MC-19-830Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
68 NE 91ST ST, Miami Shores, FL 33138
contacts
Permit NO.: MC -04-19-830
Permit Type: Mechanical - Residential
mmm WorkClosration: Pool Heater
Permit stotus: Approved
Issue Date: 04/29/2019 1 Expiration: 10/14/2019
Parcel Number
1131010200020
Floyd Gonzales Owner HAVANA AIR CONDITIONING, INC Contractor
68 NE 91 ST, MIAMI SHORES, FL 331382808 OSVALDO BORRELL
gonzalesf@aol.com 887 W 34 ST, HIALEAH, FL 33012
Business: 3055589136
Description: HEATER HOOK UP Valuation: $ 3,500.00 Inspection Requests:LLJ
2-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee
$55.00
Scanning Fee
$18.00
Technology Fee
$2.63
Total:
$132.83
Payments
Date Paid Amt Paid
Total Fees
$132.83
Check # 15212
04/29/2019 $132.83
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
reqp4ing constr ction an zoning. therm e, I uthorize the 3b name cont actor to do the work stated.
Author' d Signature: gWer / Applicant / Contractor / Agent Date
April 29, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
Miami Shores Village APR 15 N";0,
d,
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 / .�
FBC 20LI
Master Permit No. OW -04 —1q ^ W4.
Sub Permit No.i 1 `c.104 3� " , 7 C)
F-IBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
F-] PLUMBING So MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: lig rt C11 66� `
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: It -2)101-6-09-0)0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: ?001 Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): " 9- 8 00y-2C\E2- Phone#:(3) q%;L_CI R. b
Address: LA 0T G I &�-
city:141 rr t 'C'Iorc:;s State: fL— zip: d3138
Tenant/Lessee Name: f / -A Phone#: .1
Email
CONTRACTO�Ri: Company Name:
Address: �" 9 7 y-) 3?
City: �%� State: ISL Zip: 3 3-o/ _�L—
Qualifier Name: 0s vat A 1-9;11z"4 Phone#: U�o
State Certification or Registration #: �-��d° 3 Certificate of Competency #:
DESIGNER: Architect/Engineer: i Phone#: �Sstp-J35 -3S
Address: 1146 S•La 110itacity: M4mi State: Zip.33I V
.v4 f—
d�G
ne#: �3�� 3W --ye, 3(,
Value of Work for this Perrn Type of Work: ❑ Addit
Description of Work:
4 ,
Specify color of color". thru tile:
Submittal Fee $ Y _Permit Fee $
,dquare/Linear Footage of Work:
New ❑ Repair/Replace ❑ Demolition
a
w t
CCF $ 3�, ,At >,�. �� CO/CC $
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
(Revisedo2/24/2014)
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ ���
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Add ess
City )A- ; State
Zip
E01
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
day of '[ 0 lr 20 )" by
who is personally known to
me or who has producecl?q ' ¢x(1(,41 I q6C.—ql as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
c�--7 dday�of 4:�&LP)Cl 20 19 by
horfAel ' ,w_ho its personally known to
me or who has produced �r2Y1(,N� as
identification and whp,did take an oath.
NOTARY PUBLIC:
Sign: _ ,L
— Sign:
—
Print: � L S
G r'.�—I r?�2 Print:
��
. • w"v'•
Seal: i*a �e�.
'?4 •
DORIS ANAYS MARTINEZ Seal:
Notary Public State of Florida
Y,P....
: •�� �e`�
%`-
? A
DORIS ANAYS MARTINEZ
Notary Public . State of Florida
Commission fiGG 2507510°F`°
Commission # GG 250751
My Comm. Expires Feb 14, 2021
My Comm. Expires Feb 14, 2027
1001
APPROVED BY
V Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk