PL-17-208 Permit-No. PLA-17-208
�st!O1s y,� Miami Shores Village Permit Type:Plumbing-Residential
10050 N.E.2nd Avenue NE
, ► " r Work Classification:Addifiion/Alfieratit3n
" - Miami Shores,FL 33138 0000 PeIt
Permit Status:APPROVED
'-' '�` Phone: (305)795-2204
F[ORLDp'
tssueDate:2121/2017 Expiration: 08/20/2017
Project Address Parcel Number Applicant
1450 NE 103 Street 1132050310040
Miami Shores, FL 33138-2626 Block: Lot: VIKTORINEX, LLC
Owner Information Address Phone Cell
VIKTORINEX, LLC 1931 CORDOVA RD Road (305)647-6486
FT. LAUDERDALE FL
Contractor(s) Phone Cell Phone
Valuation: $ 17,130.00
BENJAMIN FRANKLIN PLUMBING- (305)335-7812
W
.�__ . Total Scl Feet: 0
Type of Work:PLUMBING AS PER PLANS>ALL PLUMBIN Available Inspections:
Type of Piping: Inspection Type:
Additional Info:PLUMBING AS PER PLANS>ALL PLUMBIN Top Out
Bond Return: Final
Classification:Residential Scanning: 1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $10.80
Invoice# PL-1-17-62734
DBPR Fee $8.99
DCA Fee $8.99 02/21/2017 Check#:407 $ 1,198.88 $50.00
Education Surcharge $3.60 01/26/2017 Check#:8300 $50.00 $0.00
Permit Fee $599.55
Scanning Fee $3.00
Technology Fee $14.40
Work without Permit Fee $599.55
Total: $1,248.88
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 ELE RICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS, ROOFING and SWIMMING POOL work.
OWNERS AF ID IT: I certify that all oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction nd z ning. Futhermore, uthorize the above-named contractor to do the work stated.
v
February 21, 2017
Au th d Signature / Applicant / Contractor / Date
Buildi Depaftffient Copy
February 21, 2017 1
1 Miami Shores Village RECEIVEf
Building Department OCT 12 ton
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 201(J
BUILDING Master Permit No. P—C �b -
PERMIT APPLICATION Sub Permit No. P I 1-=1 ' 2
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL "❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1450 NE 103 Street
City' Miami Shores County: Miami Dade Zip:
'Folio/Parcel#: )Z C),5 -Q�3 ( - 00A40 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFEE:
OWNER:Name(Fee Simple Titleholder): Py✓i r L �`..� . Phone#:— % > `10 o� '
Address:
City: �'�1\ �'�`^- 'D 6c,rG5 State: T Zip: 3 3t':�2
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: G&L Plumbing Service Inc Phone#: 105-316-56C14
Address: 13957 W 140 s reet
City: Miami State: FL Zip: 33186
Qualifier Name: Floy Arriera Phone#:
State Certification or Registration#: �—(" L 0567k-056 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for t 's Permit:$ �, `- Square/Linear Footage of Work:
Type of Work: 1z Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
L,Desc p n AWoX — ' �j c ��em. y'P L-- c � eyJ L c
h1PQ�� (�Clrfl a✓ ow t�
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ �� ' Q CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$ `Io
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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.
li�ijSignature Signature
OWNER or AGENT j CONTRACTOR
T foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
1 day of QC4 _�,20 ' hY 1 t7t day of Oli ! 20��by
I CO2i V }-t.T1Q,►vvPlo�if pe4�oha k o to Eloy Arriera _ ,who is p`e�rsonally known to �
me or who has produced ',�` me or who has produced 1�O��('d �tU' 1
identification and who did take an oath. identificatio an who did take an oath.
NO RY PUBLIC: NOTARY PU LIC:
Sig Sign:
Print: Print:
�� :_ MANARAI K.GONZALEZ *v �0.0.Y P
Seal: 3MY COMMISSION#GG 044602 Seal: ELWRAIOPEZ
EXPIRES:November 2,2020 t MY COMMISSION t FF 072394
"'•f°%;;°•'' Bonded 7Tuu Notary Public Underwriters EXPIRES:Match 21,2018
BondedTtnBudgetNotaryServices
************************************************************************************************************
APPROVED BY !y Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
12 UREDN[ZAZNAMY/PAGE RESERVED FOR ISSUING AUTHORITIES/
PAGE RESERVfE AUX AUTORITES COMPETENTES POUR DELIVRER '
LE PASSEPORT
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CESTOVNi PAS/PASSPORT/PASSEPORT CESKA REPUBLIKA/CZECH REPUBLIC/REPUBLIQUE TCHEQUE
TYP/TYPE/TYPE KOD/CODE/CODE � CISLO PASU/PASSPORT NO./PASSEPORT NO
P CZE tM 41925293
01 PRQMENVSURNAME/NOM
MIROVA
021MENO/GIVEN NAMES/PRENOM
PETRA
03 STATNI OB�AF1SfVl/NATIONALITY/NATIONALITE
I.N CESKA REPUBLIKA/CZECH REPUBLIC
04 DATUM NAROZENI/DATE OF BIRTH/DATE DE NAISSANCE 11 RODNE CISLO/PERSONAL NOlNO PERSONNEL
23.09.1980 805923/5074
06 MISFO NAROZENI/PIACE OF BIRTH/LIEU DE NAISSANCE 05 POHIAVI/SEX/SEXE
KARVINA F
«w' 07 DATUM VYDANI/DATE OF ISSUE/DATE DE DELIVRANCE 08 PIATNOST DO/DATE OF EXPIRY/DATE D'EXPIRATION
A 16.04.2014 16.04.2024
b9'MWbAv"THORITY/AUTORIiE 10 PODPISDR21TELE
MeU ORLOVA HOLDER'S SIGNATURE
SIGNATURE DU HrulAIRE
P<C Z EM I ROVA<<PET RA«««««««««««««
41925293<3CZE8009238F24041 638059235074««30
t
5NoRFs pf Miami Shores Village
<< Building Department
£ �n 10050 N.E. 2ND Avenue
logo "— ������ Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OR11D
Change of Contractor/Architect or Engineer
A change of contractor, architect or engineer must be done under a permit number. There is a $75.00 charge
for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized
signatures. If the signature of the previous contractor cannot be obtained the owner must send a certified
letter/return receipt notifying the previous contractor, architect or engineer the reason for the change. The
owner must allow 10 business days for the contractor, architect or engineer to respond. A permit application
must accompany the change of contractor form, with the information and signature of the new
contractor. The new contractor must be registered with the Village or must submit the required documents
to register with the Village.
1. Change of Contractor form completed, signed and notarized.
2. Permit application by new contractor. r
3! Required fees.
4. Copy of original letter sent via certified mail along with the returned receipt.
In addition to the requirements above the architect or engineer of record must authorized the new architect
or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed.
1.
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SgORFS GI
Miami shores Village
N.N. oil 1.1..1"
�- - Building Department
�toR11D 10050 N.E.2nd Avenue
Miami Shores, Florida 33138 a.
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Permit N. FL l G-208
Owner's Name (Fee Simple Title Holder): VI KiUp21 Nr X/LLL,/P/yl—}IUPhone#: -09 . S3 }. 900 Q
Owner's Address: I`-I Sa N i- 10 3 Saz(-r:-,T-
city:
`ICity: H 14"1 410 State : FL Zip Code: Z11 3
Job Address (Of where work is being done): P-16-0 N 10 's S512.G E f
City: Miami Shores State:—Florida Zip Code:
Contractor's Company Name: N,�A M IN FQ/ wV-L I NI Phone#: SIDS' SSS' J-81 v
Address: �b9 Y6 cS�EP10/�N Si
City: EL, Lj-k A Dnaz\� State: Zip Code: 33`3 32,
Qualifier's Name-: _IZO 6gr+() S -To -Irl Lic. Number: C FC l y c2 8 8 q_
Architect/ Engineer of Record Name: Phone#:
Address:
City: State: Zip Code:
Describe Work: 04��X4 CovL&a rj-or
I .hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to complete the contract. 1 hold the Building Official and the
Miami S ores harmless of all legal i olvement.
Signature Signature
Owner or Agent Contractor or Arc itect I
The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged before me
this 2-01day of A (,20 rl,byYIWY L1 L this nth day of C4-nb , 2011 by P4fri V ?0j-q
Who is personally known to (me or who has produced who is personally 'known to me or who has produced
tO`J" �0i6 indentification. �'r1�/Pf U C`er e_ as indentification.
i
Notary Public: Notary iC
Sign:
CECIL MARIE GARCIA
Seal: ?� Notary Ouslh-State of
Fl(
Commisslon#F GG 032881 i' •. YANADYPRIETO
A', M Comm. Expires Sep 30,2020 MY COMMISSION#FF214031
a•, a: EXPIRES:March 25,2019
BondedthruughNannnalNota'y4ssn. ? ••� d.' gondedThtuNotary Public Undenrrters
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