PL-17-575Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Pe NO: PL. -3-17-5 2
�e,mlt hype Plumbing - Rester►,
r Ctaua on A,+ddititAltttion
Pitt Status:, APPROVED
Parcel Number
Expiration: 09/16/2017
Applicant
173 NE 107 Street
Miami Shores, FL
1121360070310
Block: Lot:
Lauren Rangel
Owner Information
Address
Phone
CeII
Lauren Rangel
173 NE 107 Street
Miami Shores FL 33138-
173 NE 107 Street
Miami Shores FL 33138-
Contractor(s)
PSG PLUMBING SERVICES, INC
Phone CeII Phone
(305)796-7304
Valuation:
Total Sq Feet:
$ 3,000.00
0
Type of Work: REDESIGN BATHROOM AS PER APPROVED P
Type of Piping:
Additional Info: REDESIGN BATHROOM AS PER APPROVED P
Bond Return :
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$3.38
$3.38
$0.60
$225.00
$9.00
$2.40
$245.56
Pay Date Pay Type
Invoice # PL -3-17-63181
03/06/2017 Credit Card
03/20/2017 Credit Card
Amt Paid Amt Due
$ 50.00 $ 195.56
$ 195.56 $ 0.00
Available Inspections:
Inspection Type:
Top Out
Final
Review Plumbing
Underground
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 ELECTRI -�L BING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AF �; � �•
construct' ermore, authorize the above-named contractor to do the work stated
certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
1 ilk
n.� . 1 1
March 20, 2017
A thorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
March 20, 2017 1
BUILDING
PERMIT APPLICATION
Miami Shores Village
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
FBC 201q
Master Permit No. 'R C - \ e `"I�i
z
P
Sub Permit No. 1 " 5R -2 --
EXTENSION ❑RENEWAL
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION
PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: k 3 ` k� I 0
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores County: Miami Dade
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Typ 1? Load: Construction Type: Flood Zone: BFE: FFE:
Zip: 4i-14 5 331b
OWNER: Name (Fee Simple Titl oe#: Z% -)183- 51$
Address:
City: 0CLCA-i l E ko r6'4 State: zip: 331Fv 1
113 tO1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 75C,Y PCS t '01 St sU crt-S Phone#:
Address:
$l -C) 4.15" s-1,
City: P L -O State: l;y �lr►i�1� i�
Qualifier Name: ?ed tU 'A` )
State Certification or Registration #: 1 L-(2. t D- S 7 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Zip:
Phone#:
Address:
Value of Work for this Permit: $ 3/61,90 Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace
Description of Work: eRe tt--Fs °e
c V 1 vO 61--c-3 La
City: State: '— Zip:
n Demolition
Specify co • r of color thru tile:
Submittal Fee Permit Fee $ 6CCF $ CO/CC $
Scanning Fee . ^t- --ak•--1,Raxiomfee4 DBPR $ Notary $
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $
Technology Fee $
Structural Reviews $
(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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the agsence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
J' Signature 1ij ' / / Signature
OWNER 1
)
The foregoing instrument was cknowledged before me this The fore L
eta day of l ei1j ,20 ,1 ,by
('eV' (C 40 , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBUC:
Sign:
Print:
Seal:
41: ;°Bi,0 MY coca ISS oNN # FF1189027
* EXPIRES: March 16,2019
d4,$ 0.09P Bonded Thru Budget Notify Serves
g instrument wa . nowledged before me this
Ci day of , 20 (7 , by
'rJ-v •42iz who is personally known to
me or who has produced .4-d e._• J� Ls as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 3"8se• L- I Ps -d r e�
Seal:
************************************************************
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Structural Review
., JOSE LUIS PRIETO
'L Notary Public - State of Florida
• . 1 CtommissCi7onnf r# FF 902710 tg
NeJAMAJA
,,nnBanded through National Notary Assn.
�na
Zoning
Clerk