MC-18-1304F�ORIV
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. MC-5-18-1304
Permit Type: Mechanical - Residential
erlill't work Classification: A/C Replacement
Permit status: APPROVED
Parcel Number
issue Date: 9/14/2018 1 Expiration: 03/13/2019
Applicant
1201 NE 96 Street 1132060143830
Miami Shores, FL 33138-2553 Block: Lot: POL ZAZADZE
Owner Information Address Phone Cell
POL ZAZADZE 1201 NE 96 Street (305)790-2785
MIAMI SHORES FL 33138-
1201 NE 96 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
MIAMI CUSTOM SWIMING POOL 305-592-8066
Tons:
Additional Info: GAS HEATER
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 3
Fees Due
Amount
CCF
$2.40
DBPR Fee
$2.10
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee
$140.00
Scanning Fee
$9.00
Technology Fee
$3.20
Total:
$159.50
Date Approved:: In Review
Type of Work: GAS HEATER
Valuation: $ 4,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC-5-18-67555
09/14/2018 Check #: 5075 $ 109.50 $ 50.00
05/16/2018 Check #: 4937 $ 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
construction and zoning. Futhermore, I authorize the above- a ed contractor
Authorized Signature: Owner / Applicant /
Building Department Copy
September 14, 2018
that all work will be done in compliance with all applicable laws regulating
the work stated.
September 14, 2018
Agent
1
Miami Shores Village
AY 6 O18
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 20n
BUILDING Master Permit No. PP Gip— 13 v
PERMIT APPLICATION Sub Permit No. MCI G - ) ? o
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING �CHANICAL ❑PUBLICWORKS [:]CHANGE OF [:]CANCELLATION [:]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:.33/ 3.cr
Folio/Parcel#: / 1--52- 0�, 10 /41— 31 3 U Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder) : Phone#:
Address: t 6 -7�
City: State: Zip: , 33 /3K
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: & /)// �%S7U �uJ/ ry//Y/i�� �oLPhone#: 36)s—:�-L�f� �D 6G
Address: 1 U�o.S 12'g-S S 1'�
City: f%%/ern / �/�/Z/tJG6/ s State: F—L Zip: .33 /GG
Qualifier Name: Phone#: 66
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Ad
Value of Work for this Permit: $ist+e;d'd'n y' V W Square/Linear Footage of Work:
State: Zip:
Type of Work: ❑ Addition
�� ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Wor0w. ��l� s /•�-�—�y
Specify color of co/or'thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
CCF $ CO/CC $
Radon Fee $ G - CA DBPR $ i Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 1 0': • ��
(Revised02/24/2014)
Eli
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City State 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 issued. In the absence of such 7,ted)notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
/ / OWNER or AGENT
The foregoing instrument was acknowledged before me this
110 day of 20�, by
,7- p !J who is personally known to
me or who has produced ov 59 &e as
identification and who did take an oath.
NOTARY
Sign:_
Print:
Seal: 9lFOF
MY COMMIS61ON # GG 078130
Bonded itxu Budget Notary SenAM
Signatu
The foregoing instrument was acknowledged before me this
day of �1-
. 20 If by
J wh4personally known
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
as
Print: ----I Ah-N L �2t,1* 4� JOHNP.COELL0
Seal: + �WCOMMIS"#GG076110
NS EXPIRES: May 14, 2021
Bonded 71Mu Budget NdwySW=
APPROVED BY f v ns Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)