MCC-19-108 (2)Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: MCC-01-19-108
® - permit Type: Mechanical - Commercial
Work Classification: Alteration
Permit Status: Approved
Issue Date: 01/25/2019 1 Expiration: 07/15/2019
Location Address Parcel Number
415 NE 105TH ST, Miami Shores, FL 33138 1122310430010
Contacts
ED H OLLIE JR &W & MARCIA OLLIE Owner
EDW MCCARTHY-ARCH BISHOP
9401 BISCAYNE BLVD, MIAMI, FL 331382970
Other: 3057597750
MODERN MIDWAYS Contractor
BRIAN MORRISSEY
879 JOUST ST 102, DYER, IN 46311
Business: 3052347776
Description: SPECIAL EVENT - MECHANICAL Valuation: $ 500.00 Inspection Requests:
TEMPORARY CHURCH CARNIVAL AT ST. ROSE C CHURCH JAN 305-762-4949
25-27 2019 Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.30
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
01/25/2019 $110.30
Amount Due:
$0.00
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 -zoning./
Futhermore, I authorize the above named contractor to do the work stated.
Signature: Owner / Applicant / Contractor / Agent Date
January 25, 2019 Page 2 of 2
Miami Shores Village - :J i E
Building Department 6 i01
9
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
C20
j
Master Permit No. 19
Sub Permit No. WJ9
- ( bs
❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING 56 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
77""'" CONTRACTOR DRAWINGS
JOB ADDRESS: 4 If N E S S Tt' cy_r
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): A1xc.*1yt ocrs z oir m o'w4 l Phone#: (3 aS)1_5j2—o 5-1 I
Address: !i 4 is 1
City: M���"'I 5 N��'�-�S State: EL zip: 33 )3&
Tenant/Lessee Name: ()T. L.,.ml% CjATA4ULtc QtAV9 P Phone#: _-)Z7��
Email: M 1'a if'' R C N N C-A 64 1 INYZC I-V , oy—G
CONTRACTOR: Company Name: �'1 O � Gi2'`� � J°�S Phone#: 3-aS- 7 9'y :1 7 b
Address: 1�014'7-42 S iA-Z 115 S'-r1LGcTTNL.
City: M^ f`y'1 State: r L. Zip: ? 3 7
Qualifier Name: �tA-► 1'�i^✓ Me �c.� t �G Phone#:
State Certification or Registration #: Certificate of Competency #: C �V:�3ya
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: zip::
Value of Work for this Permit: $ C-0 �7 a Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
❑ Demolition
Description of Work: j E rH (- oYL An-Y A rn V S E '1t•y iN (Z, l p & S EvN7_
C 1-1 uytt.14 C nyLrvl Vra1 ,.)'7%,./4
Specify color of color thru tile: y...k
Submittal Fee $ ..Permit. -Fee $ i� D� t� CCF $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ Vp 30
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of �1'R/�ll�.l� A -I' LI 20 J by day of ��an , 2 by
�i ? - WS f''�l�l , who is personally known to 60-1 'Aw M 01"ZI9* , who is ersonally know o
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print: ( C — Y E:. — ( f\�
Seal:' ) Seal:
MY CON1ti11SS,c) •J # FF216S2
EY.P!RES April 02. 2019
I it jM153 flc.idt\O:]'Y> vita"
i
****************
APPROVED BY � 1/' Y�Plans Examiner
Structural Review
CATHERINE ELIZABETH NYLUND
MY COMMISSION # GG023712
EXPIRES August 23, 2020
as
Zoning
Clerk
(Revised02/24/2014)