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MC-06-21-1412 .. t\ ti�\l� �t �� t � li�1\ 1 � � � c�,` �ti� �` � ���������.:ti�. �.g�� "�� �`�i�� �ti � � � l� �1�����` ���������'�L ��t � � �� ��� ��� �,.+� • \ � `2 `4 � ` \ t l� \ �,���l\��?�� t`n "�,, �� I�ttll $�'IQC@S�6'���� t � � ' �� � ` l � � � ' U� �t;; �, ,,.y� � �� � ��t������`�� ��� �� � � ' � � I0050 NE 2 Ave ,� t� 1�� t� � �, ��� �,� �z l � ��� � 1 L �+ . C� .: tt\ ; � � � � �l�T Z1,..� ��. s� E �� Miami Shores F�33138 ��`�� ���� � � � � � � � � �� ���t� ��i� � �� ti � A\ E��\?os � z S �A i 1 ' �\. � . ,�^-,�.�,�• 305-795-�204 � ��� ��3�� � � t � `�`����������` �a' ��`� �`V>bair.�s. ` �,� � .� �Z:: .1�, ,,.\ � �. '..����.�i��.�,.���.;1 �����}�`..: �� �S z �V ` � ti.. � � 3�\�i ��„ �' . � ���` � �t���t���� ��� �xpiration: 12j21j2021 ..�. �. :.�. � t� � ,��� � �� L�eati�r�Addr�ss Parcei Number ,����.�� ����� �.4��eo���.m�H.a� �.W_m�. �_��� ��v ��� . �,���w. . ���.�m.���� �.�..,��.��_u.v�,u..._n.__...� ���n.n� � 123 NE 99 ST 21320642321�1 C�ntaets ,.�.. ��� � a��.n,�.��.�.����.�__._ �__ ��.�_��e�w��..._ _.._.__�, .��,___���_...�n��v.� �F�.e�__�_�._�w�.ww.�_..�.��.._�_�� F TNE OLkVINE�ROUP HQMES CLC Qwner �M AER CQNDETIONIN6 IR1C C�nfiractor ' 293 NE 61 ST,MIAMI, FL 33137 JOSE WILLIAM MONDRAGON � Business;3053005174 912 SW 178 WAY, HC}C�YWOQD,FL 33029 � �usin�ss:7$6436231Q � fl.€�L ABOUT CQNSTRUCTICIN INC Agent ; onie!toledo � 455 s biscayne river dr,rr�iami,Fl 33169 Business:305-300-5174 aaeetecteicale�gmail,eom RAobile:305-3Q0-5174 . � - �. . . a�. , .a��o . . . �_....�.....�, ..�.�.....�.......:......_.............,..._.._..__.,_.......�__.,._._.,_...._..,�...._....r...M._....__..........�......_..,..._,.,m..,_.._.........,...._....., ........ .. ....... ..._........,........_..�,�...,�._... .._._. � ���..___w.. � �,_,.__ !ns ectton Rec�uests � �eseription:3$�4 TONS RH�EM 16 SE�R J 4 BATNR04�t ; Valaatian: $ 2$,Q00,00 � ������'��� �'^"'� ""��'^'�'r` \�� � EXNAUST SCOPE C1F WORK IN ACCQRDANCEE PLRNS DESE�N � ��� � t �,���� ��: � � 'fatalSqFeet 3,640.QQ � ���,,. . ., ,;�. `�., �`��Z�.��:< � � ������ F�es Amount Payments Date Paid Amt Fasd Application Fee-Other $50.00 T4t�1 Fe�s $1,tt£}&.44 CCF $16.80 Credit Card 06j22J2021 $2,A�6.4Q D�PR Fee $12.6Q DCA Fee $8.44 •4mount Rue: $O.OQ Edueation Surcharge $5.60 Permit Fee $790.OQ Scanning Fee $102Af� Technalogy�ee $21.04 Total: $1,006.4€} ll l� 1�1 E' � �?t1� Qf �f In cons�deration of th� issuance to me of this permit, I agre� ta perform the wark coveeed hereurrder in complianee with ali ordinance� �nd regul�tio�s p�rta�r�ing theretc� and sn strict confoemity with the pians, drawings„ sfiatements c�r specifications submifted to the proper authorities of Miami Shores Village. In accepting this p�rmit I assume r�sponsibility for aII uwork done by either my�eEf, rrty agent, servants, Qr employ�s. I understand that sspar�#e p�rmits are required for ELECTRECAL, PG.UNBING, N1ECH�4NiCAL,WINDOWS, DQC3R� R09FI�iG and SWIMMING POC}L work. OWNERS AFFI�AVIT: I c�rtify that aIi the foregoing infcrrmation is acc at� an t all work wiil be done in campii�nce with aii ap�licabie (aw� reguiating can�truction and zon�ng. Futh�rmor�, f authorize the above name con o do the work stated. Authorized Signature:Owner / Applicant 1 Contractor i e Date 1�sne 21�2021 �age 2 of 2 . . 1 1 � 1�� �� ���°� ° �����.� ��:�.���:� I� 1 r � ��k�.� � �� � � ��� � IC�€�50 N.E.2nd Avenue,Miami Shores,Flc�rida 33138 ,� °. _� '�.w�� � _ �'` r�i.(�a�)��s zzo� �ax:(�a�}����as�z �� i�s��er�o�������o�v��vun����:{s��)x��-���� �'°�~� � � � � ��t�r F�rm�t Nc�. � �I �. ._ � � � S�b P�rmi� IV�. ���°���� �� ` � ���- ❑��i����� � ��� �R�� � Rca����� � �Ev�s�c�� � E�r��s0�� �RENEW�L ����n�a��� n����a�����. �P���ic w�R�s � ��a��E oF � ����E��a�r�o� � s��� �QNTR,�CTQR DRAWf(UC�S �oa�o��Ess: � C�tY: Miami Sh�res �oun�v: Miarni[�ad� Zip• � F�ti�/�arc�l�: f�� 1 �s the��[Id�ng Histe�eieally D�signated:Yes�.�. NC}� �ccup�ncy'fype: l.oad: �onsiructic�n Typ�:�___.��Floc�d Zone: BFE: FFE: � �� t�WNER:Nam�(Fee SEmple Titlehcalder}a (�t� � Phane#. Address: t°��� � � � � City: �� � State: Zip. T�nan�fLessee Name: Phon�#: � Email. �J� �a � � c��r�����:c��,���,y��m�: Q i � W � ��� n��,�� . /� �,ctdress: � � City: .� �tate� __.�_.. �. ... ���' � Qu�l��er Name� f�� e Ph�ne#: C� 5tate Certificatican ar Re�istr�ti�n#: � � C�rtific�te�f Ccampetency#: �ESi�NER:Architect/En�ine�r: Pt�c�n�#: Addr�ss: City: St�te: Zip: � Value of W�rk fo�r this Perm�t:� �� SquareJl�t���r Fa�ota�e of Work: Type of UVork: ❑ Addition � Alt�ration ew ❑ Repairf Repface [� Dem�lition Des�riptian�f V41ork: � t� � ��"�� � � �� � C c�^t �`� � �' ° t ` � � � S ��i �afor af c+vlor thrc� til�: su�m��cat Fe�� ��rm�t��e� ec�S co�c�� S�a�nir►g Fe�$ Radon Fee$ DBPR$ Na�tary$ � Te�hn�iogy Fe�$ Train�n�f Educ�tlon F��$ �ouble F�e$ Stru�tural Revi�ws$ Bond$ r� T�1'At,FEE Nt3UV�UE$ � •�� (����s�aoz/za/zo�a} �c�ndin��orrtpany's N�m�(ff appli�able} �canding Camp�r�y's Address Gity Stat� Zi p Mort��g��end�r's Name(if applicable} IVt�r��age Gender's Address �ity Stat� Zip �pplication is hereby m�de to�btai�r a p�rmit t�do the w�rk and inst�llatic�ns�s indicated. I eertify that n�work�r inst�llati�r� has cammeneed prior tca the issuar�ce a� � permit and th�t all wc�rk wi€I be p�rfarrrred to meet th� st�ndards of a�( lau�s r��ul�fiin� canstructi�n in this Jurisdicti�n. 1 understand that a separat� permit must b� s�cur�d foe ELECTftIC, P�UtVIBPNG, SIGNS, PQ�CS, FURN�CES, ��ILERS,NEATERS,TANKS,AiR C�N�1�`fC?�lER5, ETG..... �1NNER'S AFFIDAVIT: I �ertify that all the f�re�oAng infc�rmation is �ecur�te and that all w�rk wii) b� d�r�� in c�rnplianee writh �II applicabl�laws regu(atin�ccanstruction and zonin�. " I T E ; Y F I�l! T EC A TICE F C E CE E T Y �ESU�T' 1 Y U AYI IC F 1 �E E TS T Y � R PE . !F X U 1 T Tt�► T 1 ff �1 , � SULT` IT' Y U L� DE A Q�R EY EF E� 1 � TI�E F C E CE E T." Notice to,4p�alicarat: As a conditi�n ta th�issu�nee c�f a buildir�g��rmit�creth an e.sfimated va{ue exceeding$2�C►�, th�applicant rrt�ast prr�mis�r`n g�od faith that a copy caf th� n�tice c�f c�mm�n�ement�nd can.stru�ti�n !r`�n law brochure wrilP b�defiv�r��to the�agrsarr wh�se�aro�erty is sub}ect to attachment. Atso,a��rtifi�d�o�y of th�reec�rd�d rr�trc°�of e�amrrreneement rgaust be p�asted at the job sit� for th�first inspeetron whech oceurs seven (7J days aft�r the 6uifdirsg permit is �ssued. !n the �bs�nce caf such p�st�d ncatic�, the inspectr�n wit/nc�t be up�arc�ved arrd a r�insp�ecion�e witl b�etrarged. ���t`'`� _. ., r��~'""��=�'`� --___-_�-��...,��.� � �� —.- Si�nature '� `= �---"""`��� Si�n�tur� �W�dER�r At�EREI' ��NT�ACTdR The f e��oin�instrument�as aekn�wledg�d before m�this The far�g�ing instrument was acknowledg�d bef�re me this day of ,20 � , by d�Y� ���2Q � , by �- � _�,wh�is p�rsc�naliy kn�wn to a who is persc�nally kna��to me,�ear�he�has prc�duc�d as ���r uvha has prs�duc�d �s id�ntification and wMo ' take an c�ath. iden�ification and who did take an �th. NQTARY PEJBl1C: , fVOT�0.RY PU�LIG: , F � �+r S��n. 5���. �P1t1�: � � � �� � �rIR�: Seal: � ��t�ry��a�ec st�t��r��� Se�l: � r���r����������s Fr�r�a� � �f�f��l���T��LO�! � „ C�4��EL��rT�LGC1t� , � �Ap+�z�t�srias�r�FiF4 C1D7�35 '� hfly��mmss�s�Nhf 0Q7�35 ���,� E���r�ss�I 2B ����� Ex�srr��(�itQ6t20�� ��m�*���**���*a�z�� ����s m�*�����: ���� �x���� ���*��:�*»����:c���:�*�s*����a:�*�����*��������*���������e��a�*��*�*��:� t � APPR�VEE?�Y � r'' Pl�ns Examirter ���i�g �s,� Structurai Revievu Clerk {��v,��aQz�2�/zo�4} ���°��`�`� i�rr�i Shores Villa�e �` ��ildin� I�epartrr��nt �... ,��.�' 1tJ05C} N,E.2r�d Ruenu� � Miami Shores, FEarida 3313� ���,.����E*�*°'� °t'+�1: �305}795,22E?4 �� Fa�c:{3t}5}7s6,�97z 1 1'TI 1 T REFtMIT NUM�ER: IVt� T��s f�rrn r�ust�c��mp�ny�LL air��nd�trc+r��n�r�pl���r�n�nt p�rrrtit appl�eati�r�s. Ea�h unit ch�n�e��ut must be on i�s c�wn dat�sh�et. iVluitipl� �nits�n s€t��l�she�ts are not a���ptable. Job Addre�s(�rh�re th�wark is b�ing d�ne�: City: MiamE Sh�r�s VitE�g� �aunty: tl�iarni Rad� Zip Code: �L � I � �� � A�L UNITS UST'Cfl PLY ITN F.E.M.A INI l!M FLQ��E�EV�4TION A CQPY sF 1'ME CClNT' �1'IS REQUI�tfD W1TH A�.L SUEMtT'At�S AHRI DATA►SHEE�°REQUIIRE� �hange dise�nnectit��mea�ns:YES[� N�❑ AR�1!Sh��t Attached:YES ❑ �tQ ❑ Cantract Attach�d:�"ES ❑ 11tVIT�EtNG REPLACE� DAT� NEW UfVIT (���Il1FACTURER AHU or PIfG. UNIT MQ�EL# Cf�N�.11N[�'!VlQ�E�# KW F#E�T NQM TC}IVS ANt1 CU P6C� 2j M.C.,4 AEIt� CE} PKC� ANU ClJ FK� 2�M.O.P AFfU CE1 PKC� AHI� CU PKG 3}Vt�LTS AHU CU PK� PKC tJNIT / / PKG UNIT f / EERJSEER YES P�� REPt.�CINia C}UCTS YES NC} `fES N� R�PGq�INC ThfE�MQST�T YES NC� YES N� NEW 4"C�NCRETE St.�� YES NQ YES N� NEW ROOF STAND YES NQ YES iV� NEW RETURN PGENUM BQX YES �1Q 1, Minimum Gircuit Ampaci�y(Wir�Siz�}: 2, t�aximum t3vercurr�nt Pr�tectian (Fus�J�r�aker Si�e)� 3. Volta��ef Circuit (2�81240�4�Q}: �4. Size C3isconnecti��Mle�ns: � ��r�tract�r's Corrtpany t��me; � f� � � Phane: State�ertificat�car Registrati�an Na. µ�'°�°,� � C�rtifoeate���omp�teney M11o. ',�'i1 11��UCE." ��i�*: Q �fier's�i�nature) (�evis�doa�z�/ao�a} ������� �r�� �errr� � I`�1 �Q�' S I�� ���r�s kw��� �� ' R.1`� 1Q050 E�.�.��d Avenu� � Mi�mi a�tore�, Fl�ri�� 3313� Tel: �305� 795.22�4 F�xe {305) 756.�9T2 ' ' I� C NT GT R IS�FLQ I�A SfiAT G�RTIFEE CQNT GTQ : d9. ��4 f �� Kidd-l�t����46d ��!'1�6. ����FlL/�� �. CQPY C�F LQCAL �USlNESS T�1X RECEIPT C. C�}PY�F LIABICITY INSURANGE* D. �QPY�F W�RKERS C4NIPENSATI�N INS�IRANGE* (Wark�rs Campensafiian EXEMPTIQN must have NQTE�E Tq�WNER farm and G4ntract�r Affidavit) IF C� T CT FtAS A I�i I �A�E G4tlN C� TIFICATE �F C� P T NCY: A. �C}PY C}F CERTIFICATE �F C�MPETENCY QF Qt1ALIFIER �. C4PY C}F �(�GA� �USINE�S TaX ��CEIPT G. GC}PY OF ST�TE �ECISTERED C�NTf�ACT�(� LIGENSE QR �I�MI DADE G{�UNTY MUNI�IPA�. GC}NTI�ACTQR'S TA?C RECEIPTe D. C�PY�F LIA�I�ITY I�SURA�E* E. CQPY QF�IQRKERS C��IPENSATI�N I�VSU NC�� (Worke�Gomp�nsation EXENIPTIQN must�ave N�TICE Tt��WNE�form�nd Cantract�r�ffidavit} *Y U INSt1 NCE Gd P NY USfi ISSUE A CE TIFIGATE,AS F�LL C��tiftc�t�Flold�r: I�IA�1 SHt}RES YILLAG� �L�G�EPT 10Q5�NE 2ND AVE IA1�1 SHORES,FL 3313$ Certi�cafie mta�t sp�cify th�des�rip�i�n of�p�rati�ns or c�ntra�tar lic�nse nu�b�r. d.....�......�............... ...........�...�...............��...........�...�.....�...... USINE3S NA E: �°� & ���?r� �„ l�SINESS AQ�RESS. � � CITY � STATE ZEP USINES� PHQNE: ( } F Nt1M�E ( }_ CE��PNpNE ( } �lIALIFIE�'S NAME: �� QEIALIFIE '� LIC NU �R; � � � ; ; i � � � �����k Na1s�y��she.�rs, �ecr�t�ryy < � � ���;� Po� ���an��s,���r�r�r�r > ; - � ; � �� �`�`fi s :t� � � �� — � w—'�*�� � � � � � � �� �:,;����� � �� � "�� ��'��,e'�'� �,� j } ! i i I 3 � � j ���� ��..��� � ��� � ��i�� ' �� � � � �� ������ 1� �������� �����. ��� � � ��5� �"" � ���� �`� � 9,"�� ' � � ;, "� �� �' �"�� � ; 1 3 3 � 3 1 � � � i � £{ �, , � , , '; , , �; �`.. , , "' ' '' ,.' ';r„ � '�' . # � j � „ fg g� � i , , �E6 , � � ��� ; � ,;'/,� k"' , i � , � ,�, � ,,,, �� ' ? ���,�4 � �.� '�"< ,, �: ;; � � � � ; I F� �;� ` �; ' ���� �� r � f ;� �� � �,� � , , , , . � � � � � �� , � i �ilo���s ��rify �i���s�s c��sli�� �� �lyF{�ar�c���������.c�� � � s ; � . � � �� ��� �It�r th�� c������s�� �� �r�y��c�r�9 i ? � � . ��i� �� �yc��r I���r���, I� i� ��I����1 ��r����r�� c�t��r�h�r� �1�� li������ t� s��� ���� �������t, � ; � . , .,,,. �; „ �< ,, ; , ,,, ,; „ ,�.<. , „ ��; r , r r � ; , „,� �,r<.,,� _.. . ,, ,, ��,, � , ,.� � „ . � � , � � . � , �i��}���1�� ������ �,�{��L ���i����� ��#,� ������� 1�5 S. �r�dr��v� ���., �rr�. ��1�tJ, Ft. L��ad�rd�l�, F� �33fl1�1��5 — 9�4-�3�-4Q�� � �� �T � �, �"�� ��F�T`� � 3Q, ���: �e���pt�,'1�3—�.�2� � � � . CI�i�9��� '�I �:I*'I M A�ZFZ �C7 I"I'I� I3�T�; �N� �U�ItI��� T E':��A'Z°Z�`{�JAI��2C�3N13Z`T'�C}�+3� ��,���a�.� �� {���.�' r'����.i� �'i"ZC32�1 ���;:���T"�.� � n�r P�a�ae.,�c�s� v�zr��� r�c��� �c�� ��ir���� �p�n�d:�s/25/�0�� r��ir���� L�ca��ti�ra; ��.� �va ��as ta�,� �t���l���ue�t�#�e ��g. ����.5�9� ���t��c� ��t��;� ��er�ro�a�o�rt ��d�� �a��rt��� ��c�r�e; � F���,ms 5���� �m�Ic��y��s �iack��ne� �r������r�n�is � Fcsr��rad3ng���in��s Clrs�y iV�mtaer s�f{1��ct�ira��, �t�er�ci�ng Typ�; Tax Am�ur�t Tr�nsfsr��� �IiF F�e F°�;rs�l#y F'ric�r�'e�r� Cc�16�c„ticsn�c�st �"�at�1�'aid �7.0 0 {7 .Q Ct Q,t7 tI t?4 0 d3 �.t7 0 C3,{7 fl �2�7 n{��1 ,; , ,. � ;_, , � �- � �� ����� � � �� � ���� �� � � � �� � � � �`. : r= T'Fll� E��Ct�P�9�� ,�'["�X F2�����'"T �'hi�tax is 1e�ried f�r�he�rivilc�c�e e��desir�c� busi��ss earithi� �rt��v�rd ��auc�t��e�t3 �s % r�c�rr-r�gul�#t�ry in r�ature, Yc�u rr�u�t rt�e�t �II �e�a�niy ���le�r �c�r�'s�ip�tit� �I��ra��g � �tV�i��t V�l.,IG}e�"f�� �r�d �o�irtg r�;q�air�rr��r���, �`hi� �u�ines� 'T�x ����ip� r��a�t b� #r�r�sf�rr�d ��a � the bta��nes� is s�s�d, bu�in�s� r�arrae ha� ch�r�g�d esr �cat� h��� �cav�c� tt�� b��in��� I� ti�r�.�"hi� re ipt dc��s r�vt ir�di��t�t�a�t th�b�a�i��s� i� I���i e��tt��t €�is i� r�p�sar�c�v�ith �t�t�c�r�c� I l� s�nd r�gu3�tis�r��. ��il��g A��r���: % �'(��� �Z�Z,�I,� �'i�i��AGC7�T �t�c���� �3�?��19�Obt�tJ�9C�� 912 �'V1 1"7� b�1��,' P�.i� �9�f 1.�/2t�20 2?,�t} P�P��R.C3�E PI�+I��, �'�, 33fl29 �.�� � � � "�� ,� �:�"„ „ c;%�;, ,,,, ;<p. i,�;`"�., ,,,"��" oi , ., . „ „ �;',,,, , ",/.,,, ,, f.,� l, �;,%�s„��l� � :.,w'� / �