MC-05-19-1114, 1420 NE 101st StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
1420 NE 101ST ST, Miami Shores, FL 33138 1132050230050
;ontacts
MATTHEW ALLEN Owner VAN KIRK & SONS INC Contractor
1420 NE 101 ST, MIAMI SHORES, FL 33138 ROBERT P VAN KIRK JR
Other: 3056732847 3144 SW 13 DR, DEERFIELD BEACH, FL 33442
Business:9547554402 esandoval@vankirkpools.com !
Other:7863262747
...... .........
Description: STON JAND JE 3000T HEATER 3 JANDY JX1400 GAS Valuation: $ 7,000.00 IN
4
Inspection Requests:
HEATER (HOOKUP BY OTHERS) FOR POOL &SPA. rr�2TpE`M
€AW—
I
E
Total Sq Feet: 0.00
.... ,
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.20
DBPR Fee
$3.15
DCA Fee
$2.10
Education Surcharge
$1.40
Permit Fee
$160.00
Scanning Fee
$3.00
Technology Fee
$5.25
Total:
$229.10
Building Department Copy
Payments Date Paid
Amt Paid
Total Fees
$229.10
Check# 110068 08/01/2019
$179.10
Check # 43392 05/16/2019
$50.00
Amount Due:
$0.00
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 wo ill be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named ctor to dot work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent V ell Date
August 01, 2019 Page 2 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
QBUILDING ❑ ELECTRIC ❑ ROOFING
IM
FBC 20
Master Permit No. p-p - � —1 Gi
Sub Permit No. \ : 0
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING PWMECHANICAL [—]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: 1420 NE 101 Street
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-3205-023-0050 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): Matthew & Elizabeth Allen
Address: 1420 NE 101 Street
City: Miami Shores
Tenant/Lessee Name:
Email
BFE: FFE:
Phone#:
State: Florida Zip: 33138
Phone#:
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
State Certification or Registration #: CPC-045956
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: _
Address: City: State:
Value of Work for this Permit: --� 10Q L) Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑,w, yyAlteration New ❑ Repair/Replace
Description of Work: 5 ��'v �Ci1'L �� O-�-P/1�-
JCcn &A4 -TX 140 0 a rid 6a.k,4"' ( 6)� V. [A 0 kW
Specify color of color thru tile:
Submittal Fee $ (� ' i `'' Permit Fee $
e
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
Zip:
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ . %0
(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
Zip
City State 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 CSi2._
OWNER or AGENT
The foregoing instrument was, acknowledged before me this
day of ►� t0L YJ \ , 20 � �, by
Matthew & Elizabeth Allen who is personally own to
me or who has produced bYAy\-k^ r u- as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: V1 r '"—'/
Print: L 1 �' G V) 1 1(✓ic
Seal:
Signature
v
CONTIiACTOR
The foregoing instrument was acknowledged before me this
day of 20 y
pe onally known o
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
MY CO GG 070333
ru
EX IRIS: June 7, 2u21
30
+m' d h u Notary Public Underwriters
f-11
tart' R�ihlic - Mate of Florida
Commission #GG30615
Expires 3,27/2020
I/tAPPROVED BY i6lbl Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)