PL-15-1042 Miami Shores Village RSC -- F,.�=
Building Department i APR 30 2015
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.Vc-4 S — 10 3 7
PERMIT APPLICATION Sub Permit No. —'L S iC7`i 2�
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[�LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
2CONTRACTOR DRAWINGS
JOB ADDRESS: > N5(:2:- (7 Z S, c/
City: Miami Shores Countv: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: Ny BFE: FFE:
OWNER:Name(Fee Simple Titleholder): o 4-N I�N(2, M NNJ Phone#:
Address:,1 :?:;.'33:?:;.'33 MCI
92 S- �j
City: Y"\ State: � >J- Zip: f K p
Tenant/Lessee Name: Phone#:
Email: `
CONTRACTOR:Company Name: p \A t�\'N S�'L v+�.b i NS S��z\3.1 QA Phone#: -So -aZS-y333
Address: 1 sot'
City: 1�` Le�� Stater Zip: 33�1Z
Qualifier Name: iH p Phone#: `S6'Z.V
State Certification or Registration#: C 'FC. �y2g 11 Ci Certificate of Competency#:
DESIGNER:Architect/Engineer: _ � C�MP�L�c c Phone#:
Address: r- City: State: Zip:
Value of Work for this Permit:$ l7�� Square/Linear Footage of Work: g
Type of Work: ?d Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 7f Ps1 Li Xx" 0Q K5 LO-T- . (f) S H J"rc—*—,
(d rS Pc-+2 Pl-vh -rs
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ `Z 2,5. � CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ ✓ '
(Revised02/24/2014)
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 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 approve a reinspection fee will be charged.
Signature Signature --�--a'
ZIV OW or AGENT CONTRAC R
The foregoing instrument was acknowledged before me this The foregoing instru ent was acknowledged before me this
2�n day of Uatgk. ,20 ,� by 2:�- day of 0- GfQ�A 20 kS by
Afv,x '�ma�who is personally ►1n
known to `^(�Q(1ye� d6Ywho is personally known to
me or who has produced Q�- �'y1 �-�\2 as me or who has produced �- �i\� as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: A4Sign: 4
Print: Print: r Vv\
Seal: mw Seal: BE AM M.PASTRANA
RPBECA M.PASTRANA MY COMMISSION#EE872624
MY COMMISSION#EE872624 N� ENPIR S:FeGrvery 07,2017
EXPIRFS:Fd—mmy07,2017 oa
APPROVED BYPlans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Permit NO. PL-5-15-1042
�s Q.% y� Miami Shores Village Permit Type:Plumbing-Residential
10050 N.E.2nd Avenue NE Pe'06,
' lwoelwel Work Classification:Addition/Alteration
- Miami Shores,FL 33138-0000 Permit Status:APPROVED
Phone: (305)795-2204
toR�oA Issue Expiration: 04/05/2016
Date: 1t}/g{2015
Project Address Parcel Number Applicant
333 NE 92 Street 1132060136370
Miami Shores, FL 33138- Block: Lot: JOHN LONGMAN
Owner Information Address Phone Cell
JOHN LONGMAN 333 NE 92 Street ()__
MIAMI SHORES FL 33138-3133
333 NE 92 Street
MIAMI SHORES FL 33138-3133
Contractor(s) Phone Cell Phone Valuation: $ 6,700.00
MANNY'S PLUMBING SERVICE INC (305)219-5625
-- - Total Sq Feet: 598
Type of Work:PLUMBING FOR 2 SINKS 1 TOILET AND 1 Available Inspections:
Type of Piping:
Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning: 1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $4.20
DBPR Fee Invoice# PL-5-15-55402
$3.38 10/08/2015 Credit Card $245.96 $0.00
DCA Fee $3.38
Education Surcharge $1.40
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $5.60
Tota I: $245.96
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.
October 08, 2015
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
October 08,2015 1