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MC -08-633Inspection Number: INSP- 152262 Permit Number: MC -4 -08 -633 Scheduled Inspection Date: October 14, 2010 Inspector: Perez, JanPierre Owner: MEYER, NICOLA & GUNTHER Job Address: 860 NE 98 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Building Department Comments 3 UNITS OF 4 TONS EACH r Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments ft re 1 �� t.6 rec c6-1 October 13, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)981 -0540 Parcel Number 1132060142550 Page 20 of 22 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) t Jk m Phone # 3 "727 " 16 Owner's Address �� �/ (� /�%. q L r City o State fL / Tenant/Lessee Name Email aG,v o(, 7 / r9 /3jQ(.., Job Address (where the work is being done City Miami Shores V FOLIO / PARCEL # Is Building Historically ;1 esignated YES Contractor's Compan Name Contractor's Address City State Qualifier Name Value of Work For this Permit $ Type of Work: ['Addition Describe Work: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 DAlteration 1 vk.ur Zip 33/ SI Phone # County ` °- - Miami -Dade NO Permit No. 'v C) (%-- 69 53 Master Permit No. Phone # Flood Zone JAN _ . 2U10 BY: Zip Zip Phone # State Certificate or Registration Certificate of Competency No. Contact Phone E -mail Architect/Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: ❑New ❑ Repair/Replace ['Demolition Submittal Fee $ Permit Fee $ te ` 0 CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ See Reverse side --\ V, Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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. 4 24 Owner or Agent The for oing instrument was ac w1e . end, before m . this The foregoing instrument was acknowledged before me this day o 20, by /u A 1 l �. day of , 20 —, by 1 who is ersonally known to me or who has produced w o is personally known to me or who has produced 1 . - D '2 identification and who did take an oath. as identification and who did take an oath. NOTARY , UBLIC: NOTARY PUBLIC: i (VOA 7 _ , . C i :,- ) qoS5‘ ) ii.; :1;- 4 5 1 ,!°"4- C .:t1P" APPROVED BY Plans Examiner Zoning Sign: Print: My Commission Expires: (Revised 07 /10 /07)(Revised 06/10/2009) Signature Contractor Sign: Print: My Commission Expires: Engineer Clerk checked OWNER BUILDER DISCLOSURE STATEMENT NAME: IV +4uLtriu . Rt-L _ Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 DATE: Q 1i I i a ADDRESS: - 86o q 1112-Ei KiAt1 ii4CVLE5 FL ? 3i 8) Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor, I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied fora permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. , , Initial 3. I understand that, as an owner builder, I am the responsible party of record on a permit I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial 1.1" 1d6 4. I understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. Initialer l_ 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial Initial O V 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial U Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this 11 day of , 2010 B 41 A- 0 /r "�0 �� who was rsonall known to me or who has y s a �i Produced there License or tl ` C 2 Ill (- Ul - 2010 as identification. 1.4 O WNgR NOTARY t y � , 4 3 Oy r �,• oco., c 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial GUIA JO. 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial U- 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. , c Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850 .487.1395 or http:// www. mvfloridalicense .comldbnr /prolalbfindex..httml Initial UP) a 11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Miami Shores Village Building and Zoning Department Miami Shores, Fl 33138 RE: Property located at (address and legal description q6 41E ge sjece/ impyi f sgii' $ //l 3l 3& Very truly yours, (owner's signature ( fric/4 (print name) HOLD HARMLESS (signature) (print name) Date Gentlemen: As 1 gal owner of subject • roperty, I request the cancellation of permit number -H ' Og -3 issued LL , for the following reason: � - � .'$�r7 /w MOO Date of last inspecti I hereby apply caner- builde or authorize (new contractor) (.; to apply for such permits as necessary to construct or complete the construction On subject property. I agree to hold Miami Shores Village, its agents and authorizedpersonnel harmless and relieve them from any responsibility or liability for any legal action or damage, cost or expense Jincluding attorney's fee) resulting from the cancellation of the existing permit or the issuance of a new permit. I furthermore assume responsibility for the correction, if required, of work performed under the permit for which I am requesting cancellation. Prime contractor (only if subcontractor holds permit or if change of qualifier). STATE OF FLORIDA COUNTY OF DADE: The undersigned, being the first duly sworn, deposes and says that he /she is the legal owner of the above property. Sworn to and subscribed before me this Notary Public, State of Florida at Large day of 1)1(0 idfJlO )TJ �nA p'Us i r eiti 1ms �.IVIPt vs "'s- cosohaeleta 01D717923 Sy �II rIH� V wirer sf.P. 2,3, 2011 �urm� BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Mechanical Owner's Name (Fe Simple Titleho er) � d, M ti Kaphone # City State Zip Tenant/Lessee Name E-MAI Job Address (where the work is being done) City . Miami Shores Village County Owner's Address IVY A. e1.aotes FOLIO / PARCEL # Is Building Historically Designated YES Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ECEBVED a i -Dade Phone # er Permit No. Zip Contractor's Company Name c K off› 4 G Contractor's Address ''%, 1 s ' � fl iti City d-+1 t t 'bw Y State CI.- Zip 1 Phone # Qualifier Name L^ .. ` rfb'ISZ GAG t"i 1 53 L. a Phone # State Certificate or R,egiStrati&i No. Certificate of Competency No. E -MAIL: `_ "4 a;?> Architect/Engineer'lI (if tipplicable) Phone # t44 t4 l Value of Work For this ermit $ toot" O Square / Linear Footage Of Work: Type of Work: [Addition ['Alteration ❑New ❑ Repair /Replace El Demolition Describe Work: f c. v �vr 5. r S �, G r �/,��,f., 1cA) nY**** 4e9ciY****x oYeY$ ex aY�YeYdaka4ee9eat4r****4e:Yxak* ak **** **** *$xxxxx********•Tr &de********** eipt Submittal Fee $ Permit Fee $ 1 41101 . CCF $ CO /CC Notary $ Training /Education Fee $ c chnolo Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ B 1141uq kepm Permit No. KiaB See Reverse side —> cy Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: 1 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 ` N ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." U\ Notice to Applicant: As a condition to the issu promise in good faith that a copy of the notice o whose property is subject to attachment. Also, a cer for the first inspection which occurs seven (7) d inspection will no approvd and a reinspectio The foregoing instrum u owledged befor m The forego' instrument w.� before me thi day of wiv ' /aav , 20 D9 , by 90%145 .ridA►a hoc YA fL , day of ' , 20 who is personally known to me or who has produced PtZrle9_ who is personally known to - ': has produced as iden d who did take an oath. LOG t, • As identification and who did take an oath. NOTARY PUBLIC: : ,: _ WASHINGTON ROJAS - ` a ' •'- ,9 MY COMMISSION # 0D826696 Soto f: EXPIRES September 29, 2012 Sign: ,, (407) 398 -0153 FloridallotaryService.com Print: wA34a 4471 My Commission Expires: Oe /2)/2042 azieatx az acaYacn ae'x ar$ $x*x***xxxxxxxxx***wx•ir*w***ar ar****xdcxxxxxxx APPLICATION APPROVED BY: (Revised•02/08 /06) State init with an estimated value exceeding $2500, the applicant must d construction lien law brochure will be delivered to the person e recorded notice of commencement must be posted at the job site ding permit is issued. In the absence of such posted notice, the Zip Sign: Print: My Commission Expires: *a:x aexarx aedr$e****x nYx xia4&x dea r+YxxxaYde*4adro:***.****xxxxx Plans Examiner Engineer Zoning for the following reason: ti-y4i VIA •.I �. (Owner's Signature) gale/a Oa/ (Print Name) State of Florida County of Dade: Miami .SitrieaVi ''4 Deftwomeat 10050 NE 2nd Ave Miami Shores, Fl 33138 Phone 305-795-2204; Fax 305. 756.8972 www.miamishoresvillage.com HOLD HARMLESS PROPERTY LOCATED AT: Oroao �� S �, es S•-` a dtA,S As legal owner of subject property, I request the cancellation of permit number Mc, • 4 • ®®• to 3 issued to fE. • Date of last inspection: I hereby apply as owner - builder, or authorize (new contractor) JK.. , 11 . 00 S > to apply for such permits as necessary to construct or complete the construction on subject property. I agree to hold Miami Shores Village, its agents and authorized personnel harmless and relieve them from any responsibility or liability for any legal action or damage, cost or `expense (including attorney's fee) resulting from the cancellation of the existing permit or the issuance of a new permit. I furthermore assume responsibility for the correction, if required, of work performed under the permit for which I am requesting cancellation. (Prime Contractor -Only if subcontractor holds permit or if change of qualifier) DATE: (Print Name) RECEIVED JAN 0 Oa III IP 419 • The undersigned, being the first duly sworn, deposes and says that he /she is the legal owner of the above property. Sworn to and subscribed before me this day of . ataeffi- Notary Public, Sate of Florida at Large Miami Shores Village Building D Change of Contractor /Architect Permit No At.. 4. Owner's Name (Fee Simple Titleholder) ,,,,, g ) W Owner's Address ab.o w1 E 9 & yr City Moo. '7A State VI, Zip Phone # e foregoing instrument was acknowledged efore me this S day of 9A iw-y ,20 09 Y , ornrrri,c ra ho is personally known to me or who has produced puvus Lr (&6 as identificatio and whc) dirt Vice pn (lath Ol"•k WASHINGTON ROJAS C MY COMMISSION # D0826696 ° EXPIRES September 29, 2012 7) 398 -0153 FloridallotaryService.com NOTARY Sign: Print: w /139104 -ror (2016S My Commission Expires: 173/29/L0) z Chg4/1 8/08 Signa Job l Address (of where the work is being done) P 1 , 4E , 14, � 1.1,1, 'i 2 4. t3 G, Contractor's Company Name h'cb.rP Phone # Contractor's Address 1 o pw t, City 44, LA &.Lb! -t 1,1:044445 State Wit,. Zip Qualifier < r e.4co T ,z.ri'i**S / 3 ZQ1 Architect/Engineer of records name Address City State Zip /'t tw° Describe Work: t�/1 >r. vr% (- 4— — - � °��droA tle:�s ^. I hereby certify that the work has been abandoned and/or the contractor /architect is unable or unwilling to complete the contract. I hold the Building Official and the V' age of Miami Shores harmless fro ; - legal; i vo v ment. chitec Contract The foregoing instrument was before ackno before me this day of 1)E ( -By who is personally known to me who has produced as identification and who did take an oa My Commission Expires: 0 2009 Florida Certified Services Co. 'SETTING THE STANDARD FOR QUALITY& SERVICE' December 8, 2008 Village of Miami Shores Building Department 10050 Northeast 2nd Avenue Miami Shores, Florida 33138 Re: Mechanical permit cancellation Permit# MC08633 Dear Building Official: BY: This letter is to serve notice that I want to have the above mechanical permit cancelled effective immediately as I am no longer the mechanical contractor on such project. Contractor has failed to complete payment obligations as set forth on our agreement terms. I have sent notice to contractor in writing via US Mail Return Receipt. Please see attached copy of receipt and letter. Address: 860 NE 98 Street Miami Shores, Florida Permit# MC08633 G.C.: Southern Engineering & Construction 1000 Ponce de Leon Blvd. Ste 206 Coral Gables, Florida 33134 Sinc Jorge : Sariego Flori Certified Services, Corp. Ph# 305- 984 -8116 Lic# CMC1249661 / CACO57101 16218 SW 48 Terr. Miami, Florida 33185 • Ph. 305.984.8116 • Fax 305.553.4023 Lic. & Ins. CACO57101 0 8 2108 Mc� "CnM tt a December 2, 2008 Jonathan E. Yager Southern Engineering & Construction, LLC 1000 Ponce De Leon Blvd. Ste 206 Coral Gables, Florida 33134 Re: Meyer project, Mechanical permit cancellation Jay: Florida Certified Services Co. `SETTING THE STANDARD FOR QUALITY& SERVICE' Jorg:' ariego Flora • Certified Services, Corp. Ph# 305- 984 -8116 Lic# CMC1249661 / CACO57101 This letter is to serve notice that I am officially canceling the mechanical permit for the project listed above due to lack of payment. You will need to contract with a new mechanical contractor to apply for a new mechanical permit and complete the project. I have contacted the Village of Miami Shores Building department and advise them of such action at which time they may be placing your project on hold until you acquire a new mechanical contractor and permit. 16218 SW 48 Terr. Miami, Florida 33185 • Ph. 305.984.8116 • Fax 305.553.4023 Lic. & Ins. CACO57101 � � 5 f7C r= yrps-3r, r = .. , LAB k, BY __ . Florida Certified Services Co. 'SETTING THE STANDARD FOR QUALITY & SERVICE UNITED STATES POSTAL SERVICE • Sender. Please print your name; address, and ZIP +4 in this box • c \o ..a. e c- \ \ sw '4t Mt i "k(*v. s33\ *.5 S•V ■cQJ (Act . SENDER: COMPLETE THIS SECT /ON • Complete items 1, 2, and 3. Also complete item 4 If Restricted Delivery Is desired. ■ Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the matipiece, or on the front if space permits. 1. Article Addressed to: t}Y�tr� vS�r�rst{;. 4 Cfr►lt. l oot 'pc>~.ce., lam► ?)wk. Sr c. 1.0(o Co 4 Go..b4s jrait. 333 j 2. Article Number (1erfronm moo 7 O01r 015"0 00 0 Z 1 I SS 1 Mo PS Form 3811, teary 2004 Domestic Return Receipt . Service Vie Caned Man Registered ❑ ❑ Insured Man First-Class Mail Postage & Fees Patd USPS Penult No. G-10 BY: COMPLETE THIS SECTION ON DELIVERY D ❑ A Addressee IveryO. Del D. Is Whey address differed from item 1? ■ Yes If YES, Wider delivery address below: 10 No ❑ Express Man ❑ Return Receipt for Meiotmandise C.O.D. 0 7008 0150 0002 1159 9886~ 13 Yes 10251602414540 16218 SW 48 Terr. Miami, Florida 33185 • Ph. 305.984.8116 • Fax 305.553.4023 Lic. & Ins. CACO57101 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) A/TN -t cam.` Phone # Owner's Address `p� 0 1.1E- 9 e 's City "1l A.. cil—lsan.5- $. State l._ Zip 3 I `5 Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name f r .. ( e S) %.,, f-v � Cl Phone # Contractor's Address !ti4z,c S%-./ _t tr - City "t°1.. - 0/ v.A.0 State ( - _ !~" .ck„rfi.;_ State Certificate or Registration No. C,p t o ( Qualifier Name E -MAIL: S%.,c e. c: a @ e � c "A.k=" Architect/Engineer's Name (if applicable) Value of Work For this Permit $ de Type,of W Desc‘ibe Wor Submittal Fee $ Notary $ Scanning $ 3 " VO Bond $ Structural Review. $ Training /Education Fee $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 County Miami -Dade Zip p 1�. 245-0 ration **** ak ****aYaxxSc**** ****xaYxxxxx xxxxx *F New Permit Fee $ ' Ds 1. (e 0 Radon $ DPBR $ Permit No. MC VS` (050 Master Permit No. f-CO . Phone # Zip 31 LVA Phone # Certificate of Competency No. Phone # Square / Linear Footage Of Work: Code Enforcement $ Double Fee $ **** xx 4 ex de& xxxx*******wxxxaYx*****xxxxxx* Total Fee Now Due $ 2.14 0 APR e! -4 2 CKl - See Reverse side BY: ti►—� ❑ Repair /Replace ❑ Demolition CCF $ 4-Z13 CO /CC Technology Fee $ 1 • W Zoning $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 1 understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: 1 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement roust be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. he absence of such posted slice, the inspection will not be approved and a reinspection fee will be charged. NOTARY PUBLIC: NOTARY PUBLIC: (Revised 02 /08/06) it Signature Signatu re A f i Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instru : nt was acknowledged before me this 9 day of , 20 , by , day of _ who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. ,20 by as identification and who did take an oath. Sign: Sign: Sig d Print: Print: , . ;. �d04P LB l .� My Com ` �: sNO�ry Put- State o1 Fbdda My Commission Expires: My � Expires Od4 2009 t uieaYdea4xxxxxxx 4rdrw**11x$eac******** Y**** ae*** wxxxxxxxx &atxx &****4c****a4oY****** % xxSc xx x x* ** ,, OFF,., \\ � • 1 /11111 „ \\ Bonded By `� Bonded By I1A71L • APPLICATION APPROVED BY: 4/ i Plans Examiner it Engineer Zoning 66 Ai 9`g sfXEf City Miami Shores Village County Miami -Dade Zip 3.f 3� FOLIO / PARCEL # / / 32 412 Job Address (where the work is being done) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. NC PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) gaef Ay Phone # w -- 9 a-72.7V / Owner's Address 1 / r / i( t f 9 City /v j/ /i/if ( State /-4 Zip 33/ Tenant/Lessee Name '71 Phone # Email CU� 77 9 v z t y `54 4344 Is Building Historically Designated YES NO > - Flood Zone Contractor's Company Name �Y J je_. j Phone # Contractor's Address City Qualifier Name Phone # State ECEVE JAN 2 0 2010 Master Permit No. ee - 2 -27z- Zip State Certificate or Registration No. Certificate of Competency No. Contact Phone E -mail Architect/Engineer's Name (if applicable) Value of Work For this Permit $ \ 0, op 0 Square / Linear Footage Of Work: Type of Work: EAddition ❑Alteration ❑New ❑ Repair/Replace Describe Work: t/N Ce, J 0imi dNaT 7D T or(JITS 1, Submittal Fee $ ******** * * * * ** * * * * * * *** * ** * ** * * ** * * * *** F * * * * ** * * * * * * * * * ** *** * * * * * ** ** ** Permit Fee $ t o i D Notary $ Scanning $ I ' Radon $ DPBR $ Double Fee $ Violation date: Training/Education Fee $ Phone # CCF $ CO /CC $ Technology Fee $ Bond $ Structural Review. $ Total Fee Now Due $ 31 2'0 ❑ Demolition See Reverse side Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 Pi e it ® Signature 1 Owner o A ent '� Contractor The a ins�s a owlelged re me this U-O The foregoing instrument was acknowledged before me this day of - S . .-4 , 201n, by Co (J. 1 day of , 20 _ , by who is personally known to me or who has produced Sign: Print: who is personally known to me or who has produced As identificatio ' i tT e an oath. as identification and who did take an oath. .�` �� stlt c \ ? u R i g NOTARY PUBLIC: •7: P.• xp ir�o�;` �Or cD , NOTARY PUBLIC: O2012 •F , P. F I F L My Commission Expires: \ APPROVED BY I 1 (Revised 07 /10 /07)(Revised 06/10/2009) State Zip Engineer Sign: Print: My Commission Expires: Plans Examiner Zoning Clerk checked UNITED STATES POSTAL SERVICE SENDER: COMPLETE THIS SECTION 4. • Sender: Please print your name, address, and ZIP +4 in this box • ' . (\\ kbm,t • Complete items %, 2, and 3. Also complete item 4 if Restricted Delivery is desired. • Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mallplece, or on the front if space permits. 1. Article Addressed to: ktizAt 5 ievroliu.A4L. cle Number (Tnmsfer from sere/ PS Form 3811, February 2004 5 Domestic Return Receipt COMPLETE THIS SECTION ON DELIVERY D. .elivery ad• ,4 =rent from item 1? 0Y If YES, enter delivery address below: leNo 3. Service lype 0 Certified Mall o Registered 0 insured Mall 7007 1490 0003 8001 6347 First -Class Mail Postage & Fees Paid USPS Permit No. G -10 o Express Mali ❑ Retum Receipt for Merchant!' 0 C.O.D. 4. Restricted Delivery? (Extra Fee) 0 Yes 102595-02-