PL-16-2766 4 AD
1.n
Miami Shores Village lulrr� jng,-�ierai _
10050 N.E.2nd Avenue NE tfor087tf� �
Miami Shores,FL 33138-0000
/yypr�pp� ` Phone: (305)795-2204 y t
fiLORIt '
3 6 Expiration: 05/29/2017
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Project Address Parcel Number Applicant
1173 NE 103 Street 1122320310070
Miami Shores, FL 33138-2651 Block: Lot: JAMIE 8 AMY B DEROSA
Owner Information Address Phone Cell
JAMIE S AMY B DEROSA 1173 NE 103 Street (561)699-2428
MIAMI SHORES FL 33138-
1173 NE 103 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
ROSMEL POOL INC (305)592-7900
_.. . _ .._... ..__.. ,..... _... ._ .. ._...,._w ...... a ...._. ,_.. _ ---- Total Sq Feet: 0
Type of Work:POOL PIPING 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 $1.20
DBPR Fee InVOICe# PL-10-16-61624
$3.38 11/30/2016 Check#:13632 $ 187.96 $50.00
DCA Fee $3.38
Education Surcharge $0.40 10/13/2016 Check#:13512 $50.00 $0.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $237.96
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 AFE0AV1_T:"V certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio and zo ' g Futhe authorize the above-named contractor to do the work stated.
' November 30, 2016
ArngDe
ed Signature Owner / Applicant / Contractor / Agent Date
Buil rtment Copy
November 30,201 1
Miami Shores Village
Building Department rC OV'E D
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 OCT 13 2016
Tel:(305)795-2204 Fax:(305)756-8972 _
INSPECTION LINE PHONE NUMBER:(305)762-4949 J�
FBC 2014
BUILDING (waster Permit No � 2965
PERMIT APPLICATION sub Permit No.'FL ((8— 2-q
❑BU DING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: i 1 �7�3 �� 1 mn 5t
City: Miami Shores County: Miami Dade zip: 3 b 1 a s
Folio/Parcel#: 1 1 • Z 20Z, 031 ° ®®-i S_3 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): J ci ww"i -e— —OU q-tse, Phone#: SkO1 °k.9 cli • ZA L6
Address: 1 1-1.-5 "F 10:5 5t
City: M y Qm% S bade S State: L Zip: —*AB 12)'6
Tenant/Lessee Name: t`1 I p+ Phone#:
Email:
CONTRACTOR:Company Name: i2r),5w,e 1 i`�t�15 Phone#: 2S®S'-:S 9®cl,
Address: 1 1 •l3 1. i 1 S't
City: MI pmt 31 1' _S State: 4:L Zip: 2
Qualifier Name: M t 4-t76.vc VC,V-42-1C, Phone#: 2>C:�S° °7•_1 00
State Certification or Registration#: i d4 5 Cy'6®4 Certificate of Competency#:
DESIGNER:Architect/Engineer: e%Q-1" A7F '7402191 Phone#: ZCe 1
e
Address: Sw Z y S $# 1 1 1 City: M cx r n i State:.;:L Zip:
Value of Work for this Permit:$ 'Z,Of)® Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
P
Description of Work: ca P
Specify color of color thru tile:
Submittal Fee$ - QZ� Permit Fee$ ��� CCF$ 1• Z0 CO/CC$ yj
Scanning Fee$ Radon Fee$ '3 DBPR$ 3• 3a Notary$
Technology Fee$ ( G(2) Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ ' C
TOTAL FEE NOW DUE$/V-I• —1.�
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address °�
City
State Zip
Mortgage Lender's Name(if applicable) eJ
Mortgage Lender's Address fV
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 approv nd a reinspection fee will be charged.
Signature
Signature
OWN R or AGENT CONTRACTOR
The foregoing instrument s acknowledged before me this The foregoing instrument was acknowledged before me this
I l day of 20 by % 1 day of �J 1 by
who i ersonally kno to
IM i ti"�'1aya✓Q jGi s er o
me or who has produced
as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print-
Seal: IP�Gt✓e r - n��
Print: a're�®*�
Seal: MARCOSA P ARTNEZ
Or
Seal S w�r,RcOa @�tA NEZ
EyP1REIS i ti
h1YCOP.�\41 SI id FF 008989
L< H o viayth23
APPROVED BY
Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)