PL-17-2308•
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue N
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Parcel Number
Permit NO. PL -9-17-2308
Permit Type: Plumbing - Residential
Work Classification: Gas
Permit Status: APPROVED
Issue Date: 9/27/2017
Expiration: 03/26/2018
Applicant
9290 N BAYSHORE Drive
Miami Shores, FL 33138-
1132050270240
Block: Lot:
RICKI LONDON
Owner Information
Address
9290 N BAYSHORE Drive
MIAMI SHORES FL 33138-2949
9290 N BAYSHORE Drive
MIAMI SHORES FL 33138-2949
Phone
Cell
Contractor(s) Phone CeII Phone
AA MASTERS MECHANICAL AIR MOV (305)244-0667
Valuation:
Total Sq Feet:
$ 1,100.00
0
Type of Work: GAS LINE FOR STOVE AND WATER HEATER
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
$1.20
$2.25
$2.25
$0.40
$150.00
$9.00
$1.60
$166.70
Pay Date Pay Type
Invoice # PL -9-17-65161
09/27/2017 Credit Card
Amt Paid Amt Due
$ 166.70 $ 0.00
Available Inspections:
Inspection Type:
Final
Press Test
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 an z ning. , Futhermo'i?, auttjorize the above-named contractor to do the work stated.
Authorized Signature: Own r Applicant / Contractor / Agent
Building Department Copy
September 27, 2017
Date
September 27, 2017 1
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
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 712017
stiA
FBC 2011
Master Permit No.'C ff)`-�-11 ^
Sub Permit No. PL I 1 Z3 0
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
Q r� n<v) CONTRACTOR
�
JOB ADDRESS: c `L0 of�'t lJ re Pc/11)-e
❑ CANCELLATION
❑ SHOP
DRAWINGS
City: Miami Shores County:
Miami Dade
Zip:
Folio/Parcel#: /1 ` ..O s—O %3- 0 `10 Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone:
BFE:
NO
FFE:
OWNER: Name (Fee Simple Titleholder): .RICt v G%!V Phone#: %—.22.3 —
Address: -C)- 410 AA -Nn c'a4`f f'`e 7>c-cCe_
City: t --{k` t` &M S korr S State: 1:—
Zip: 3/ 31?
Tenant/Lessee Name: Phone#:' —
Email:
CONTRACTOR: Company Name: , 4.4t4S (E cQ 1 eCt/tArNG4 L to Phone#:
S1 1 t— gL)tTE S2�
Address:
City: C S Mt' State:
Qualifier Name: 'FE Cc( (Ix LJ- frA
State Certification or Registration #: t✓ F 14 2 44 1 6 q Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ (I( /CYO Square/Linear Footage of Work:
Phone#:
Zip: 3 G
Type of Work: ❑ Addition ❑ Alteration
Description of Work:
gAs
New ❑ Repair/Replace ❑ Demolition
A(4 CFA c Q.. tt:eT r 2
Specify color o
Submittal Fee $
Scanning Fee $
v!(.9.1 Aaglefi3V
61 thru the 'ista
Catet0 00 I, nraztimmO,i
CCF $ CO/CC $
Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 1(.1(4- .7 0
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.
Signatu e
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
eP ) day of } l— a-1 , 20 f , by .9 C. day of '52P -rt s, -, -f , 20 (1' , by
IZ1cvLl. Lie..--) , who is personally known to T� (��t A-es,1 test e --;who is personally known to
me or who has produced as me or who has produced (--L OL._, as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
454:.
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NOTARY PU
Sign:
Print:
OLIN
VERONICA LEON
Notuy Public - State 01 Floritte
Commission M GG 033197
*****************ass*******s*** r '+*
APPROVED BY
(Revised02/24/2014)
0•4110.--m, — — w 4
Plans Examiner
Zoning
Structural Review Clerk