PL-17-2608Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
•m it
Permit NO. PL-1 1-17-2608
Permit Type: Plumbing - Residential
Work Classification: Pool - Private
Pennit Status: APPROVED
Issue Date:12/G/2017
Expiration: 06/04/2018
Parcel Number
Applicant
12 NE 101 Street
Miami Shores, FL
1132060131380
Block: Lot:
DAVID AND JANICE SNOW
Owner Information
Address
Phone
Cell
DAVID AND JANICE SNOW
12 NE 101 Street
MIAMI SHORES FL 33138-
12 NE 101 Street
MIAMI SHORES FL 33138-
Valuation:
Total Sq Feet:
$ 900.00
0
Type of Work: POOL PIPING PLUMBING
Type of Piping:
Additional Info: POOL PIPING PLUMBING
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
$2.00
$0.20
$225.00
$3.00
$0.80
$233.85
Pay Date Pay Type
Invoice # PL-11-17-65530
11/01/2017 Check #: 2401
12/06/2017 Check #: 2451
Amt Paid Amt Due
$ 50.00 $ 183.85
$ 183.85 $ 0.00
Available Inspections:
Inspection Type:
Main Drain
Final
Rough
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 PLUMB! ECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFI
construction a
all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
e, I authorize the above -named contractor to do the work stated.
December 06, 2017
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
Building Department Copy
December 06, 2017 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Horida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION UNE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
IA -PLUMBING ❑ MECHANICAL PUBLIC WORKS
JOB ADDRESS: I a N i D ,S4-
RECEIVED
1 2017
NO
h
FBC20i*{
Master Permit No. 4j pp 1.R - 2 VJ 0 R
Sub Permit No. ? 1 (R -Z( D 8
❑ REVISION ❑ EXTENSION El RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip: 1 3
Folio/Parcel#: \ 1- 3 a (?c0 - Ol 3 13 S 0 Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1X1ii a S nO Phone#: 3 30
Address: (a 1-tE 01 S
City: ( it v'l/A S `l O Y,C S State: cFL,
Zip: .5 g 1 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
j rS10 POok Co
Address: AA `�I 00 Nu) s'f- 14- / (
City: V"l t CUAAzi
Qualifier Name: COX LOS
State Certification or Registration
State:
e c4 L Z
•
NO
Phone#: :0S ` 3.(0 " / �a
Zip: 3 1(--(c'
Phone#: _SOS- - S'/ a — 9 39 D-
#: C l2 IDS 7331( Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ C40DO
D. Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
PODP;pl'ng PGA d,s1_,J
Description of Work:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ 5C) Permit Fee $ �-:� — CCF $ ' HOC)
Scanning Fee $3 Radon Fee $ 2 - DBPR $ 2 . 2S
CO/CC $
Notary $
Technology Fee $ , cep,x) Training/Education Fee $ 2 Double Fee $
Structural Reviews $ (71 Bond $
TOTAL FEE NOW DUE $ ) 9? • e�
(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 . - . ppr i ved and a reinspection fee will be charged.
Signatu
OWNER or AGENT
The foregoing instrument was acknowledged before me this
31day of VCt"e , 20 , by
DMn-t , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
1
L
as
7 5-
GLADYS BORGES
MY COMMISSION # FF 177110
EXPIRES: December 17, 2018
, Bonded Tin Norarj Public Undarwri:ers
*********
APPROVED BY
Signature
C'NTRACTOR
The foregoing instrument was acknowledged before me this
3154- day of ')V2-t! ,20 1% , by
��t r (, > (iCinr761 ( 2,-who is personally known to
me or who has produced
as
identification and who did take an oath.
NOTARY PUBLIC:
Seal:
Plans Examiner
GLADYS BORGES
MY COMMISSION # FF 177110
EXPIRES: December 17, 2018
Bonded Thai Notary Public Und rwri:ars
Zoning
(Revised02/24/2014)
Structural Review
Clerk