PL-16-2176Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. PL--16-2176'
Permit Type: Plumbing - Residential
Work Classification: Addition/Alteration
Pennit Status: APPROVED
Issue. Date: 912312016
Expiration: 03/22/2017
Parcel Number
Applicant
10682 NE 11 Court
Miami Shores, FL 33138-2123
1122320280500
Block: Lot:
MARC ALBERT ILLOUZ
Owner Information
Address
Phone
Cell
MARC ALBERT ILLOUZ
7934 WEST Drive
NORTH BAY VILLAGE FL 33141-
1540 MERIDIAN Avenue
MIAMI BEACH FL 33139-
Contractor(s)
D'SHIN PLUMBING LLC
Phone
(786)516-5536
Cell Phone
Valuation:
Total Sq Feet:
$ 1,000.00
400
Type of Work: ROUGH SET AS PER PLANS
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.25
$2.25
$0.20
$150.00
$3.00
$0.80
$159.10
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-8-16-60844
09/23/2016 Credit Card $ 159.10 $ 0.00
Available Inspections:
Inspection Type:
Top Out
Final
Review Plumbing
Underground
,
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 certif I the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zonin uthorze the above -named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
September 23, 2016
Date
Building Department Copy
September 23, 2016 1
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
LUMBING ❑ MECHANICAL
JOB ADDRESS: /0(pi 2 /" 6
IVlldl I II JI IUI CJ V IIIdge
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
ROOFING
❑PUBLIC WORKS
I (" .X
City: Miami Shores County:
AUG e 2 Zt110
BY:
FBC 20N 54-11
Master Permit No. RG(D _a 114
Sub Permit No. 1'L 1)311(o
❑ REVISION EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Dade Zip: 313 U
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder):/1kv V c. /I A gib('
Address: &-((F�A fel )Owt 2_
NO
BFE: FFE:
Phone#: q4---% 3‘,..- (02l ?
City: WV' 0.)441%, "PD State: F
Tenant/Lessee Name: Phone#:
5 ` dcnC_sma.� �V1 U\ .j
Email: (� t. CQil(11
CONTRACTOR: Company Name: I I,.)► 11 10 f ,UMbCv1 L I-C_. Phone#:
Address: i 150 NAO I S"
City: }��awi ( State: FL Zip: 5.310 5
Qualifier Name: alined \ 1 311 N 1 f' 1'\' Phone#: %(o 53q to 3601
State Certification or Registration #: Ci' C-1Y2cOS)
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ /! 000 Square/Linear Footage of Work:
Zip:
33 l 3C)
Type of Work: ❑ Addition c _Alteration I I i Newco per
C jet
Description of Work:
75cpS1(s5536
Certificate of Competency #:
❑ Repair/Replace I l Demolition
aU3
Specify color of color thru tile: �,(Submittal Fee $ Permit Fee $ /C45 CCF $ a • n CO/CC $ c2
Scanning Fee $ �(` 03 Radon Fee $ 2 • Z5- DBPR $ 2. .— Notary $ r
P
Technology Fee $ `� • SO Training/Education Fee $ 0 ' 20 Double Fee $ Y✓
Structural Reviews $ 0 Bond $ 0
TOTAL FEE NOW DUES S9 • 16
,Bonding Company's Name (if applicable)
B( iding 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.
Signature_
Signature
O1/1(f`R or AGENT ) CONTRACTOR
Thfor , oing instrum as acknowledged before/me this The foregoing instrument was acknowledged before me this
day of . v �- �/ , 20 [ 6 , by day of _ YC L 20
onall known to
�Lm.L•L Y
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.
NOTARY PUBLIC: NOTARY PUBLIC:
, by
is personally known to
Sign;
Pri
Seal:
oy�a�r r? y Commission Expires May 30, 2018
`fi Commission # FF 104626
Bonded Through National Notary Assn,
as
Seal:
AI Commission # FF 104626
Bonded Through National Notary Assn.
************************************************************************************************************
APPROVED BY
' Plans Examiner
Zoning
Structural Review
Clerk