PL-16-2806 t01,
'�" '" � '
1s�, Miami Shores Village yy E3 7 �'iinj Res ,
0 10050 N.E.2nd Avenue NW �
iFIY -Se+
Miami Shores,FL 33138-0000
Phone: (305)795-2204 {rmT#Sf j,
�oR� .fh Expiration: 05/16/2017
Project Address Parcel Number Applicant
162 NW 109 Street 1121360100220
CANOR PATO CARLA GRISONI
Miami Shores, FL 331684317 Block: Lot:
Owner information Address Phone Cell
CANOR PATO CARLA GRISONI 162 NW 109 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
ROSMEL POOL INC (305)592-7900
Total Sq Feet: 0
Type of Work:POOL PIPING Available Inspections:
Type of Piping: Inspection Type:
Additional Info:POOL PIPING Top Out
Bond Return: Final
Classification:Residential Scanning: 1 Water Main
Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee Invoice# PL-10-16-61670
$3.38 11/17/2016 Check#:13631 $ 187.96 $50.00
DCA Fee $3.38
Education Surcharge $0.40 10/17/2016 Check#:13550 $50.00 $0.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $237.96
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated.
November 17,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 17,2016 1
Miami Shores Village CEXN17114:e
Building Department ocr
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201(4
BUILDING Master Permit No.R)PP 10" 7-KCS
PERMIT APPLICATION Sub Permit No. P` f(0- aC)(0
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1(0Z 5't
City: Miami Shores County: Miami Dade zip: l D
Folio/Parcel#:_ 1 S • -7- 1 afc •010 •fes 2= Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):_e-03112192ri R940 Phone#: S•371 •440C:)4q
Address: W u..) 1 a Ci isf
City: t-®1 e i ShO rr 4C.� State: T-L Zip: :b3161
Tenant/Lessee Name: A. Phone#:
Email:
CONTRACTOR:Company Name: :Tchvj� I In C... Phone#: ?aOS•S"9 2.•'19 Ot)
Address: fialpp "%^j 2.S St . { 1
City: fr- et-G1 State: Zip: 31�1
Qualifier Name: _,''� ✓-'fL+�. X/�w-, _I=% Phone#:3C7$•�gZ .�q�p
State Certification or Registration#:_e% -2C-I!T=Ka1 Q4 Certificate of Competency#:
DESIGNER:Architect/Engineer: -fit n 1 p das TP -7,4095i phone#:!fit •2[e,l • ''Z.1
Address "%1s Sidi Ci t'•'1 I aw+i
City: State FL Zip: I-F-S15$
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ /Re lace
Re air
p p El Demolition
Description of Work: pool j
Specify color of color tthru tile:
Submittal Fee$ cJ 0 r
'vy Permit Fee$ �� ® CCF$ 20 CO/CC$
Scanning Fee$ • � Radon Fee$ DBPR$ Notary$
Technology Fee$ Q Training/Education Fee$ J' Double Fee$
Structural Reviews$ 0 Bond$ t
TOTAL FEE NOW DUE$ `
(Revised02/24/2014)
Bonding Company's Name(if applicable) 1�
Bonding Company's Address N
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address 1,J
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.
Signat9m Signature . 2� ®'
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
12 day of 201 -' ,by day of20 Y ,by
who rsonally know o M V'®-V-dcwho is ersonally kno 1 0
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:
!�(� y� Sign:
Print: �i a C�� -,a-z-- Print: �1v-t1 e-2—
Seal: P" ai Seal
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8
APPROVED BY � PlansfExaminer Zoning
° Structural Review Clerk
(Revised02/24/2014)