PL-18-1972Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. PL-7-1 8-1972
Permit Type: Plumbing - Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 8/7/2018
Expiration: 02/03/2019
Parcel Number
Applicant
1030 NE 95 Street
Miami Shores, FL
1132050120070
Block: Lot:
ROLAND NIEMAN
Owner Information
Address
Phone
Cell
ROLAND NIEMAN
1030 NE 95 ST
MIAMI SHORES FL 33138-2548
Contractor(s) Phone
AROUND THE CLOCK GAS SERVICE 305-231-3632
Cell Phone
Valuation:
Total Sq Feet:
$ 1,500.00
0
Type of Work: NATURAL GAS LINE TO GENERATOR
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
$1.20
$2.63
$2.00
$0.40
$175.00
$3.00
$1.60
$185.83
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-7-18-68311
08/07/2018 Check #: 1758 $ 135.83 $ 50.00
07/23/2018 Credit Card $ 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 AF,
construction
oregoing
thorize the a
Authorized Signature: Owner / Applicant
ation is accurate and that all work will be done in compliance with all applicable laws regulating
na ned contr cto to o the ork stated.
/ Contractor / Agent
August 07, 2018
Date
Building Department Copy
August 07, 2018 1
BUILDING
PERMIT APPLICATION
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
JUL 23 2018
FBC 2onb
Master Permit No. �FELI — 1' 1Z
Sub Permit No. 1 U ` t°112
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
j�
�CONTRACTOR DRAWINGS
JOB ADDRESS: NO
O-3 0 NI�• r^ . GU—
1 Jr S *".e -et-
City: Miami Shores County: Miami Dade Zip: 3 ) 3 X
Folio/Parcel#: \ 3 ? 0 S " o\ a 0 V ¥ Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction /aType::' /� Flood Zone: BFE: FFE: p
OWNER: Name Fee Simple Titleholder): a Ala /.1 / %. /r PrPhone#: ?C' �90 o . 7-
Address: /O3) /L16 S'_ S
}- �i
City: xi/ & �ifA % J !�► GJ e � State: /-' � Zip: ?.3/ 3 a
Tenant/Lessee Name: )12
Email:
Phone#:
CONTRACTOR: Company Name: h- YN-DJ \('-d �\i•N R (\o t `I v -i""S
Address: 13 1 + - 0`) k") i b ¥ A V f '-- i�
City: T"' PIA A ( '- C ` State: 2'F L Zip: 3 -5 0 /
Qualifier Name: 4 J by jj (9 (Iv, Z-' t - l / f 7— Monet
L
State Certification or Registration #: PG — t 4 3 _S Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: / City: State: Zip:
Value of Work for this Permit: $ (2 S 0 O • .0 `J Square/Linear Footage of Work:
Type of Work: ❑ Addition` ❑ Alteration El New ❑ Repair/Replace ❑ Demolition
iv Description of Work: )'i AA— G cs-S L t e Ay) d 6 CO O n-e Cfl c,J
0 - Gt?v^-e.,•..-ati.
305--�� 13Co�a
9-r3 O
Phone#:
Specify color of color thru tile: -r ---'-
Submittal Fee $ Permit Fee $ (7 , • co
Scanning Fee $ Radon Fee $ 2— ' (:)'-. DBPR $ 2 ° 6 3 Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ _ Bond $
TOTAL FEE NOW DUE $ 1 3`D . Ca
CCF $ CO/CC $
(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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absepee,, of such posted notice, the
• inspection will not be approved and a reinspection fee will be charged.
Signature
4;tififid-ps, lam/
OWNER or AGENT C
The foregoing instrument was acknowledged before m this
�J day of AJ7Vi G ,20 / ,by
//R0/a n /ail P +ihtiGL.'f , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Auttj od-i6 a()DRSUA
•
�1�RY •! ALEJANDRA GRI(i0$ESCU
* ` ' • MY COMMISSION t FF 143529
e� EXPIRES: July 212018
'tan"' Bonded AM Budget NOY Services
************************************************************************************************************
Signature
ONTRACTOR
The foregoing instrument was acknowledged before me this
•-..S— day of "rev', 4,, ( , 20 c y , by
1
4 L4-✓ Gai't2,,,-/ Lt-. , who is personally known to
me or wo has produced ,¢/ f 0-ti ("dA[?^-••as-
identification and who did take an oath.
NOTARY PUBLIC:
4
'-�,'Fi F 444 My Comm. Expires Jan 22, 2021
Bonded through National Notary Assn.
v. e0
Now
EDWIN L SILVER
Notaty• P.utq li`c,-.St�tB of Florida
Co*+t�ie4Ib1 f GG 051232
Sign:
Print:
Seal:
APPROVED BY � :/oe Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)