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PL-16-2680Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -9-16-2680 Permit Type: Plumbing - Residential Wm Classification: Pool - Private Permit Status: APPROVED Issue Date: 10128/2016 Expiration: 04/26/2017 Parcel Number Applicant 253 NE 101 Street Miami Shores, FL 33138-2422 1132060134800 Block: Lot: RICARDO J POL JTRS BERNARI Owner Information Address Phone Cell RICARDO J POL JTRS BERNARDO J 253 NE 101 Street MIAMI SHORES FL 33138- 253 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone FLORIDA POOL PATIO CORP (305)815-0181 Valuation: Total Sq Feet: $ 1,500.00 0 Type of Work: POOL PLUMBING Type of Piping: Additional Info: POOL PLUMBING Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $3.38 $3.38 $0.40 $225.00 $3.00 $1.60 $237.96 Pay Date Pay Type Invoice # PL -9-16-61525 10/28/2016 Check #: 7566 09/29/2016 Credit Card Amt Paid Amt Due $ 187.96 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Main Drain Final Rough Review Plumbing 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. October 28, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date October 28, 2016 1 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 RECEIVED SEP 2 9 7.(1'=5 QQFBC 20 BUILDING Master Permit No. ✓PP - 4q PERMIT APPLICATION Sub Permit No. Q I l "Z(D 75 0 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ®PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Z53 /1/E-- /0/ 5/ City: Miami Shores County: Miami Dade Zip: T 3 / Z' Folio/Parcel#: N �✓ ZO6 7/) VS !) Is the Building Historically Designated: Yes NO x Occupancy Type: Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): /2/ e&/'ch ,P®/ Phone#: Address: ZS 3 /06 /e/ FFE: city: /1�,-ii State: Zip: 3 3 %3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: AG 77 4 Phone#: Address: � ?e;'/ Old / City: State: Zip: 3.3/-1 C.-- Qualifier Name: ieeiie,vate; Gaal D Phone#: State Certification or Registration #: � /57 8 Z Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ /L Type of Work: ❑ Addition n Alteratiion Description of Work: ABS// sge mil Square/Linear Footage of Work: New ❑ Repair/Replace ❑ Demolition 4", 1 Specify color of color'thru tile' • Submittal Fee $ Permit Fee $ CCF $ I• 2© CO/CC $� Scanning Fee $ . Radon Fee $ 3 • 38' DBPR $ '• .56 Notary $ O Technology Fee $ G,Training/Education Fee $ Double Fee $ Structural Reviews $ - Bond $ Q (Ravicedro/74/7n141 TOTAL FEE NOW DUE $ l� 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 $25, t00 he a•.Iicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure ytilr deliver-: to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencerne t must be •.sted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence o uch posted notice, the inspection will not be approved and a reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this ef C MEM "V //j� , 20 1. by f(MEM "V , who is personally known to Signature CONTRACTOR The f. -going instrument was acknowledged before me this er:27 day of /fid 4t ' , who is personally known to as , 20 /0 , by me or who has produced as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: —7 Print: identification and who did take an oath. NOTARY PUBLIC: Sign: ..� Print: � •,:r°�:=^.��,��r�— _; '• •nom 1 X11 1 1 1 I �� ; • - Commission # FF 245464 otary Public . S IRO Seal: _ _ Seal: • "r! �' �; � Commission tate o/Florida ,F My Comm. Expires Jun 30, 2019 oFF�da;°•'�` My Co n # FF 245464 nil l Bonded through National Notary Assn. '^I�"• wedExpires Jun 30, Through National Notary q ., PV �•� APPROVED BY (0asfie nein" /1n /,n1 AI JG /4i Plans Examiner Zoning Structural Review Clerk