PL-17-2689Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
1441 NE 102 Street
Miami Shores, FL
Owner Information
Parcel Number
Permit NO. PL -11-17-2689
Permit Type: Plumbing - Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 11122/2017
Expiration: 05/21/2018
Applicant
Address
1441 NE 102 Street
MIAMI SHORES FL 33138-2621
Phone
CeII
Contractor(s)
DOUGLAS ORR PLUMBING INC
Phone CeII Phone
(305)887-1687 (305)887-1687
Valuation:
Total Sq Feet:
Type of Work: GUEST BATHROOM REPLACE IN SAME LOCA
Type of Piping:
Additional Info: GUEST BATHROOM REPLACE IN SAME LOCA
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
$2.00
$2.00
$0.20
$100.00
$3.00
$0.80
$108.60
Pay Date Pay Type
Invoice # PL -11-17-65631
11/13/2017' Credit Card
11/22/2017 Credit Card
Amt Paid Amt Due
$ 50.00 $ 58.60
$ 58.60 $ 0.00
$ 1,000.00
40
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 ll ork�ill b -Q ne i co pliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-named contrac
Authorized Signature: Owner / Applicant / Contract
Building Department Copy
mber 22, 2017
Date
November 22, 2017 1
{ BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
PLUMBING ❑ MECHANICAL PUBLIC WORKS
a JOB ADDRESS: 1441 NE 102 Street
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
RECEJVE
NOV 13 NV
ci,e
511.1
FBC 2014
Master Permit No. ? C f- 20 I 4
Sub Permit No. Y \ I Z(08 _ I
❑ ROOFING ❑ REVISION ❑ EXTENSION LiRENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#:
11-3205-024-0170
Occupancy Type: Load:
Construction Type:
OWNER: Name (Fee Simple Titleholder): William Howell
Is the Building Historically Designated: Yes NO X
Flood Zone:
BFE: FFE:
Phone#: 305-757-8449
Address:1441 NE 102 Street
City: Miami Shoresstate: Florida
Tenant/Lessee Name: Phone#:
Zip: 33138
Email:
CONTRACTOR: Company Name 1Y U las On( Plum to n9 Ino Phone#: V
301 nIa Iev p�1 e
Address: �r J�, �y,
city: M1 a rfl ii p p/rnn/gy ' State: l (i Zip: not/
Qualifier Name: V Sl 1 1l'� v 1 ► Phone#: O5 p I to
a� 3 �
State Certification or Registration #: CFC 051 tile LI Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Square/Linear'Footage of Work: -4'O S,9
(V alu`e of Work for this Permit$" AtG
1 Type of Work: ❑ Addition ❑ Alteration ❑ New El Repair/Replace ❑ Demolition
Description of Work: Guest Bathroom - Replace in same location plumbing fixtures, ,
a f i Ior D7int re'i'n.. trtehuaiic
Specify color of color thru tile:
Radon Fee $ 2 -
Training/Education Fee $
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Permit Fee $
CCF $ CO/CC $
DBPR $ 2 - Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ og •J
Bonding Company's Name (if applicable) IV la
Bonding Company's Address
City State /� Zip
NMortgage Lender's Name (if applicable) ) a.
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.
Signature
OWRorAGENT
The foregoing instrument w
day of
I l l m
s ac nowledged before me this
,20 1-1 ,by
ho is pe . n.II known to
me or who has produced
identification and who did take an oat
thS NI'j
_,,,cdaiwidymtraum
NOTARY P
Sign:
Print:
Seal:
1pRY P44(i CHANDRA LYNN TAYLOR
* MY COMMISSION t FF 192031
• EXPIRES: March 16, 2019
****************s9rAP******* onded This ***t****Services**************************+******s*s********s******************s***
Signature
CONTRACTOR
The foregoing in.tr.- ment was acknowledged before me this
day of —tt9 Ulf -{ , 20 1 , by
Wayne
, who is personally known to
me or who has produced as
I .
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print:
Seal:
IIh h .' ..1C i1
4 4 / :is. , • 1
r,, ;, M, MONICA AL -
? I MY COMMISSION # GG 005041
►: EXPIRES: October 22. 2020
V"SP:
od..S.; Bonded Thni Notary Public Underwriters
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Structural Review
Zoning
Clerk