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PL-17-1701 Permit NO. PL-6-17-1701 mt Petmit Type:Plumbing-Residential Miami Shores Village 'Perill 1oosuw.s.2nd Avenue mE Miami Shores,FLoo1o8-0000 Pefmit Status:APPROVED Phone: (305)79*2204 issue Date: 711212017 [ Expirati on: 01/0812018 ' Project Address Parcel Number Applicant 0929 NE 4 Avenue Road 1132060171280 MARVIN R LIST&MARIA T MAN Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell MARVIN R LIST&MARIA T MANERBA 9929 NE 4 AVE Road (305)858-0204 MIAMI SHORES FL 33138 9929 NE 4 AVE Road MIAMI SHORES FL33138' Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 PSG PLUMBING SERVICES, INC (305)796-7304 Total Sq Feet: Type of Work:WATER AND DRAIN LINE TO OUTSIDE SIN | m | Type of Piping: Inspection Type: Additional Info:WATER AND DRAIN LINE TO OUTSIDE SIN Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Annt Paid Arnt Due CCF $1.20 Invoice# PL-6-17-64456 DCA Fee $2.25 Education Surcharge $0.40 06/30/2017 Credit Card $50.00 $0.00Permit Fee $150.00 / Scanning Fee $3.00 Technology Fee $1.60 " ' In consideration of the issuance to mo of this permit, | agree to perform the work ov"oreu 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 n | assume responsibility for all work done uveither myself, my 000m, servants, or employes. | understand that separate n*nnua are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS, ROOFING and SWIMMING POOL work. ovvwERe*FF| foregoing movnnanvn is oonu,oto and that all work will be done in compliance with on oppnoomo laws mou|onnu cvnvtmct' mo,izomoabove-named oontnoomrmuvmo*wmm000u. ~�_-- July 12 2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department� �� n��Un�U�� n��n �� ~~�� ' _° .- n-� i ,�'"• �` A,�0.'V AiL AAV\ Miami Shores Village Building Department JUN 02017 10050 N.E.2r d Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 ' BUILDING Master Permit No. R�. Z ' 1-7 r2S?q PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 19firlu M B I N G ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ! -12 ! !y L t-f 7Lk JVC- City: Miami Shores County: Miami Dade zip: 33/3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: i OWNER: Name(Fee Simple Titleholder): )( W-flTy r x/ L-T / Phone#:y Address: K !n.29 ,ar 417/k City:_1611,q !:n i S ho c cC State:A E�z Zip: x 3 3 13� Tenant/Lessee Name: Phone#:)( Email: �t / �^ CONTRACTOR:Company Name:l7/-c P/V)n9 4 J Iki c�V ICtS A/ Phone#: ')A-56 g�� Address: 3�'z " � S City: O p,PLL-l1 k 4- State: Zip: ©5 t{ Qualifier Name: 'pccGc-o Se tlf-o i tgU2- Vy A 10 Phone#:�� State Certification or Registration#:r FC'�/ CJ2 <a 5-7 Certificate of Competency#: DESIGNER:Architect/Engineer: - Phone#: Address: City: State: Zip: Value of Work for this Permit:$ , Square/Linear Footage of Work: Type of Work: ❑ Addition [ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Descriptionof Wo k: CA _. .. f b0063 to W,*?.ailCuq q+r1014M1011 W Wall, !b Ot1SQE 1i V6noi2alm°llo� • �c�e • = %,», p.tn.SS tuL 291iQX3.mrio1 VM e 1 OS,SS 11%2911gx3. ..�:v� _• `.;�+�,w e•,` 11W.yr f!1l isnoi±cN lSuoxti Wiling Specify c for o mol" ``' ", ° ' I � Submittal Fee$ J 1 Permit Fee$ �� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ II TOTAL FEE NOW DUE$ i lo (Revised02/24/2014) 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. PSignature ( Signature 01 VNER or AGENT C NTRACTOR r The foregoing instrument was acknowledged before me this Afegoing instrument was acknowledged before me thisa9 !' day of J u iC�L 20 1- by day of J U RI r— ,20 17 by r.,4� s/•SJ- who is personally known to Ano" ZYn�^�� who its personally known to me or who has produced F-1 b4- as me or who has produced P L as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ` ui5 PRIETO Sign: Notary Public- e Print: JOSE L Print: Nov 4 le- t s - I` :N ommisslort#�FF 902710 My Comm.Expires Jul 22,2019 -. Seal: °,;,; •' Bonded through National Notary Assn. Seal: ) + a F` � My Comm.Expires Jul 22,2019 '��"• Banded through National Notary Assn. i r APPROVED BY /` 7 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) j