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MC-15-2796 P-16-2-32- -J- Miami Shores Village Building Department artment N° 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 LID _ -- Tel:(305)795-2204 Fax.(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 p FBC 20 ► --1 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING M ELECTRIC ❑ ROOFING REVISION ❑EXTENSION ❑RENEWAL [PLUMBING MECHANICAL []PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP ►� CONTRACTOR DRAWINGS C� JOB ADDRESS: v "� G�- 5A- City: Miami Shores�-0 County: Miami Dade Zip: Folio/Parcel#: 1`� 0L Is the Building Historically Designated:Yes NO Occupancy Type: & Load: Construction Type: Flood Zone: BFE: FFE: �� \(r-, 1 OWNER:Name(Fee Simple Titleholder): �_'i~/2- lRJ � "�aPhone#: Soy— �P-0 15 Address: City: e7 L Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Phone#: Address: 5n, City: f$�j AnM'a State: Zip: 33 CQ2 Qualifier Name: MkI21an (l lj'/� Phone#: State Certification or Registration M I s AACA 3 Oct Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ElNew CK Repair/Replace ❑ Demolition Description of Work: 0- A c 4 ; P-'Oti Specify color of color thru We: Submittal Fee$ _Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I (Revised02/24/2014) I . Rem-4ing 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 ELECTRICALIORK,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 excee ' g$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occ seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approve nd a reinspection fee will be charged. Signature4Signature Owner or Agent Contractor The foregoing instrument was acknowledged before)me *s-U— The foregoing instrument was acknowledged before me this day of In 20S-,by _W'.& day of n ,20 15,by Otry .Gn, I-ao- � who is personally known to me or who has produced who i ersonallyknownto or who has produced VL D), As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: % Sign: Print: ��--�`--"''-=--m=-= � Print: M Commission Ex s>Y P�, E w•,.P�. "`'� My Comlmsslo � g;�o, NADINE AUSl'ERFIELD Y . o, s NADINE AUSTEF r��Lo Plotary Public Staie of Flora Notary Public-State of Florida - 017 n 1 *) My Commission Expires Nov 7,2017 �r o tI, Cem,i scion Er�G F 7 FF 556b1 of F; Commission,. +pskoNkekk�k#ksk�kksk�$+��Ia"'"'rim_\"�`^'h%hkih��Xaek� �athskshsh ksk�s?k=.k�ls�? �skk��k*�'sskkSsskskekk�=k�kkkksk��Ntk�h��.?k.Xt� �!"k_?�'h'k�.� kaksksk .I APPROVED BY J~ V Lan Examiner Zoning Structural Review Clerk Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 16 - MIAMFQADE MIAMI-DADE COUNTY -STATE OF FLORIDA N/A November 02,2015 LOCAL BUSINESS TAX RENEWAL 5937991 2015 -2016 APPLICATION RECEIPT.6194708 STATE#CACO21309 DBA/BUSINESS NAME: BUS.COMMENCEMENT DATE:12/01/2006 EDD HELMS AIR CONDITIONING AND ELECTRIC SEC TYPE OF BUSINESS BUSINESS LOCATION: MECHS SPEC MECHANICAL CONTRACTOR 17850 NE 5 AVE 50 MIAMI,FL 33162 OWNERlCORP. APPLICATION DETAILS EDD HELMS AIR CONDITIONING INC FEE AMOUNT C/O WADE HELMS Receipt Fee 110.00 PHONE# 305-653-2530 UMSA Fee 110.00 17850 NE 5 AVE Beacon Council Fee 55.00 MIAMI,FL 33162 Bingo Permit Fee 0.00 Nightclub Permit Fee 0.00 Multi-Municipal Contractor Fee 0.00 Restricted Contractor Fee 0.00 Library Fee 0.00 Transfer Fee 0.00 NAICS CODE: 238990 Doing Business without a License Penalty 0.00 Late Penalty 0.00 Collection Cost 0.00 NSF Fee 0.00 Prior Years Due 0.00 Amount Recently Paid - 275.00 TOTAL AMOUNT DUE: 0.00 ................................................................................................................................................................................................................................................................................................................. If no longer in business,please notify us in writing. To pay online go to www.miamidade.gov/taxcollector Review and correct the information shown on this application. To pay by mail, make check payable to: Miami-Dade County Tax Collector A 25%penalty will be assessed to anyone found operating Business Tax without a paid local business tax, in addition to any other 200 NW 2nd Avenue penalty provided by law or ordinance(Sec 8A-176(2)). Miami FL 33128 To pay in person go to: A Certificate of Use and/or City Business Tax 200 NW 2nd Avenue Receipt may also be required. (305)270-4949,fax(305)372-6368 A service fee of not less than$25.00 up to a minimum of 5% will be charged for all retumed checks. t RETAIN FOR YOUR RECORDS t ................................................................................................................................................................................................................................................................................................................. MIAMI-DADE COUNTY- + DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT + N/A November 02,2015 STATE OF FLORIDA LOCAL BUSINESS TAX RENEWAL 2015 - 593 9912016 APPLICATION IIIIIIIIIIIIIIII�III IIIIII�IIIIII III IIII�IIIIIRECEIPT.6194708 S ATE#CACO2 309 BUSINESS LOCATION: 17850 NE 5 AVE MIAMI,FL 33162 BUS.COMMENCEMENT DATE:12/01/2006 SEC TYPE OF BUSINESS OWNER/CORP. MECHS SPEC MECHANICAL CONTRACTOR EDD HELMS AIR CONDITIONING INC 50 APPLICATION IS HEREBY MADE FOR A LOCAL BUSINESS TAX RECEIPT OR PERMIT FOR THE BUSINESS PROFESSION C/O WADE HELMS OR OCCUPATION DESCRIBED HEREON.I HAVE BEEN INFORMED OF ALL ZONING RESTRICTIONS IMPOSED ON THIS RECEIPT. I SWEAR THAT THE INFORMATION IS TRUE AND CORRECT. EDD HELMS AIR CONDITIONING INC C/OWADE HELMS 17850 NE 5 AVE SIGNATURE REQUIRED SEE INSTRUCTIONS ABOVE 178 MIAMI,FL 33162 Please pay only one amount.The amounts due after Sept 30th include penalties per FS 205.053. if Received By Nov 30,2015 Dec 31,2015 Jan 31,2016 Feb 29,2016 Please Pay $0.00 $0.00 $0.00 $0.00 7000000000000000000000006194708201600000027500000000000005 permit : MC-1 6-279 Miami Shores Village � 'Permit type:Mechar cal-Residential 10050 N.E.2nd Avenue NE C Replacement Miami Shores,FL 33138-0000 Phone: (305)795 2204 ;, >Ft7tit 5ia1r � ' R€ t Issue Expiration: 05/02/2016 Project Address Parcel Number Applicant 478 NE 92 Street 1132060140020 Miami Shores, FL Block: Lot: THOMAS ROGER&CHRISTINA' Owner Information Address Phone Cell THOMAS ROGER&CHRISTINA WHITE 478 NE 92 Street (305)546-1030 (305)439-2855 MIAMI SHORES FL 33138- 478 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 5,100.00 EDD HELMS AIR CONDITIONING AND (305)653-2530 Total Sq Feet: 0 Tons:4 Available Inspections: Additional Info:REPLACE A/C UNIT(4 TON UNIT) Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 DBPR Fee Invo'iCe# MC-11-15-57643 $2.68 11/04/2015 Check#:6259 $ 152.46 $50.00 DCA Fee $2.68 Education Surcharge $1.20 11/02/2015 Check#:6258 $50.00 $0.00 Permit Fee $178.50 Scanning Fee $9.00 Technology Fee $4.80 Total: $202.46 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. F t ermore,I authorize the above-named contractor to do the work stated. November 04, 2015 Authori e t •Owner / Applicant / Contractor / Agent Date Building Department Copy November 04,2015 1