MC-05-1164 (2) 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 be appy ed and a reinsp ion fee will be charged
Signature 0 Signature
Owner or Agent Co ctor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �17-
day of ,20CEby day of 20�by
who is orally 'm o me or who has produced who is pe me or who has produced
AP identifi 'on and who did take an oath. as idemification and who did take an oath.
NOTARY P . llj NOTARY PUBLIC:
Sign: �17Df1' 4 Sign: ori. 11T
Print: print •
My commission Expires: My ��ponfts CQ.I=
APPLICATION APPROVED BY:, tT
Plans Examiner
Engineer
chc 05/13/03 '
Zoning
i
I
Miami Shores Village
10050 N.E.2nd Avenue
Miami Shores,FL 33138-0000
0 Phone: (305)795-2204 Fax: (305)756-8972
Permit
Permit Status:APPROVED
Issue Date: 1/31/2006 Expires: 1210812006 Permit Number: MC-12-05-1164
Owner's Name: CHRISTINE PACHECO one: (305)491-5584
Permit Type: Mechanical-Residential Parcel#: 1121360130640
Work Classification: Addition/Alteration
Block: Lot:
Job Address: 10418 2 Avenue NE Section: PB:
Miami Shores Village, FL 33138-
Contractor(s) Phone Primary Contractor Total Square Feet 0
A.G.MECHANICAL INC. Yes Total Valuation: $ 6,000.00
Comments: Reouired Inspections
A/C UNIT FOR NEW ADDITION PERMIT BP2005-1473 Rough
Rough Duct
Ventilation
Smoke Test
Additional Information Hood
Smoke Det Test
Tons: Additional Info: Final
Classification:Residential
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.
Fees Due Amount Invoice Number Amt Due Amt Paid
CCF $3.60 MC-1406-23666 $223.05
Education Surcharge $1.20 Total:
Permit Fee-Additions/Alterations $210.00
Scanning Fee $3•003 PAID
Technology Fee $5.25
Total: $223.05 GG
Building Department File Copy 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.
Applicant Signature
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL a
'�iureio�
Phone: (305)795-2204 Fax: (305)756-8972 SW 22
tspecf on Number: INSP4 693 Permit Number, MC-1.2-06-1164
Inspection Date: 11/15/2006 Permit Type: Mechanical - Residential
Inspector: Perez,JanPierre -
CL Inspection Type: Final
Owner: PACHECO,CHRISTINE Work Classification. Addition/Alteration
Job Address: 10418 2 Avenue NE
Miami Shores Village,FL 33138- Phone Number (305)491-5584
Parcel Number 1121360130640
Project: <NONE>
Block: Lot:
Contractor: A.G.MECHANICAL INC.
Building Department Comments
Inspector Comments
Passed
Failed
Correction a
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re-inspection fee is paid.
Monday,November 13,2006 Page 1 of 2