MC-18-3107Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
F�-rub
issue Date:12/05/2018
Parcel Number
1090 NE 104TH ST, Miami Shores, FL 33138 1122320290190
Contacts
Permit NO.: MC-10-18-3107
Permit Type: Mechanical - Residential
Work Classification: Pool Heater
Permit Status Approved
Expiration: 04/08/2019
Description: 5 TON POOL HEATER Valuation: $ 4,500.00 Inspection Requests:
305-762-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$3.00
DBPR Fee
$2.03
DCA Fee
$2.00
Education Surcharge
$1.00
Permit Fee
$85.00
Scanning Fee
$9.00
Technology Fee
$3.38
Total:
$155.41
Payments Date Paid
Amt Paid
Total Fees
$155.41
Check # 42919 10/09/2018
$50.00
Check # 43042 12/05/2018
$105.41
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 AF.I VIT: I certify all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating ns ction and zon' uthermore, I authorize the ve named contractor to do the work stated.
Autho Signature-bwne'r / //Applicant / Contractor / Agent Date
December 05, 2018 Page 2 of 2
Miami Shores Village r�q
Building Department s
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �►
Tel: (305) 795-2204 Fax: (305) 756-8972 �Y.
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. BC
PERMIT APPLICATION Sub Permit No. ,MC18 - 3107
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING 0 MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
1090 NE 104th Street
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Pa rcel#: 11 -2232-029-0190 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Richard E Mellett J TRS & Erika Batey J TRS Phone#:
Address:1090 NE 104th Street
City: Miami Shores State: FI Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Van Kirk & Sons Inc. Phone#: 954-755-4402
Address: 3144 SW 13th Drive
City: Deerfield Beach State: Florida Zip: 33442
Qualifier Name: Robert P. Van Kirk Jr. Phone#: 954-755-4402
045956
State Certification or Registration #: CPC-A,1 Certificate of Competency #:
DESIGNER: Architect/Engineer: Ibmali I M CySa" CZ nJ✓ • Phone#: b `t&3
Address: 12 k 0. b Nyi k 5 N City: Co Prjn!55 State: TL Zip: 3307
co '
Value of Work for this Permit: $ W I �60.Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work:
i4
Specify color of color thru tile: 13S a
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $,
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $ '' rr
TOTAL FEE NOW DUE $ d� • `4
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
N/A
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 2,f!56 120 JP by
Richard E Mellett J TRS & Erika Batey J TRS who is personally known to
me or who has produced .0 c- 5.3nO - 00-75-- 2�- s
identification and who did take an oath.
NOTARY PUBLIC:
Signature AA
CONTJACTOR
The foregoing instr ent was acknowledged before me this
J�l day of ' 20 T� J by
To4'14 P-Va h k < < ) ( -, who is personally known to
me or who has produced
identification and who did take an oath.
as
NOTARY PUBLIC:
RY P
Sander -'
' t\'cta . Pubi.c-Stateotr :n a
Sign:
alie
�. G 3C 15
Print: 17.a—j'In �Cti v�l�Il l�t7b '` Expires 3/27/2020
Seal:
****A*P*P*R*O**V*E*D**BY**********************�A lans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)