PL-18-1617Miami 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-6-18-1617
Pefnlit Type: Plumbing - Residential
Work Classification: Gas
Permit Status: APPROVED
6/13/2018
Expiration: 12/10/2018
Parcel Number
Applicant
474 NE 95 Street
Miami Shores, FL 33138-
1132060140440
Block: Lot:
ANNE & NESTOR MORALES
Owner Information
Address
Phone
Cell
ANNE & NESTOR MORALES
474 NE 95 Street
MIAMI SHORES FL 33138-
(305)283-7233 (305)733-6534
Contractor(s) Phone CeII Phone
REGOSA ENGINEERING SERVICES IN (786)262-2964 (786)344-8720
Valuation:
Total Sq Feet:
$ 2,450.00
0
Type of Work: NEW GAS LINE 75' WATER HEATER
Type of Piping:
Additional Info: NEW GAS LINE 75' WATER HEATER
Bond Return :
Classification': Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$2.25
$2.00
$0.60
$150.00
$3.00
$2.40
$162.05
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-6-18-67912
06/12/2018 Credit Card $ 50.00 $ 112.05
06/13/2018 Credit Card $ 112.05 $ 0.00
(l92Gp 5
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.
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
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
June 13, 2018
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
Building Department Copy
June 13, 2018 1
/
Technology Fee $
Structural Reviews $
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
JUN 1 2 2018
PcFBC 20-19
Master Permit No.; P a S 8
Sub Permit No. P le- _ ( (It
-3,
BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1?-9 / y �S 57
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: //3 2 2‘O ��C�9l�� Is the Building Historically Designated: Yes
Occupancy Type: Load:
Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): ))AJ fly . CA !.i q 1 ((Y E5
s�D�2 i{fl ( r S
Address: 1 �" � �� S�
City: �J--kk SV\�(C' S State: j'`
BFE: FFE:
Phone#: D,S - a? 3
Zip: 3 3 I�
Tenant/Lessee Name: Phone#:
Email: . ,
CONTRACTOR: Company Name:
QE605J3 6/%4/ /Y 4rf22N(&)P4(e Phone#: 3 2 8 / 3 1 /
Address: /59 20 /iC e'-
City:
Qualifier Name:
State Certification or Registration #: C,C/4j A 2. % 2.
State:
6 i57-AVo
Zip: 337 G 2
2 %8/3y/
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $ _2 4 s- U
Type of Work: ❑ Addition n Alteration`
Description of Work: /S/641/ 6.1S 1//5//'
Phone#:
Certificate of Competency #:
♦ Oi ilfri-OAUSUS `i:311.1
�1 wit A,..w .^s��y •..
R� i'l;i ;U t6 4 ' i t 1' ;ekl
j Mille 13 ' oli?r ,n ., e•ij� � Zip:
r t} Rf! qth. ndt)i11 .t .�;i ? 7c4�'•
SSquarea.!lLinear Footage of Wprk:•''r
fit.":�r":iC+nR��.v:'•,-.n".:mws ���e+ ��.crvy.q.... � ta,;a.P,.. �t
Fl New ❑ Repair/Replace ❑
S 1f/e9Te/Z
Demolition
1
,1011
Specify color of color: thru'tile:
A
Submittal Fee $ "- =' '' ' " Permit Fee $ / 5-d
Vifrt.03 t~:A
•
Scanning Fee $ Radon Fee $
Training/Education Fee $
CCF $
CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Vtl
Bonding Company's Name (if applicable)
S
Bonding Company's Address
City r 1 J 1 State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
r _.s
City State Zip
1 ) d•
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature d^P
OWNER or AGENT
4` � Signature
The foregoing instru nt was acknowledged before me this
) C7 day of ,20g ,by
-
r who has produc . ,'
identification and whorl,.
NOTARY PUBLIC:
Sign:
Print:
Seal:
CONTRACTOR
The foregoing instrument was acknowledged before me this
/2 day of 015 ,20�� S by
o is personally known to
6ir7RV0
Notes Politic • State of Fladds me or who has produced
Commission I FF 2 75
as
Comm. Expires Asp 2ti.201Y 0 identification and who did take an oath.
BaxNdttrouiliWood Nasty Assn. i NOTARY PUBLIC:
: Nfftary 'tihlir jl f .: ut
F F 23211711
piles Aug 10.201$
slaw�rh NatICfl Iy
**************************************************
APPROVED BY
Sign:
Print:
Seal:
*************
Plans Examiner
Jodi Ellis Cardena8._
NOTARY PUBLIC
Comm# GG185896
%V E 19 Expires 2/14/2022
Zoning
Structural Review Clerk
(Revised02/24/2014)