MC-19-2029Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: MC-08-19-29
(j Permit Type: Mechanical - Residential
• Work Classification: Pool Heater
Permit Status: Approved
Issue Date: 09/04/2019 1 Expiration: 03/02/2020
Location Address Parcel Number
278 NE 103RD ST, Miami Shores, FL 33138 1132060134860
Contacts
HB Growth Properties LLLP Owner TEST AND BALANCE AIR CONDITIONING Contractor
278103 CORP
AGUSTINE ALVAREZ
Business: 3052181798
Inspection
Description: INSTALL HEAT PUMP Valuation: $ 3,500.00 Requests:
4949
to replace permit MC17-2416 Total Sq Feet: 0.00..j
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
$9.00
Technology Fee
$2.63
Total:
$123.83
Payments
Date Paid Amt Paid
Total Fees
$123.83
Credit Card
09/04/2019 $123.83
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, drawing�,s tements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all wgrk d e by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANIaAl-, NDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing formatio iXrate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I aut rize the ab, contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
September 04, 2019 Page 2 of 2
Miami Shores Village RECEIVED
Building Department AUG 3 p 2079W
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
,FtBC 2-T 01
BUILDING Master Permit No. NIA'" [l — p— gDgq
PERMIT APPLICATION Sub Permit No.%./'—40-4a— agtG
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 24ENEWAL
❑PLUMBING ' MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
q A CONTRACTOR DRAWINGS
JOB ADDRESS: 2, PC 40 �p '5�—
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: QConstruct(LOU—)ion
�T,ype: 1- Flood Zone: BFE: FFE:
y
OWNER: Name (Fee Simple Titleholder): �'L `�I�A0 MLr�, Phone#:q5q r'L L 6
Address: '�,A
City: U &A �QWL (:5:�d State:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address: % ')� S 5 1
City: .4-AAIrW1 I
Qualifier Name: k A-)
State Certification or Registration
DESIGNER: Archite
Address:
Value of Work for th
Type of Work: ❑
Description of Work:
Gl
�rmit: $�
dition ❑
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
one#:
Phone#: TS�. L [ � q 40
��-�� Phone#: -
+L-I to Certificat of Competency #: _
Phone#:
Kr
: State
ear Footage of Work:
n � ❑Repair/Replace
Permit Fee $
Radon Fee $
Training/Education Fee $
Zip:
❑ Demolition
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 2 e3
(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 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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of , 20 , by
, who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
as me or who has produced
20 by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: Seal:
as
******•********�**********�***r*r*******r**********�**r*r*******sr+et*s******�******s**rr****rr**�*******�**•
APPROVED BY
Plans Examiner
Structural Review
Zoning
Clerk
(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 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
OW ER or AGENT CONTRACTOR
The foregoing instrume s/acknowledged before a this
day of "' 20. by
me or
06,
ide
Print:
Seal:
known to
as
The foregoing instrument was acknowledged before me this
day of k)
120 �, by
V!tjp :J
who is personally known to
me or who has prod
as
KAIH
INEPINCHEI
identification a
�}! #GG079431
�6 , 2021
NOTARY PUB I
�
Sign:_
Print:
Seal:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
CA(