MC-19-1350 (2)Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: MC-06-19-1350
(� Permit Type: Mechanical - Residential
iWork Classification: Alteration
Permit Status: Approved
Issue Date: 06/18/2019 I Expiration: 01/06/2020
Location Address Parcel Number
79 NE 91ST ST, Miami Shores, FL 33138 1132060130130
Contacts
ROBBIE & KARLA SINGER Owner
79 NE 91 ST, MIAMI SHORES, FL 33138
GABY AC CORP Contractor
LAURA MENDIOLA
Business: 7862901982
Description: A/C CHANGE OUT 4 TON, HOOD AND DUCT. Valuation: $ 7,000.00 Inspection Requests:Inspect 4949
Total Sq Feet: 370.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.20
DBPR Fee
$3.68
DCA Fee
$2.45
Education Surcharge
$1.40
Permit Fee
$195.00
Scanning Fee
$3.00
Technology Fee
$6.13
Tota I :
$265.86
Payments
Date Paid
Amt Paid
Total Fees
$265.86
Check # 1069
07/09/2019
$265.86
Credit Card
06/18/2019
$265.86
Credit Card
07/05/2019
$265.86
Amount Due:
$-531.72
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, 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 construction and zoning. Futhermore, I authori he abc,je namgd cory raor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
July 09, 2019 Page 2 of 2
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Permit NO.: MC-06-19-1350
�Permit Type: Mechanical - Residential �I n�
Work Classification: Alteration
Permit Status: Approved
Issue Date: 06/18/2019 1 Expiration: 12/16/2019
Parcel Number
79 NE 91ST ST, Miami Shores, FL 33138 1132060130130
Contacts
ROBBIE & KARLA SINGER Owner GABY AC CORP Contractor
79 NE 91 ST, MIAMI SHORES, FL 33138 LAURA MENDIOLA
Business: 7862901982
Description: A/C CHANGE OUT 4 TON, HOOD AND DUCT. Valuation: $ 7,000.00 Inspection Requests:
TotalSq Feet: 370.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.20
DBPR Fee
$3.68
DCA Fee
$2.45
Education Surcharge
$1.40
Permit Fee
$195.00
Scanning Fee
$3.00
Technology Fee
$6.13
Total:
$265.86
Payments
Date Paid Amt Paid
Total Fees
$265.86
Credit Card
06/18/2019 $265.86
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, 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
reguction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
SignatureXwner / Applicant /
Contractor / Agent
Date
June 18, 2019 Page 2 of 2
��`q Miami Shores Village
� .Tmi
i
��\ BuildingDepartment , -_4 ' . W
\ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �V
Tel: (305) 795-2204 Fax: (305) 756-8972 B
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBc 201�
BUILDING Master Permit No. ^�C-d3-I�i-SI�
PERMIT APPLICATION Sub Permit No. MCI-0b- 19 - Gsb
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING MMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS:
Citv: Miami Shores Countv: Miami Dade Zip:
Folio/Parcel#: / / — 3 / Q � 0/ U l Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
13
OWNER: Name (Fee Simple Titleholder): I L� /� /� �� �i a ��Phone#:
Address: � 1, i f' S / r
City: �"l.l,, ,.,._ C` ��.��,� State: %!�/ Zip:
Tenant/Lessee Name:
Email
CONTRACTOR: Company Name:
Address
9
9L - /)gov
City: , �„ /,/;� , i// State: `� Zip: ti /
Qualifier Name: �; p�A-4 -if`may G lR Phone#: —,2
State Certification or Registration #: �/iLyL;�O L/(� Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
Phone#:
City: State
Value of Work for this Permit: $ $ 1 o o Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition ❑ Alteration ElNe❑ Repair/Replace ❑ Demolition
Description of Work: / JlL C&,:�, is 1 l'
u
Specify color of color thru tile:
" cr
Submittal fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
Notary $
Double Fee $
Bond $
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 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 opprov d and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
(�a-on day of J II+U r' . 20 1 Cl by
f/
K%trLLol S kJQrCC who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: f%2tS 7ntot
++�c �
6—
Seal: � rvue , 0 �,,,m� May 301202'
res t4'k n W*
�j7 OTC 1tw
�OF W ^_
The foregoing instrument was acknowledged before me this
day oof^ - . 20 1 Q by
�ZQ<G , "� fJ�101�. who is p sonally own to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
4V cry r $ rdes °
Print: Arm
OF Expires t0i17i2pzz 268584
Seal:
as
APPROVED BY 1 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)