PL-18-1049Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. PL-4-18-1 049
Petrnit Type: Plumbing - Residential
Work Classification: Gas
Permit Status: APPROVED
Issue Date: 5/15/2018
Expiration: 11/11/2018
Parcel Number
Applicant
544 NE 106 Street
Miami Shores, FL 33138-
1122310140200
Block: Lot:
LEISA & MICHAEL WILLIAMS
Owner Information
Address
Phone
Cell
LEISA & MICHAEL WILLIAMS
544 NE 106 ST
MIAMI SHORES FL 33138-2046
Contractor(s)
FOREVER GAS CORP
Phone
(305)298-0193
CeII Phone
Valuation:
Total Sq Feet:
$ 1,700.00
75
Type of Work: INSTALLATION OF GALVANIZED 1 PIPE L
Type of Piping:
Additional Info: INSTALLATION OF GALVANIZED 1 PIPE L
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$2.25
$2.00
$0.40
$150.00
$3.00
$1.60
$160.45
Pay Date
Invoice #
04/20/2018
05/15/2018
Pay Type
PL-4-18-67237
Credit Card
Check #: 1729
Amt Paid Amt Due
$ 50.00 $ 110.45
$ 110.45 $ 0.00
Available Inspections:
Inspection Type:
Final
Press Test
Review Plumbing
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.
AVIT: I -rtiforegoing information is accurate and that all work will be done in compliance with all applicable laws regulating
zoning. uthetmor 1 a thorize the above -named contractor to do the work stated.
Authorized Signature: Owner
/ Applicant /
Contractor / Agent
May 15, 2018
Date
Building Department Copy
May 15, 2018 1
OWNER: Name (Fee Simple Titleholder):
Address: t...471q , QC / 0 L
/ dyri,,$
Value of Work for this Permit: $
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
RECEIVED •
APR 20 2018
v\ 41
FBC 2011
BUILDING Master Permit Noa 18 -OO A CD
PERMIT APPLICATION Sub Permit No91 1E5 'ioLdi o1
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
SvV ILl6 /o
City: Miami Shores �c County:
Folio/Parcel#: / (� �•)' 3 I " 0 / " O Z• 6 0
Occupancy Type: S F Load:
City:
Tenant/Lessee Name: kj. //At
�G�
Email: qa/O/G, 3 c 9Aua// Gnm
ICONTRACTOR: Company Name: fv,�C'V Oti C_ ,S Phone#: SOS - Le)7-0)93
/
Address: / ? / n) A) (A)V 4v F .r -/o
Miami Dade Zip:
Is the Building Historically Designated: Yes
Construction Type: 6)/////;iii,cC� S Flood Zone:
State:
NO
0 BFE: FFE:
Phone#: 7f 0 77 W35
City: /4l4/%14
Qualifier Name: UEIa �dY1'z4 CZ
State Certification or Registration #: 24,4 /9 C)
DESIGNER: Architect/Engineer"
State: f
Zip:
,? .5/ 3
Phone#: 7:C 877 41/37
Zip: 336115
Phone#: 3os. Zoiq ..'0lg 3.
Certificate of Competency #: ui y 4 6
Phone#:
Address: City: State: Zip:
Square/Linear Footage of Work: %r
/760,
Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ De olition
Description of Work: %,.,!: //C. i,riot 9G_/k-et. )7)7.2 //' fre'//h e.
r e A/ a gd - , LJ� 02-P4rGL71-vir
Specify color of
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
color thru;tfle: , "::i,
,gc3d:r> Y±x43'PermitFee$°` `(J0
Radon Fee $ . W
Training/Education Fee $
6,,;
CCF $ t.:i ..v • .`•.CO/CC $
C. Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 10 • LIS
DBPR $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City r ../ ...State Zip
Mortgage Lender's Name (if applicable)
Mortgage Leride`r's Address
City ' ? i ` "� 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
ti
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
OWNER or AGENT
Signature''
CONTRACTOR
The foregoing instrument was acknowledged before this The foregoing instrument was acknowledged before me this
C—'1iO; ydayof:___kpo 1,------'20 -(t.. by �. �� Idayooff �r�p •i' 1 20 1`t�?by
�V� I,,k,A. �.k u ,.„ (.(ii�i,, who is personally known to_ l :S ?`C,—V-0>IZ.CL��Z_, w o is personally known to
for who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:,\,7��
k Print: O'{� i'�J 6I rQ \4&eSCU
Seal:
APPROVED BY
tARY • Fv�,
ALEJMIDRA GRIGORE�
tF
EXPIRE
identification and who did take an oath.
NOTARY PUBLIC:
(
01 Ley G, DY,eS uJ1
•,44• ALEJANDRA GRIGOREBCU
MY COMMISSIONF 11362g . ' * MY COMMISSION t FF 143529
S 21 — s EXPIRES: July 21, 2018
�'a n� Banded Nu Budget Notary Strikes
Jam' c• p, noel- Bonded Thru Budget Nan $e hrvlces
Sign:
Print:
Seal:
Plans Examiner
Zoning
(Revised02)24/2014)
Structural Review
Clerk