PL-17-2769 Perm,t,NO. P'L-11-17-2769
Asx°REs Miami Shores Village Pennit'Type:Plumbing-Residential
�i• 10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 "
a rn*l WorlcClassitication:Addition/Alteration
Permit Status:APPROVED
Phone: (305)795-2204
[ORADp
Issue Date:2/5/2018 Expiration: 08/04/2018
Project Address Parcel Number Applicant
107 NE 91 Street 1132060133300
Miami Shores, FL 33138- Block: Lot: SAM SZABLA
Owner Information Address Phone Cell
SAM SZABLA 107 NE 91 Street (305)781-5895
MIAMI SHORES FL 33018-
107 NE 91 Street
MIAMI SHORES FL 33018-
Contractor(s) Phone Cell Phone Valuation: $ 1,800.00
QUINTERO GENERAL CONSTRUCTIO (786)487-5738 Total Sq Feet: 0
Type of Work:GUEST HOUSE BATHROOM Available Inspections:
Type of Piping: Inspection Type:
Additional Info:GUEST HOUSE BATHROOM Top Out
Bond Return: Final
Classification:Residential Scanning: 1 Review Plumbing
Underground
{
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
Invoice# PL-1417-65719
DBPR Fee $3.38 02/05/2018 Credit Card $ 186.83 $50.00
DCA Fee $2.25
Education Surcharge $0.40 11/21/2017 Credit Card $50.00 $0.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $236.83
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Fut rmore,I authorize the above-named contractor to do the work stated.
February 05, 2018
I Authoriza Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
February 05, 2018 1
Miami Shores Village ;P:
Building Department NOV 2017D
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2011—
,BUILDING
01`.BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No. `Z .
F-1 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /0 N, g� sr
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): S��"1 5 Z�O��`f Phone#: ,Z -)'$/-Tn S
Address: ,,/� �/ 9'l S f
City: State: Zip: 33 0 1
Tenant/Lessee Name: // Phone#:
Email: 54,-t ® S;4" 72A 6/.4 .",-1
CONTRACTOR:Company Name: �fa 68.j2 -C COJ f& 4�Phone#:
Address: ////8�0
'City: Wl%, c.S State: f't Zip: 3201 Y
`Qualifier Name: ��e�� d 0 ai`.) Phone#: �G
State Certification or Registration#: CFC 1q2 5f 3 Certificate of Competency#:
'DESIGNER:Architect/Engineer: Phone#:
;Address: ' 9 City: State: Zip:
Value of Work for this Permit:$ <�goo - a Square/Linear Footage of Work: �� Cd Seia✓10EJ
•Type'of Work: ❑ Addition ❑ Alteration
❑ New Repair/Replace E-1 Demolition
`Description of Work: ae 1 r,4v AagAy O k-4 1- Aewte 16
L 01
ties Phi �v.�cc- ot
�.✓ .a�t 7 s e s gD L�
6.41�12� C o /��C Av j Acaye lura �� �ico.�c :a,�o�'s�i�✓9 ,�Ocp .
-Specify color of color thru tile:
rl-NA
Submittal Fee$ i Permit Fee$ _ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ �--• 2-� DBPR$ *3* '7el Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 186
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
t
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.
r
a
"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 atthment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection whit ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not pr ve and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The forein instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
2-0day of �Ov�P+•v`vZti, 20 /3- by 'ZO day of 0oue'(06Gr 20 [7 , by
5.4*ut 157--Z7-4 who<pe:rso=nallyknow] o l�erncf�do G)JJtn4'-0 who is personally known to
me or who has produced as me or who has produced 18`5 clrw" as
identification and who did take an oath. identification and who did take an qath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sion: Sign:
Print: ti Print: State of Florida
° Commission#GG 119484
Seal: ,•tJayPo'•,, MARIJAIR RAVELO Seal: '-9rE d�°�� M Comm.Ex ares Jun 27,2021'
Ll-tv-�
e : Notary PublicState of Florida ' oFF� , y DCommission#FF 206163
My Comm.E;apires May 5,2019
100► ii�afihNa*ry 1v,
APPROVED BY P r Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)