MC-19-1894Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: MC-08-19-1894
Kc
Permit Type: Mechanical - Residential
I f � Work Classification: Pool Heater
Permit Status: Approved
Issue Date: 08/22/2019 1 Expiration: 02/18/2020
Location Address Parcel Number
1421 NE 104TH ST, Miami Shores, FL 33138 1122320320060
Contacts
Henry Dow Owner
1421 104
FLORIDA POOL PATIO CORP Contractor
CLAUDIO SEBASTIAN VALERO
4655 SW 71 AVE, MIAMI, FL 33155
Business: 3058150181 nadineflpoolpatio@gmail.com
Description: POOL HEATER Valuation: $ 3,500.00 Ins ection Requests:
1305-762-4949
TotalSq Feet: 465.00
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
$3.00
Technology Fee
$2.63
Total:
$117.83
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$117.83
Credit Card
08/22/2019 $117.83
Amount Due:
$0.00
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 oqnnstruction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
August 22, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
Miami Shores Village RE';VED
Building Department AUG 16 o�s�
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY;
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 19
Master Permit No. «Pf '- 0S l - IZ ZC)
Sub Permit No. MCC 1 " ) 0 94F
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING fS MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
r, !� CONTRACTOR DRAWINGS
,r
JOB ADDRESS: % `'I 2 I �I G /Ot f 4 `t (�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): C �1 QC)(-0 Phone#:
Address: I LJZ I Ij C 10C( k
Atci01l GJ�oyp S � l
Zip:
3�)13e::�
City: State:
Tenant/Lessee Name:
Phone#:
Email:
CONTRACTOR: Company Name: C>�` �- ��� �-
Phone#:
0i y
l�
A:S3�3,�
Address:
City: In n mk State: 1
Zip:
3�)
Qualifier Name: Clru6 (v ( V
Phone#:
S n
6010
State Certification or Registration #: ��C lu
Certificate of Competency #:
DESIGNER: Architect/Engineer: z
Phone#:
Address:
City: State:
Zip:
r
Value of Work for this Permit: Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteratio ❑ New
❑ Repair/Replace
❑ Demolition
Description of Work: L
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $_
DBPR $
Co/CC $
Notary $
Double Fee $
Bond $ G
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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 low 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 t Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
%) day of 20 by
N"C.1�� DQ!=� who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:V
Seal:
GGo
1%
c
'0 . �4}�r.`io'�
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 �'"t by
d quC l (() \Ja �e I✓-'-D who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
'0N
�s*r***ass************�*� *** * *�** •: **s***/h*/*t
APPROVED BY -PlaExaminer Zoning
Structural Review Clerk
(Revi sed02/24/2014)