PL-16-1830Project Address
1551 NE 103 Street
Miami Shores, FL 33138 -
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. PL -6-1 6-1830
Permit Type: Plumbing - Residential
Work Classification: Pool - Private
Permit Status: APPROVED
Issue Date: 11/28/2016
Expiration: 05/27/2017
Parcel Number
1132050310210
Block: Lot:
Applicant
KURT GUSTINGER
Owner Information
Address
Phone
Cell
KURT GUSTINGER
1216 NE 93 ST
MIAMI SHORES FL 33138-2941
(305)751-5554
Contractor(s)
AQUATIC ENVIRONMENTS
Phone
(786)390-9029
CeII Phone
Type of Work: POOL PIPING.
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$3.38
$3.38
$0.20
$225.00
$3.00
$0.80
$236.36
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL -6-16-60410
06/30/2016 Check #: 2969 $ 50.00 $ 186.36
11/28/2016 Check #: 3227 $ 186.36 $ 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, WINDO k OORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing inform �f' J cu - and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, 1 authorize the above- = y'��� •-f - ctor to do the work stated.
November 28, 2016
Authorized Signature: Owner / Applicant / Contr- for / Agent
Building Department Copy
Date
November 28, 2016 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
►UN 3 2016
FBC20(4s
IR
Master Permit No. iw •• • -182
Sub Permit No. • t
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL
❑PLUMBING ❑ MECHANICAL E] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1551 N.E. 103rd Street
City:
Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3205-031-0210 Is the Building Historically Designated: Yes NO X
Occupancy Type: SFR Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Kurt GUStinger
Address: 1551 N.E. 103rd Street
Phone#:
City: Miami ShoresState: FL zip: 33138
Tenant/Lessee Name: NA
Email:
CONTRACTOR: Company Name: Aquatic Environments
Address: 11767 South Dixie Hwy #203
Phone#:
Phone#: 786-390-9029
City: Pinecrest
Qualifier Name: Luis Espinosa
State: FL zip: 33156
Phone#: 786-390-9029
State Certification or Registration #: CPC 057282 Certificate of Competency #:
DESIGNER: Architect/Engineer: TC Engineering Phone#: 305-261-0321
Address:7805 SW 24 Street LL�� City: Miami State: FL Zip: 33155
Value of Work for this Permit: $ 1� .. �� Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Work:
Ta)/-
❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile: 0 �}-
Submittal Fee $ ..-(:)2 3
waPermit Fee $ J2 -i 2� CCF $ i 6 Z/
CO/CC $
Scanning Fee $ 3 Radon Fee $ 3 • 8- DBPR $ 3 .3<3 Notary $
Technology Fee $ . b 0 Training/Education Fee $ • a a Double Fee $
Structural Reviews $ � Bond $
TOTAL FEE NOW DUE$ 13(0.30-
(Revised02/24/2014)
•
Bonding Company's Name (if applicable) NA
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) NA
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. h ' ' ence of such posted notice, the
inspection will not bel approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
?CI(day of1 ',"•� 1
', 20 C. , by day of J-7}.9-- , 20 , by
Kurt Gustinger
'I,
CbNTRACTOR
The foregoing instrument was acknowledged before me this
, who is personal own to
Luis Espinosa
, who is personally known to
me or who has produced as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
i•
APV %/
as
Iebtary Public - State of Florida
•. omm is on
Myr Comm. Expires Dec 13, 2019
ut`'# Bondldthrouph National Notary Assn
,.
************************************************************************************************************
APPROVED BY
(Revised02/24/2014)
Plans Examiner Zoning
Structural Review Clerk