PL-16-3208 Permit NO. PL-11-16-3208
�syO1s y� Miami Shores Village hermit Type:Plumbing-Residential
n
10050 N.E.2nd Avenue NE
Work Classification:Pool -Private
Miami Shores,FL 33138-0000
Per Phone: (305)795-2204 Permit Status:APPROVED
FLORIDA`
Issue Date: 12/15/2016 Expiration: 06/13/2017
Project Address Parcel Number Applicant
1561 NE 103 Street 1132050310220
Miami Shores, FL 33138- Block: Lot: M2J4 HOLDINGS LLC
Owner Information Address Phone Cell
M2J4 HOLDINGS LLC 1561 NE 103 Street (786)290-8051
MIAMI SHORES FL 33138-
660 NW 125 Street
NORTH MIAMI FL 33168-
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
AQUARAMA POOL INC (305)934-4226
Total Sq Feet: 0
Type of Work:NEW POOL EQUIPMENT. Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Main Drain
Bond Return: Final
Classification:Residential Scanning: 1 Rough
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# PL-11-16-62167
$3.38 11/23/2016 Check#:2964 $50.00 $ 186.36
DCA Fee $3.38
Education Surcharge $0.20 12/15/2016 Check#:3002 $ 186.36 $0.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $236.36
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 IT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constru ion and zon . Futhermor I authorize the above-named contractor to do the work stated.
December 15, 2016
Au at • wner / Applicant / Contractor / Agent Date
Bung Department Copy
December 15,2016 1
Miami Shores Village RECEIVED
g NOV 2 3 2016
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
F BC 20( (�--y
BUILDING Master Permit No.-BFPI'o r �
PERMIT APPLICATION Sub Permit No.a Ido- 32-08
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
�LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/l ,� CONTRACTOR DRAWINGS
JOB ADDRESS: �� `to I tL�E ti
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Ciccupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): tboin/100 ' LPhon #:
Address: ��
City: V\_\()M , Stater Zip:
Tenant/Lessee Name: Phone#:
Email: �-S 1r►(1�11 �qvi �,r • (Ory)
CONTRACTOR:Company Name: �� A— F_(2 JL Phone2
Address: p __�`�
City: `�� State: Zip: 3
Qualifier Name: _ � Phone#: _
State Certification or Registration#: �� ercae o
g ��� � ti—Certificate 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 ❑ New epair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ oz� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ DO__Notary$
J�
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 approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CON RACTOR
There ing instrument was acknowledged before me this The foregoing instrument was acl owledged before me this
day of 20�� by _day of-
20—f-P�by
rL I I'>f��,who is personally known to o is personally known to
me or who has produced as m r who has pr duce as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
"pY n�•''4 ANCHEZ
Sign Grp i Sign:
Print: 18 Print: ,' EX i
civics.com 1141
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Seal: IorldflNotaryService,com
aniasn�; Seal:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)