PW-17-547 es i, Miami Shores Village iii ryeubutpl
10050 N.E.2nd Avenue NE " '{
... M €I crus l�Public
Miami Shores,FL 33138-0000 ' 3
Phone: (305)795-2204 �' `A P
Expiration: 06/06/2017
Project Address Parcel Number Applicant
1551 NE 103 Street 1132050310210
Miami Shores, FL 33138- Block: Lot: MARGARITA DOSAL
Owner Information Address Phone Cell
MARGARITA DOSAL 1551 NE 103 ST
MIAMI SHORES FL 33138-2627
Contractor(s) Phone Cell Phone
TECO PEOPLES GAS SYSTEM 305 957-3857 Valuation: $ 100.00
( ) (305)9701783 '
_.,.,. _ ._•. :::. w.. _,..._......_.tt. Total Sq Feet: 0
Scanning:3 Available Inspections:
Inspection Type:
Final
Excavation
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# PW-3-17-63131
$2.00 03/08/2017 Check#:1293 $ 114.60 $0.00
DCA Fee $2.00
Education Surcharge $0.20
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $114.60
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 nd in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this p t I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for EL T ICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFI AV I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction an ing. Futhermore,I authorize the above-named contractor to do the work stated.
�, March 08, 2017
ut ze nature:Owner / Applicant Contractor / Agent Date
Building Department Copy
March 08,2017 1
Miami Shores Village RECEIVED
Building Department MAR 02 2017
10050 N.E.2nd Avenue,Miami Shores,Florida 33138r
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 5
FBC 20M
BUILDING Master Permit No. ?'--,j l 4F4�
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1551 NE 103rd ST.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): RIGHT OF WAY Phone#:
Address:
City: State Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: TECO PEOPLES GAS Phone#: 954-453-0806
Address: 5101 NW 21 AVE. STE. 460
City: FT. LAUDERDALE State: FL Zip: 33309
Qualifier Name: JESUS VEGA Phone#: 954-453-0806
State Certification or Registration#: E1608 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 1000 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition
Description of Work: INSTALL A NEW 3/4" PLASTIC GAS SERVICE
'T® '2f�.�i� �x?ja--r_P IRo2ml'dlaw
�4o --- t 15 Z
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ no CCF$ e (0 CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ o Training/Education Fee$ ' Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ I I
(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 CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,20 by -i day of W AY-G L-t— 20 1? by
who is personally known to r b titi. A who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification nd ho did take ap oft
NOTARY PUBLIC: NOTARY P LIC: k 'FGB, HUBER i NUNEZ
C? ` _ Notary Public-State of Florida .,
�„ E My Comm. Expires Sep 11,2017 1
.: t ommission # FF 04367 '
Sign: Si n pry tt pn
i
Print: Print:
pF�,,, HUf3EH y NUNEZ �I.
Seal: Seal: 4R I,wY Public-State of Florid
My Comm, Expires Sep 11,201!
Cornmission # FF 04367=;
f
APPROVED BY vV " �' Glans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)