PL-16-1796 Permit NO. PL-6-16-1'796
�sO1s i, Miami Shores Village Permit,Type:Plumbing-.Residential
t
10050 N.E.2nd Avenue NE Work Classification:Addition/Alteration
....�+
Miami Shores,FL 33138-0000 1 .
"` Phone: (305)795-2204
Permit Status:APPROVED
�ORtOA
issue Date:7/612016 u' Expiration: 01/02/2017
Project Address Parcel Number Applicant
1420 NE 103 Street 1132050310030
Miami Shores, FL Block: Lot: MARC AND ANNE LITZENBERG
Owner Information Address Phone Cell
MARC AND ANNE LITZENBERG 1420 NE 103 Street
MIAMI SHORES FL 33138-
1420 NE 103 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: =30,000.00PSG PLUMBING SERVICES, INC (305)796-7304
Total Sq Fee
Type of Work:NEW CONSTRUCTION Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning: 1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $18.00
Invoice# PL-6-16-60365
DBPR Fee $15.75
DCA Fee $15.75 07/06/2016 Credit Card $ 1,082.50 $50.00
Education Surcharge $6.00 06/28/2016 Credit Card $50.00 $0.00
Permit Fee $1,050.00
Scanning Fee $3.00
Technology Fee $24.00
Total: $1,132.50
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 cerpfy,that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zon h ermore, I authorize the above-named contractor to do the work stated.
July 06, 2016
Autho zed Signa r' Owner / Applicant / Contractor / Agent Date
Building Department Copy
July 06, 2016 1
Miami Shores Village
j Building Department u 016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax: (305)756-8972 BY
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2011 '31*
BUILDING Master Permit No. C,- 3`JS-5,6
PERMIT APPLICATION Sub Permit No. PLV16- 1796
BUILDING F\I ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: "1 Z f/ �(� l a s S I
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): 1Vt grg, L I fZC. ��'1��j Phone#:
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: v 6 'rli I 6_i426 2C Phone#: '-7W Y
Address: �� /�W 2 S 7-
City:
City: AAS- State: Zip:
Qualifier Name: ���A Q O � � (,J_z/�-G-�ti Phone#:
State Certification or Registration#: r(f U Z6 Zc,'--7 Certificate of Competency#:
;DESIGNER:Architect/Engineer: Phone#:
)'.:Address:
i City: State: Zip:
t Value of Work for this Permit:$ 30,iV Square/Linear Footage of Work:
-Typeof'Work: ❑ Addition ❑ Alteration rNew ❑ Repair/Replace ❑ Demolition
i Description of We ork: /V P r✓ c*,oa 5ujr_t'to r 5 bey-fh/�Y►Z 5 - La1.
- ...... .. r. ^!n:F+iwA�+i ^ w:W w..:rben•WT. lafewvi.'..�.. -wr .\
.Spec_' color pfco/or.thru tile: ..
„..;...
Submittal Fee$ CCF$ CO/CC$��) Permit Fee$ %®�
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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Bonding Company's Name(if applicable)
Bonding Company's Address
. t
CityState Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
r
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) ays after the building permit is issued. In thea en a of such posted notice, the
inspection will not be approved and a reinspectio fee will be charged.
r�
Signature I Signature
i
OWNER_drA6E,NT— �NTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
y day of u ,20 1 U by -Z) day of 20. 1 I x by
�ru\,e k-r� 6-t VL w is personally kno n to ?.c�2� ��z,V�y� h0 is personal) nowtn
me or who has produced as me or who has produced
identification and who did take an oath. identification and who did take an oath.
i
NOTARY PUBLIC: NOTARY PUBLIC:
Signe� �i. Jf' ' M Sign:
•MR.
Print: 0Aaja A.SCAPZQROLIGi•- Print: ,••'�i': n J T 9
�1Y COMMISSIO„a FF 242191 �.: i,81 N N
Seal: ^; EXPIRES:ocimer 18,2019 Seal: -:,tg ai
of R BondedThru Nota 'ublie Underwriters :rw
fl; riters
APPROVED BY Y vr('/ ` Plans Examiner Zoning-
Structural Review Clerk .
(Revised02/24/2014)