PL-17-2623Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Parcel Number
Permit N0. P i-11-1°7-2623
Permit Type: Plumbing - Residential
Worts GiassiTcetiori: Septic
Permit<tatus: APPROVED
Expiration: 05/13/2018
Applicant
443 NE 94 Street
Miami Shores, FL 33138-
1132060140510
Block: Lot:
SETH LONG
Owner Information
Address
Phone
Cell
SETH LONG
650 W Avenue
MIAMI BEACH FL 33139-
650 W Avenue
MIAMI BEACH FL 33139-
Contractor(s)
MR C'S PLUMBING & SEPTIC INC
Phone
(305)651-7859
CeII Phone
Cq
lF
Valuation:
Total Sq Feet:
$ 6,500.00
500
Type of Work: INSTALL NEW SEPTIC DRAINFIELD
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 3
Fees Due
Bond Type - Owners Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Amount
$500.00
$4.20
$4.50
$3.00
$1.40
$300.00
$9.00
$5.60
Total: $827.70
Pay Date Pay Type
Invoice # PL-11-17-65547
11/08/2017 Check #: 537
11/02/2017 Credit Card
11/14/2017 Credit Card
Bond #: 3552
Amt Paid Amt Due
$ 500.00 $ 327.70
$ 50.00 $ 277.70
$ 277.70 $ 0.00
Available Inspections:
Inspection Type:
HRS Approval
Final
Review Plumbing
CA NCFt L Fn
In consideration of the iss -nce to me of. this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in stjct conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting thi .-;t I asme responsibility for all, work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for CA PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS A
construction an
e foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
ermore, I authorize the above -named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
November 14, 2017
Date
Building Department Copy
November 14, 2017 1
(WILDING
PERMIT APPLICATION
IVI Id 1 III al IU1 CJ V I I IdgC
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
NOV 02 29V
FBC20N
Master Permit No.-Il 9•(02
Sub Permit No.
I BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION
((PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
DB ADDRESS: ¥ I ►' t-e— V
El EXTENSION ❑RENEWAL
ElCANca ON ❑ SHOP
CEL1RffGS
iiy: Miami Shores l County: Miami Dade Zip: '' 3 ) 7 '
F olio/Parcel#: // Q/ $6206 -? I — 057 0 Is the Building Historically Designated: Yes NO (i
'c:cupancy Type: Load:
C PWNER: Name (Fee Simple Titleholder):
?• cldress:
1 errant/Lessee Name:
r mail:
❑ CHANGE OF
r, c TNTRACTOR
Construction Type:
SGl7 14 o`ycc--)
,V . She e
Q/LGt' SCtOY�4/ State:
N/
Flood Zone:
•
'CONTRACTOR: Company Name:Alli • G 5 / (01.4A. 21
pt% - n• ( 49- i"—Q-_
ily: qit QA State: Zip: 33-(0
me� (04- ., Phone#: BUJ 'kS
�7
:lualifier N
:ate Certification or Registration #: „..57 \ 45b (J. L Certificate of Competency #:
BFE: FFE:
Phone#:
Zip:/ 38'
Phone#:
! 'ESIGNER: Architect/Engineer:
.t ddress:
alue of Work for this Permit: $
'I ype of Work: ❑ Addition ❑ Alteration
[ ,c scription of Work:
Phone
CANONFC,-7
Square/Linear Footage of Work:
Ig New ❑ Repair/Replace
Phone#:
City: State: Zip:
5-15-6
❑ Demolition
Il K OPram-1 ef 01
K 11> )k
,!:pecify color of color thru tile:
ubmittal Fee $ rn.° . n Permit Fee $ 360--- CCF $ CO/CC $
Scanning Fee $ ' Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $ �C ) E 0
Structural Reviews $ Bond $
TOTAL FEE NOW DUES
1
Signature
CONTRACTOR
The foreg,oing instrumenttjw�s acknowledged before
me this The foregoing instrument was acknowledged before me this
day of / VD V , 20 /T , by day of / VIV , 20 // , by
e/ %, who is personally known to fL 011We , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Bonding Company's Name (if applicable) ,�
BondingCompany's Address / V
Pt -
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
i; ispection will not be approved and a reinspection fee will be charged.
Signatur
OWNER or AGENT
,tfet /,t RA4i/;)
as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
• kW DONALD MARTIN,
*****************
APPROVED BY
MY COMMISSION # GO102743
EXPIRES Mav 0
Sign:
Print:
Seal:
Plans Examiner
Al A1`'6i✓7
.-•:ili"ik DONALD. MARTIN
''' ,MY COMMISSION# GG102743
'y•t;,• EXPIRES May 09, 2021
**i. 1************************a
Zoning
Structural Review Clerk