MC-19-527Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 03/18/2019
Location Address Parcel Number
29 NE 109TH ST, Miami Shores, FL 33161 1121360040600
:ontacts
Permit No.: MC -03-19-527
Permit Type: Mechanical - Residential
work Classification: Alteration
Permit status: Approved='
Expiration: 09/16/2019
JACQUELINE GONZALEZ Owner TRIUMPH AC & REFRIGERATION CORP Contractor
29 NE 109TH ST, Miami Shores, FL 33161 ARIEL JIMENEZ
Mobile: 3052818409 8821 NW 112 TER, HIALEAH GARDENS, FL 33018
Business: 7865120548 areyes@triumphac.com
Inspection Description: NEW A/C 3TON & DUCT WORK. NEW EXHAUST Valuation: $ 6,850.00 Ins sRequests:
n n
FAN & DRYER X PLANS 305-e tio
49
Total Sq Feet: 593.50
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.20
DBPR Fee
$3.60
DCA Fee
$2.40
Education Surcharge
$1.40
Permit Fee
$189.75
Scanning Fee
$3.00
Technology Fee
$5.99
Total:
$260.34
Payments
Date Paid Amt Paid
Total Fees
$260.34
Credit Card
03/11/2019 $50.00
Credit Card
03/18/2019 $210.34
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 fo all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, M H NI AL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoin in tK
ccurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I autho i med contractor to do the work stated.
Authorized Signature: Owner / Applicant /
March 18, 2019
/ Agent
Date
Page 2 of 2
BUILDING
PERMIT APPLICATION
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 ❑ ELECTRIC ❑ ROOFING
FBC 20
Master Permit No. _ 104 301-4
Sub Permit No. Ci 3-� q —S 2 1
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING H MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 29 NE 109 Streeet
City Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFEE: q
OWNER: Name (Fee Simple Titleholder): URI'TQ 071011AZ Phone#:as _2�`1 —(�'T� I
Address:29 NE 109 Street
City: Miami Shores State: Zip:
Tenant/Lessee Name: Phone#:
Email: namaste.gonzalez@gmail.com
CONTRACTOR: Company Name:
Address: IT Eo Z 'V
City: 46
Qualifier Name:
r 0-r, re�'w
p: -*) > o /,a
State Certification or Registration #: CAI / $ / 4 ZZ `} - Certificate of Competency #:
DESIGNER: Architect/Engineer:
Value of Work for this Permit:
Type of Work: ❑ Addition
Description of Work:
ne#:
City: State Zip:
Square/Linear Footage of Work: l/g�22
Alteration E] New ❑Repair/Re lace ❑Demolition
:5 O
IL 3>r' e r/zylc�c,c t
Specify color of color thru tile:
Submittal Fee $ Sb Per Fee $ CF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 1 2 2
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 issueN. Ithe absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
I I � 11�C
Signature Signature
OW ER or AGENT ACTOR
The fo going instrument
was acknowledged before me this The foregoing instrume t was acknowledged before me this
day of f " I0rC120 by clay of 20 I by
a\jlitn Gi��qZ who is personally known to i' \Q who is personally known to
mor who has produced as me or who has produced(--UyQy L C"Si as
identification and who did take an oath. identificatio�l an,, ho did
NOTARY PUBLIC: NOTARY PUIBLIC: \
Sig
Sign:IL
PI
Print:
Q i
1►RY P4 �i,
Seal: =r e`er;
y
CK
Notary Public - State of Florida
Seal:
* : _
Commission # FF 931348
a ' • YANADYPRIETO
fir.
My COMM. Expires Oct27, 2019
., :. MY COMMISSION # FF 214031
o,F
'°� Y`'�
Bonded through National Notary Assn.
7 EXPIRES: March 25, 2019
11,nsE�taminer
APPROVED BY
Zoning
Structural Review
(Revised02/24/2014)
Clerk