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EL-19-735Location Address Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Its Issue Date: 04/12/2019 Parcel Number 1060 NE 104TH ST, Miami Shores, FL 33138 1122320290220 Contacts Permit NO.: -04-19-735 Permit Type: Electrical - ResiderWal Work Clossffication: Alteration Permit Status: Approved Expiration: 10/01/2019 Description: DUCHESS MINI SPLIT, NEW PACB UNIT SMALL Valuation: $ 550.00 Inspection Requests:305-�62-4949 NEW MINI SPLIT POWER EXISTING Total Sq Feet: 0.00 Fees ERIC )NOODLING Owner 1060 NE 104 ST, MIAMI SHORES, FL 33138 Other: 7275600539 MOODY ELECTRIC INC Contractor JOHN MOODY 3812A N 29 AVE, hollywood, FL 33020 Business: 3057582000 $50.00 CCF $0.60 Description: DUCHESS MINI SPLIT, NEW PACB UNIT SMALL Valuation: $ 550.00 Inspection Requests:305-�62-4949 NEW MINI SPLIT POWER EXISTING 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 Payments Date Paid Amt Paid Total Fees $110.30 Check # 9646 04/12/2019 $110.30 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws r ting nstruction and zoning. Futhermore ize the above named contractor to do the work stated. a• A'td m✓ /CJ 0-- orized Signature: Owner Applicant / Contractor / Agent Date April 12, 2019 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 9 ELECTRIC ❑ ROOFING �E"El !ED APR 0 4 019 FBC 20 Master Permit NoML 04 — — �3 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION F-� SHOP CONTRACTOR DRAWINGS JOB ADDRESS: C (s C'- Alk-`� City: Miami ShoresCount : Miami Dade Zip: S/ Folio/Parcel#: t' Z Z fi Z C% y Z Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: t t ' Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Ly', 1�'10Q�7� V F Phone#: `72'% t<�f —03 Address: tyb U l`i l 0 S de �•i City: _A�/Q.it4.( WAd Lsf '� State: 3,30 Tenant/Lessee Name: "-- t�'/ Phone#: Email: /-. ullot< �/ �/ /1 Gi �' b% H'/ j n. y in ds CONTRACTOR: Company Name: / Glig:y— ` �, Phone#: Address: City:��©Q1 State: �G /g . Zip: Qualifier Name: /�� Phone#: _50 State Certification or Registration #: rtificate of Competency #: DESIGNER: Architect/Engineer: !/ Phone#: Address: City: State: Zip; Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition FM Alteration El New L ❑ Repair/Replace El Demolition Description of Work: ,{�/t) �/�f� /� ,yL(T �,, �T� /� _ _ A Specify color of color thru'ti/e: , ' ,� ti Submittal Fee �'' ,,, "F . ` " $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) Double Fee $ Bond $ TOTAL FEE NOW DUE $ 0 3 d 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..... i 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 o'condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must ment and construction lien law brochure will be delivered to the person promise in good faith that a copy of the notice of commence whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site X - the curs s n (7) days after the building permit is issued. In the absence of such posted notice, the nd u rei ection fee will be charged. SignatureJ� Signature ., OWNER or AGENT , , , .,, �.�,_ l �_' a CONTRACTOR, ' _ ' The foregoing•inst�ument was acknowledged beforme this The foregoing instrument was a'ckknowledged before me this ' /,• 2p by. hbay of t6 CJ KC Y 1 120 = by tiay"of• „ who is personally known to JL1 lif) 1� M OTJ . who is personally known to me or who has produced ��— as mor who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBI,LC: NOTARY PUBC:�. ;Y Sign: Sign:_ Print: - Print:. Sea CATi1ERINE A, DUSW B �rlda Seal: *v a , N"ryi�on A CG 104199 1 �,re,g�yyrta,26C1 Ase. ,4.norgl,tioui�Y *s*******s************ APPROVED BY « Plans Examiner Structural Review (ReVised02/24/2014) Qy-ww". d Notary Public State of Fbrlda Rebeca Munoz My Commission FF 918344 qExpires 09/08/2019 ----........ **.********* ************ Zoning Clerk