MC-18-2399Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: MC-9-18-2399
Permit Type: Mechanical - Residential
work Classification: Pool Heater
Permit Status: Approved
Issue Date:11/08/2018 1 Expiration: 05/07/2019
Location Address Parcel Number
119 NW 110 ST, Miami Shores, FL 33168-4320 1121360030550
Contacts
PRISCILLA BRANCO HAISLEY Owner PRISCILLA BRANCO HAISLEY Applicant
119 NW 110 ST, MIAMI SHORES, FL 33168 119 NW 110 ST, MIAMI SHORES, FL 33168
Other:9546485602 Other:9546485602
ROSMEL POOLS INC Contractor
WILFREDO JR LEIVA
9300 NW 25 ST 103, DORAL, FL 33172
Business: 3055927900
Description: NEW POOL &SPA HEATER CONNECTION Valuation: $ 2,000.00 Inspection Requests:
Total Sq Feet: 0.00
Fees
Amount
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total :
$110.20
Payments Date Paid
Amt Paid
Total Fees
$110.20
Credit Card 09/10/2018
$50.00
Check # 15128 11/08/2018
$60.20
Amount Due:
$0.00
Building Department Copy
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.
IDAVIT: I certify that all the
ruction and zoning. Futhermo
r " ,
ng information is accurate and that all work will be done in compliance with all applicable laws
iorize the above named contractor to do the work stated.
Owner
/ Agent
Date
November 08,ogm Page 2 of 2
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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
S P 10 2018
BY
FBC 20 (-7�
Master Permit No. — 239
Sub Permit No.14C 19 ` 2: q
❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING g MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Il c1 9LO Ito ;5
City: Miami Shores County: Miami Dade Zip �LP�
Folio/Parcel#:Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder).�>L`1 WA kk IJf y = }i0k�iC9 Phone#: L0 �Q -S,azi
Address:`VA � •W• VIC %-
City: I`AlLtrni 6kO(IEs State: . Zip: 91W .
Tenant/Lessee Name: I��W Phone#: f(//k
Email: t J A
CONTRACTOR: �Coompany Name`:
Address: d d ,7 W 3/s�
Phone# 54f �, o -%/3
City: 14/4!-! e" State: /`'� Zip:
Qualifier Name: Q%S e'er-44 &I ILQt-
tIL,,rr)` Phone#:
State Certification or Registration #: c�/-1 �(�� S-� 4/.- Certificate of Competency #:
DESIGNER: Architect/Engineer: I Aun. l f7i ora,l ;•IG, . j y �'i • d040g9 Phone'#: r 6s-
Address I�15' S w . 2� � $k,1 III City: P/11 Gtch t State: �� Zip33155
1
Value of Work for this Permit: $ ;mw •co Square/Linear Footage of Work: '•
Type of Work: ❑ Addition yp ❑ Alteration N�w ❑Repair/Replace ❑Demolition
Description of Work: tJA-$ T'420� `S QQr-a
Specify color of color thru tile: c
Submittal Fee $ V - (JC) Permit Fee $ ` c CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE
(Revised02/24/2014) <q
'3 •
Bonding Company s Name (if applicable)
Bonding Company s Address
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
A/
State
Zip
Zi
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. r
"`WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR*PROPEATY:*-`IF-Y'OU 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 tie 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 a�ved and a reinspection fee will be charged. ' .
Sign
r
SG�
OWNER or AGENT
The foregoing instrumient was acknowledged before me this
a4 day of -F V 1 \1 120 g by
me or who has produced I
identification and who did
NOTARY PUBLIC:
Sign:
Print:«
Seal:
who is personally known to
DORIS ANAYSMARTINEZ
�' •' Notary Public - State of Florida
Commission; GG 156732
My Comm. Expires Feb 14, 2021
Signature
CONTRACTOR
The foregoing i strument was acknowledged before me this
0 day of -J 20 by
OSk"30 ' who is personally known to
me or who has produced 1 a"
identification and who did take vv�� DORIS ANAYS MARTINEZ
Notay Pjoa, - State of Florda
NOTARY PUBLIC: ':�� Co?Tsson=GG156732
My Comm Exo-'es Feo '4.2021
— - — Sign: J ,
n� Print:
Seal:
0%
*s***
�V) t
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)