MC-18-888Permit NO. MC -4-18-888
eHO1 Miami Shores Village M Permit Type: Mechanical - Residential
s 10050 N.E. 2nd Avenue NEPerl"11' Work Classification: pool Heater
Miami Shores, FL 33138-0000
Permit Status: APPROVEDPhone: (305)795-2204
F ORLDp`
Issue Date: 5/4/2018 1 Expiration: 10/31/2018
Project Address Parcel Number Applicant
280 NE 91 Street 1132060190410
Miami Shores, FL 33138- Block: Lot:
KIRSTIN INCELLI
Owner Information Address Phone Cell
KIRSTIN INCELLI 280 NE 91 Street (786)801-8654
MIAMI SHORES FL 33138-
280 NE 91 Street
MIAMI SHORES FL
Contractor(s) Phone Cell Phone
PARKWOOD POOLS AND PAVERS LL (954)583-3355
Tons:
Additional Info: POOL HEATER
Classification: Residential
Approved: In Review
Comments: Date Approved:: In Review
Date Denied: Type of Work:
Scanning: 1
Fees Due Amount
CCF 1.80
DBPR Fee 2.00
DCA Fee 2.00
Education Surcharge 0.60
Permit Fee 105.00
Scanning Fee 3.00
Technology Fee 2.40
Total: 116.80
Valuation: $ 3,000.00
Total Sq Feet: p
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC -4-18-67052
05/04/2018 Credit Card $ 66.80 $ 50.00
04/05/2018 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Review Mechanical
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 zoni Futhermore, I authorize the above-named contractor to do the work stated.
AOec'nq 12o Ag May 04, 2018
Authoriz d Si nature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 04, 2018 1
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 Master Permit No
PERMIT APPLICATION Sub Permit No
FBC 20(`-1
BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS [:]CHANGE OF [:]CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 2zo Kf, 1I -
City: Miami Shores
p y
County: Miami Dade Zip:
uFolio/Parcel#: ` (.lo - 11q1 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:
jFlood
Zone: BFE:/ /) FFE:
OWNER: Name (Fee Simple Titlpholder): .5 l J_ 1.J\ 1 Phone#:
Q/li- !J -X)—=
7 iso. . I- /n i, I -%
Add
City: '( r1 1C U State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: c 2 i,,1 =J,_ i Phone#: 4L
Address: 13 It'Kin1-k 2 iVll
Z
City:a6A`W State: Zip:
Qualifier Name: hone#:
State Certification or Registration #: CSI `1 VUe Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $_a_ Square/Linear Footage of Work:
Type of Work: Addition Alteration
TOADescriptionofWork: TOA0Lclt
Specify color of color thru tile:
Submittal Fee $ GO ' Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Revised02/24/2014)
New Repair/Replace
V` ` CCF $
Zip:
Demolition
CO/CC $
Radon Fee $ 0 • (:)=) DBPR $ Q ' 00 Notary $
Training/Education Fee $ 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 Address
City 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.
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.
Signeture l I Signature ''
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
A day of 20 A by day of 20 by
who is personally known to
IJ
who is personally known to
me or whbL produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
Seal: Seal: .y"r Notary Public State of Florida
Pierrend <
Notary Public State of Florida
Adrian Rojas Pierrend
Adrian Rojas
GMyCommissionGG 183888mission
Expires
aC My Commission GG 183868 a ti
Expires 02/07/2011
APPROVED BY ns Examiner Zoning
Structural Review
Revised02/24/2014)
Clerk