addition
❑ Alteration ❑ New
❑ Repair/Replace
❑ Demolition
Description of Work:
l✓8l- e)lq✓see"S
. /1ec''/
rAle.,
Specify color of color thru tile: /-
Submittal Fee $ Permit Fee $ D b 19 v;�CCF $ CO/CC $
Scanning Fee $ W Radon Fee $ Z DBPR $2 • 25 Notary $
Technology Fee $ 1 " 60 Training/Education Fee $ 6' (4� Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $ 1
TOTAL FEE NOW DUE $ (Do `75
1
Bo r g Company's Name (if applicable)
Bo g Mpany's Address
City
State
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: 1 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. A
Signature -- Signature
O NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoii g instrument was acknowledged before me this
day of _,L 20by day of (�4— � 20 ( -51 by
who is personally known to �'� �-�2� o ��- �".�kr� , who is personally known to
me or who has producedQ-25�)
�- 2 ` hs� me or who has produced 2y e L <<Cch2 as
identification and who did take an oath. • oz�VZZi identification and who -did take an oath.
NOTA
IC:
i
Sign:
Print:
Seal: o��"r.e
� •tk�-9�w11
E*
:
My Comm(ssW M
`
Mwah 12, 20f
CWrrWon Na GGd'IS99
NOTARY P
Print: t
Notary Public State of Florida
Seal: ft Carlos Jose Flores
My Commission GG 112267
Expires 06/2o/2o21
APPROVED BY <,-\uPlans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)