RC-16-1820 (3) Permit NO. PL-6?-1 6-1 822
Miami Shores Village Permit Type:Plumbing-Residential
10050 N.E.2nd Avenue NE Work Classification:Addition/Alteration
Miami Shores,FL 33138-0000 Per 1"tPermit Status:APPROVED
Phone: (305)795 2204
F�OR�DA
Issue nate: 12120/2016 Expiration: 06/18/2017
Project Address Parcel Number Applicant
138 NE 106 Street 1121360050050
Miami Shores, FL 33138- Block: Lot: COREY MANION JTRS
Owner Information Address Phone Cell
COREY MANION JTRS 138 NW 106 Street
MIAMI SHORES FL 33138-
138 NW 106 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,700.00
DEL RIO&SON PLUMBING CORP (786)295-0098
___ _................._..... . ..._ __._____. _� Total Sq Feet: 0
Type of Work:PLUMBING FOR NEW BATHROOM(ONE TOIL 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 $1.20
DBPR Fee Invoice# PL-6-16-60402
$3.38 12/20/2016 Check#: 132 $237.96 $0.00
DCA Fee $3.38
Education Surcharge $0.40
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 assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTR L,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDA I : 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 ' g. Futh more, I authorize the above-named contractor to do the work stated.
December 20, 2016
Autho d Signature:Owner / Applicant / Contractor / Agent ate
Building epartment Copy
December 20, 2016 1
Miami Shores Village FBY
rVFlr3
Building Department 0 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 T
FBC 20 1 q
BUILDING Master Permit No. G
PERMIT APPLICATION Sub Permit No. u(o- I �122-
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
''PLUMBING ❑ MECHANICAL [—]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 0 co
0
SA—
City: Miami Shores County: Miami Dade Zip: 3
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: //'' Construction Type: Flood Zone: BFE: Cf FFE:
OWNER:Name(Fee Simple Titleholder): Ca I a��n Phone#:
Address: V L
City: 1 QVM1 r �5 State: r Zip: �I a
Tenant/Lessee Name: Phone#: �d/' 3�1
Email:
CONTRACTOR:Company Name: uM Phone#:G��>2�S (DO U
Address: bcka SU-3
City: State: Zip: 3 7) .,
�, 1 .s� � ,
Qualifier Name: Phone#:
State Certification or Registration#: �'�L 4 2 l LCertificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ / 7e o•0 U Square/Linear Footage of Work:
Type of Work: ❑ Addition ,\ `❑ Alteration ❑ New F-1 Repair/Replace ❑ Demolition
Description of Work: 1 5� � 6k7,0 l�—& 1 b�C2 lS1a-c._
s\/�O-JD.�-
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ , CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$_
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 2 �J
(Revised02/24/2014)
n
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will n e ap roved and a reinspection fee will be charged.
Signature �1 Signature
OWNER or AGENT C 0�{y 1'�Gnr,ly► CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
07 day of U,W-t 20 41b by �2 7 day of JO r7 E- 20 16 by
U� ahlu 0 who is personally known to '-�Ie 11R,U ,who is personally known to
me or who has produced "'' (Ol$
p as me or who has produced 9 3G/-pas
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC-
Sign:
Print: Lf� .a Print: ai ¢ Uzo esu
Seal: Seal: MMTE ORO P'E$A
AM Notary Public State of Florida MY COMMIS
SlOH M"017372
0 . Michael Robert Jaar g MREs:1+�t3,iot7
My Commission EE 831947 or
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APPROVED BY ! Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)