PL-18-804Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000,
Phone: (305)795-2204
Project Address
Permit
Issue Da
Permit NO. PL-3-1 8-804
Permit Type: Plumbing - Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
3/30/2018
Expiration: 09/26/2018
Parcel Number
Applicant
141 NE 102 Street
Miami Shores, FL 33138-
1132060131830
Block: Lot:
MARGUERITE MERRILL
Owner Information
Address
Phone
Cell
MARGUERITE MERRILL
141 NE 102 Street -
MIAMI FL 33138-2324
(786)423-5653
Contractor(s)
Phone , Cell Phone
PSG PLUMBING SERVICES, INC (305)796-7304
Valuation:
Total Sq Feet:
$ 1,500.00
0
Type of Work: RELOCATE KITCHEN SINK INSTALL DISH
Type of Piping:
Additional Info: RELOCATE KITCHEN SINK INSTALL DISH
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Amount
$1.20
$2.25
$2.00
$0.40
$150.00
$3.00
$1.60
Total: $160.45
Pay Date Pay Type
Invoice # PL-3-18-66953
03/30/2018 Credit Card
03/28/2018 Credit Card
Amt Paid Amt Due
$ 110.45 $ 50.00
$ 50.00 $ 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 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructiordo��rmore, I authorize the above -named contractor to do the work stated.
March 30, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
Building Department Copy
March 30, 2018 1
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
MAR 27 1018
soh �
FBC 20
BUILDING Master Permit No. -•3, �`'- _ /?
PERMIT APPLICATION Sub Permit No. P 1 �� S 0 <'`
❑BUILDING, ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City:
4// ad 12s 4e
Miami Shores County:
Miami Dade Zip: 5,9J.F 6
Folio/Parcel#: //.3a (5‘. 0/ 3/ Is the Building Historically Designated: Yes
Occupancy Type: Load:
Construction Type:
OWNER: Name (Fee Simple Titleholder): X 1 2r46' //,
Address:
Flood Zone: BFE:
NO
FFE:
1L JK7/Z/ Phone#:
27e"' /O�'4AS
City: 0- �ilDi' State:
Tenant/Lessee Name:
Email: i"(Q/�' '7N ri-i//j f?79//
Zip: 53/30
Phone#:
Phone#:. 05-
' % — yW
Zip: 3,30
Phone#:
Certificate of Competency #:
DESIGNER: Architect/Engineer:. Phone#:
Address:
CONTRACTOR: Company Name: ft6 //U/44/2, T1�Ci
Address: 5 (�� /1 0 /o2 z5 -
City: OM L6r1(71 State: ?CZ
f t:
Qualifier Name: / 7I7 � 4/12,04
State Certification or Registration #: ()`IT,
Value of Work for this Permit: $� //� " Q� Square/Linear Footage of Work: ;t
*-/,‘:-Type of Work:•t. 0- Addition .40 Alteration ❑ New;;
ln❑ Repair/Replace •• El Demolition
Description of Work: Ree � �i�lc�%%'% en , 7 'Y°' f%ir
�►` �7 1 «' •6Aej1-
�^ City: — .. State: Zip:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ /9 CCF $ CO/CC $
Scanning Fee $ Radon Fee $ a-- GO DBPR $ P • .9.-s Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
I
Structural Reviews $ Bond $ t
TOTAL FEE NOW DUE $ f� I 0 + 5 -
(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
J
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
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument w s acknowledged before me this
o8 day of LA) , 20 __AP__, by 4 3 day of /i//Z v , 20 , by
42,4,E /7,'/v E3U//, who is personally known to ?Oda, ( J71./x?li , who is personally known to
4/ as me or who has produced
identification and who did tak
NOTARY PUBLIC:
me or who has produced
identification and who d'
NOTARY PUBLIC:
Sign:
Print:
Seal:
RICARDOCESAi1R�AM IS
;,S's� •� P4otafy f tali( - St t Fkxicla
• l • - Commission M GG 139002
My Comm. Expires Aug 28,2
021
• Itonckd through National Notary Assn.
�(4
NgtoS
Notary Public - State of Florida
Commission # GG 139002
My Comm. Expires Aug 28, 2021
Bonded Ihrough National Notary Assn.
Sign:
Print:
Seal:
•***►*******************►******************************************************** ***************************
APPROVED BY
3
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)