MC-18-3329Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
issue Date: 11/20/2018
Location Address Parcel Number
371 NE 103RD ST, Miami Shores, FL 33138 1121360130270
Contacts
Permit NO.: MC -10-18-3329
Permit Type: Mechanical - Residential
Work Classification: Pool Heater
PermitStatus: Approved
Expiration: 04/29/2019
GONZALO & JOHANNA NOALES Owner HAVANA AIR CONDITIONING, INC Contractor
371 NE 103, MIAMI SHORES, FL 33138 OSVALDO BORRELL
Mobile: 3056329753 GNOALES@GMAIL.COM 887 W 34 ST, HIALEAH, FL 33012
Business: 3055589136
4
Inspection Requests;
Description: INSTALLATION OF HEAT PUMP
VaLSqFeet:
2,000.00 Inspec ion Re
To299.00
Fees Amount
Application Fee - Other 50.00
CCF 1.20
DBPR Fee 2.00
DCA Fee 2.00
Education Surcharge 0.40
Permit Fee 50.00
Scanning Fee 3.00
Technology Fee 2.50
Total: 111.10
Payments Date Paid Amt Paid
Total Fees 111.10
Check # 15151 10/31/2018 50.00
Check# 15157 11/20/2018 61.10
Amount Due: $0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFID IT: certi that all the foregoing information is accurate
regu 'ng con and z ng Fut
01
ore, I auth e t above name cod
Authorized gnature: Owner / Appl' nt / Contractor / Agent
that all work will be done in compliance with all applicable laws
r tondo tt work tated.
d
1 ,
C7 'mss G .Y f
Date
November 20, 2018 Page 2 of 2
Miami Shores Village RECEIVED
Building Department OCT 31 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION:LINE PHONE NUMBER: (305) 762-4949
BUILDING.,
PERMIT APPLICATION
BUILDING ELECTRIC ROOFING
FBC ``2019'
Master Permit No0PPV --99z6
Sub Permit NAAC
REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 3 I•I• . lC
City: Miami Shores County: Miami Dade Zip: ?61-5b
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE:
FFEL-:
OWNER: Name (Fee Simple Titleholder): (ODh2U IO >aal Phone#: —AC& (08a- I &
Address: an I 1j. 1c)3 .
City:A=% `JhO State: qL.. Zip:3$
Tenant/Lessee Name: Phone#: fyltq
Email:
CONTRACTOR: Company Name: ff /''/" U c o ' 1 !i M / {/
T
LsL • Phone#:
Address:
City: _ /744W-0
Qualifier Name: .5
State Certification or Registration #:
Zip: 3.3 0 % -Z---
Phone#,,
3 Certificate of Competency #: 3
W
DESIGNER: Architect/Engineer: Phone#:,
Address: City: _ State:: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Addition Alteration
I
Newpair/R place ' Demolition
Description of Work:•. _r•
x
SSA .
9• lAlt: •f I Y: S
Spgdjjcacolor of color<thru% tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
Revised02/24/2014)
Bonding Company's Name (if applicab
Bonding Company's Address
City , '
i
Mortgage Lender's Name (if applicable)
Mortgage Lende'r's Address
City 1 i , I State
A
Zip N
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. + • <
P .. :'i 1 6 _
WARNING 7 'ORWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUit"MOPEATY1r. 45 YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COM,WIENCEMENT." 1
Vie• •'6 J+ >: a .
Notice to Applicant: As a con ion to the issuance of a building permit with an estimated value exceeding, $2500;: the Applicant must
promise in good faith that a py of the notice of commencement and construction lien law brochure will be delivered'to,t¢e person
whose property is subject t ttachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection 1w4f h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be app ved and a reinspection fee will be charged. '
Signature,
R or AGENT
The foregoing instrument as acknowledged before me this
dayof i1') 20, by
who is personally known to
me or who has produced SOY1C 11 1 kr-ZLLV) as
identification and who did take an oath.
NOTARY
Print:
Seal:
Signature
CONTRACTOR
The foregoing instrument was ackknnowwledged before me this
o
cZ
dayr off 20 by
05W1& CX1 4 1 who is personally known to
me or who has produce d.4-&tf QW 1 h as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Commission k GG 250751
My Comm. Expires Feb 14, 1021 1Seal:
Commission # GG 250751
My Comm. Expires Feb 14, 2021
APPROVED BY `V Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)