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MC-06-891msq 4( 3:a5 City /92 /d17) Qualifier AO/9Am $ Value of Work For this Permit c 6 u Total Fee Now Due $ t 8 C:= 3 . 4 0 (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING IMMEEV Permit No.MC-CG —09 j PERMIT APPLICATION A 0 2006 aster Permit No. FBC 2001 BY: _ ---- - - - - -- . Permit Type (circle): Building Electrical Plumbing Mechanica Roofing Owner's Name (Fee Simple Titleholder) / & cil l/ e Phone # Owner's Address 1 7 P0 A' i /0 3 Sr Cit "Am s0 re f State Ai Zip 3' 3 P Tenant/Lessee Name Phone # Code Enforcement $ Structural Plan Review. $ Job Address (where the work is being done) / '7 / C / f7 City Miami Shores Village County Miami -Dade Zip 3 3/3, Is Building Historically Designated YES NO Contractor's Company Name /qi.J , KAZ C Phone # Contractor's Address /J / 5 £(....) /S 7" State Ft 4 6, 0 9.( 2 0(.1 d grrei Zip 7,6" -- 3,x 7 State Certificate or Registration No. Certificate of Competency No. Go Architect/Engineer's Name (if applicable) Phone # Type of Work: ['Addition DAlteration ['New Describe Work: -4dd it 4k f47fre- M fllq f"/ 44.11 Square Footage Of Work: ****************************F , *, * *** * * ** * * *** * *** * * * * * ** Submittal Fee $ Permit Fee $ W 7 Notary $ Training/Education Fee $ t - Scanning $J' • C Radon $ Repair/Replace ❑ Demolition 07) CCF $ -CCD CO /CC Technology Fee $ 4 . ^ Bond $ 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. 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 tl`e abse e of such posted notice, the inspection will not be a. .roved and a reinspection fee will be charged Signatu Chc 05/13/03 10 . Owner or Agent The foregoing instrument was acknowledged before me this=DY day of . W&&1_, 20'7(o , by 7ia-YI eka, t'l. who is p aerl'Ily known to me or ho has produced Signature Contractor The foregoing instrument was acknowledged before me this Z-9I day oft , 200(4 , by --dv ( "e ° , who is ersonally known tom or who has produced as identification and who did take an oath. NOTAI: i NY, dalia Santiago As identification and who did take an oath. NOT : LIC: NuIAEA ,':1BLIC- ST+TE')F FLORRATARY PUB .. . k, f Mi Santiago Sign: ; Sig n n =, va4 i 3 �' - r ` ' .. : _ 33923 Print/ jRp , 4 44....AAs i tir:'c: MAY 25. 2009 PrintO)i ch44q :!1, 4�o 1:y; `res: ,��:.;' 25, 2009 ( Bonded Thru :,ti..+uC Bond Inc. I": Bonded Thru .`.c+.+,euc 'Swath.. 'o., Inc. My Commission Expires:sf as 9 My Commission Expires: 5)z / ********************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** * ** ** * * ** * * * ** * * * * * * * ** APPLICATION APPROVED BY: G Plans Examiner Engineer Zoning Permit Type: Mechanical - Residential Work Classification: New Job Address: 1480 103 Street NE Miami Shores Village, FL 33138- Comments: INSTALL NEW AIR CONDITIONING SYSTEM Additional Information Fees Due CCF Education Surcharge Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Building Department File Copy Applicant Signature Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Amount $3.00 $1.00 $175.00 $3.00 $4.40 $186.40 Permit Issue Date: 4/11/2006 Expires: 04/07/2007 Owner's Name: THOMAS AND SANDRA CHAILLE Contractor(s) RED LAND AIR, INC Phone 786 -242 -1967 Primary Contractor Yes Tons: Classification: Residential Additional Info: 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 authorize the above -named contractor to do the work stated. Invoice Number C__ c . Parcel #: Block: Section: MC-4-06 -24433 Total: APR 1 PAID Permit Status: APPROVED Permit Number: MC -4 -06 -891 Phone: (305)528 -2129 1132050310070 Total Square Feet: 0 Total Valuation: $ 5,000.00 Required Inspections Rough Rough Duct Ventilation Smoke Test Hood Smoke Det Test Final Amt Due $186.40 Lot: PB: Amt Paid NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Inspection Date: 05/01/2006 Inspector: Perez, JanPierre Owner: CHAILLE, THOMAS AND SANDRA Job Address: 1480 103 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: RED LAND AIR, INC Building Department Comments Friday, April 28, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: New Phone Number (305)528 -2129 Parcel Number 1132050310070 Lot: Phone: 786- 242 -1967 Page 2 of 2 Passed Inspector Comments ,� 4 ,./- ‘7 Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Date: 05/01/2006 Inspector: Perez, JanPierre Owner: CHAILLE, THOMAS AND SANDRA Job Address: 1480 103 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: RED LAND AIR, INC Building Department Comments Friday, April 28, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: New Phone Number (305)528 -2129 Parcel Number 1132050310070 Lot: Phone: 786- 242 -1967 Page 2 of 2