MC-17-1476 (2)Miami Shares Village AFC
Building Department ✓G�o ��GF ?: o
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
I"Bc Zo I'll
BUILDING Master Permit No. z-C-Al —
PERMIT APPLICATION Sub Permit No. Cn
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑1PLUMBING rM-I MECHANICAL ❑PUBLICWORKS
JOB ADDRESS: 278 NE 103rd Street,
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-013-4860 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee simple Titleholder): HB GROWTH PROPERTIES LLLP Phone#:954-774-4616
Address:17071 W DIXIE HWY
City: MIAMI
Tenant/Lessee Name: Vacant
Email:
State: FLORIDA
33160
CONTRACTOR: Company Name: Test & Balance Ail` Conditioning Phone#: 305-218-1798
Address: 8355 W Flagler Street, #164
City. Miami state: Florida Zip: 33144
Qualifier Name: Agustin Alvarez Phone#: 786-354-6816
State Certification or Registration #: CAC 1815710 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: _
Address: City: State:
Value of Work for this Permit: $ i.1 � ,CEO Square/Linear Footage of Work:
Type of Work: El Addition Alteration ❑ New ❑ Repair/Replace
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 2 G CCF $_
Scanning Fee $ Radon Fee $ 2 �� DBPR $
Technolo ee $ �' O Training/Education Fee $
Structural Reviews
((J. Qo
(RevisedMn4/2014)
Z3
❑ Demolition
Lam✓ f�"E� ��
3 ' Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 3
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Nf applicable)
Mortgage Lend-wlsAddress
City
State
Zip
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no woik 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 Signature
OWNER or AGE CONTRACTOR
The foregoing instrume was ac nowledged before me this
day of Q L .20 l , by
who sonally known
me or who has produced
identification and who did take an oath.
as
The foreg g instrument sacknowledged before me this
y of LO QL 20 1 by
personally known t
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: A
Sign:_
Print:
Seal: now uuougn ist bane msffidrICe Seal: U,-4
M1'COMMISSION #FF991944
EXPIRES: MAY 12,2020
Bonded through 1st State Insurance -
TV II -
APPROVED BY Plan Exam, er Zoning
Structural. Review
(Revisedo212412014)
Clerk
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. MC-6-17-1476
Permit Type: Mechanical - Residential
Pen
Olt Work Classification: Addition/Alteration
Permit Status: APPROVED
Parcel Number
Issue Date: 12/20/2017 ] Expiration: 06/18/2018
Applicant
278 NE 103 Street 1132060134860
HB GROWTH PROPERTIES LLLI
Miami Shores, FL 33138-2431 Block: Lot:
Owner Information Address Phone Cell
HB GROWTH PROPERTIES LLLP 17071 W DIXIE Highway
NORHT MIAMI BEACH FL 33160-
17071 W DIXIE Highway
NORHT MIAMI BEACH FL 33160-
Contractor(s) Phone Cell Phone
TEST AND BALANCE AIR CONDITION (305)218-1798
Tons:
Additional Info: WORK BASED ON PROVIDED PLANS
Classification: Residential
Approved: In Review
Comments: Date Approved:: In Review
Date Denied: Type of Work:
Scanning: 1
Fees Due
Amount
CCF
$4.20
DBPR Fee
$3.68
DCA Fee
$2.45
Education Surcharge
$1.40
Penalty Fee
$100.00
Permit Fee
$245.00
Scanning Fee
$3.00
Technology Fee
$5.60
Work without Permit Fee
$245.00
Total:
$610.33
Valuation: $ 7,000.00
Total Sq Feet: p
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC-6-17-64186
12/20/2017 Check #: 5141 $ 610.33 $ 0.00
Hvanaoie mspecruons:
Inspection Type:
Final
Rough Duct
Review Mechanical
Underground
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 respoGbility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMjifNG, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDA
is accurate and that all work will be done in compliance with all applicable laws regulating
contractor to do the work stated.
December 20, 2017
Buildin
DecDec member
r Signature:Owner / Applicant
//Department Copy
2017
/ Agent
1