PL-17-921Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
1022 NE 91 Terrace
Miami Shores, FL
Owner Information
JENNIFER JORDAN
Permit
Permit NO. PL -4-17-921
Permit Type: Plumbing - Residential
Work Classification: Addition/Alteration
Pennit Status: APPROVED
Issue Date: 41712017
Expiration: 10/04/2017
Parcel Number
Applicant
Address
1132050010300
Block: Lot:
1022 NE 91 Terrace
MIAMI SHORES FL 33138-
JENNIFER JORDAN
Contractor(s)
EH WHITSON PLUMBING
Phone
954-929-3599
CeII Phone
Phone
(386)986-9440
Cell
Valuation:
Total Sq Feet:
$ 2,178.00
0
Type of Work: INSTALL KITCHEN SINK AND DISH WASHE
Type of Piping:
Additional Info:
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
$2.25
$2.25
$0.60
$150.00
$9.00
$2.40
$168.30
Pay Date Pay Type
Invoice # PL -4-17-63562
04/07/2017 Credit Card
04/04/2017 Check #: 397
Amt Paid Amt Due
$ 118.30 $ 50.00
$ 50.00 $ 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 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.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
April 07, 2017
Date
April 07, 2017
1
BUILDING
PERMIT APPLICATION
E BUILDING El ELECTRIC
EI PLUMBING 0 MECHANICAL
JOB ADDRESS: 1022 NE 91 Terrace
Miami Shores Village
Building Department
10050 N.E 2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION UNE PHONE NUMBER: (305) 762-4949
Ej ROOFING
0 PUBLIC WORKS
RECEIVED
APR 0 4 2017
S -h
FBC 20 NI
Master Permit No, Na C -
Sub Permit No. Q 1
E REVISION
El EXTENSION E RENEWAL
n CHANGE OF El CANCELLATION 0 SHOP
CONTRACTOR DRAWINGS
City: Miami Shores
County:
Miami Dade Zip:
11-3205-001-0300
Follo/Parce14;
Occupancy Type: Load:
Construction Type:
OWNER: Name (Fee Simple Titleho)der): Jennifer Jordan
Address: 1022 NE 91 Terrace
Is the Building Historicalty Designated: Yes NO
Flood Zone: BFE: FFE:
Phone*:
City: Miami Shores
Tenant/Lessee Name:
Email:
State: FL
Phone#:
Zip: 33138
CONTRACTOR: Company Name: E • H. Whitson Plumbing
Address: 423 South 21 Avenue
Phone#: 954-929-3599
city, Hollywood
Qualifier Name: John Lipka
State: FL zip: 33020
Phone#:
State Certification or Registration #: CFC1425789 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
Phone#:
City: State:
-r-4V4 2t.4uare/Linear Footage of Work:
Value of Work for this Permit: $ 217.8M°
Type of Work: Fl Addition El Alteration LI New 1I Repair/Replace El Demolition
Zip:
Description of Work; Install new shower pan and drain line,water line and steam line for future steam
unit
ceplicicg P 1 - - 1,-500
Specify color of color thru tile:
Submittal Fee $ Permit Fee 5 /5 CCF $
Scanning Fee $ Radon Fee 5 OBPR
Technology Fee 5 Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL. FEE NOW DUE $ B •30
CO/CC $
Notary $
fRevised02/24/2014)
1
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 ;7J days after the building permit is issued. In the absence of such posted notice the
inspection will not be approved.-. :. -' .spection fee will be charged.
it v
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of (, lo , 20 , by
rdClwho is�personally �known to
me or who has producedP� t3 204Su (D24P
identification and who did take an oath.
NOTARY PUBLIC:
r
Signature
The foregoing "i strument was acknowledged before me this
A/
me or who has produced
,20 ( j ,by
whd is personally known to
identification and who did take an oath.
Sign:
Print:
Seal:
om. MY COMMISSION # GG 044602
z EXPIRES: November 2, 2020
Bonded Thru Notary Public Underwriters
Sign
Print:
Seal:
**$4*********$****4*$****$*4*************i*******s$*******,***,****************$4**************i***,.***M***
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Structural Review
Zoning
Clerk