PL-17-1991Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Pei
Permit NO. PL-8-17-1991
Permit Type: Plumbing - Residential'.
Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue bate: 8/7/2017
Expiration: 02/03/2018
Parcel Number
Applicant \
925 NE 95 Street
Miami Shores, FL 33138-
1132060143100
Block: Lot:
JUDITH H LEFFERDINK
Owner Information
Address
Phone
Cell
JUDITH H LEFFERDINK
925 NE 95 Street
MIAMI SHORES FL 33138-
(847)975-8540
925 NE 95 Street
MIAMI SHORES FL 33138-
Contractor(s)
G&L PLUMBING SERVICE
Phone Cell Phone
305-551-5090 (786)225-3648
Valuation:
Total Sq Feet:
$ 1,500.00
0
Type of Work: PVC PIPING INSTALLATION
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
$3.38
$3.38
$0.40
$225.00
$3.00
$1.60
$237.96
Pay Date Pay Type
Invoice # PL-8-17-64787
08/07/2017 Credit Card $ 187.96 $ 50.00
08/04/2017 Check #: 5534 $ 50.00 $ 0.00
Amt Paid Amt Due
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 LEC '- ' •• L, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
ollarelA
• i r • r °71Owner / Applicant / Contractor / Agent
OWNER : AFID
construct on . d z
certify at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
Futhermo e, 1 a rize the above -named contractor to do the work stated.
August 07, 2017
Date
Building D - partment Copy
August 07, 2017 1
NUrve�PC�2> � 01,72 ce)
fl �� go(40.412,;(
t4
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: (30S) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
'PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
JOB ADDRESS:
cS�"\
City:
((F��BC�2 0 14
Master Permit No. L3 P C t7. / 5 /5
Sub Permit No. `P(— 1— 1 q rI
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
cq11 E gS'sr
DRAWINGS
Miami Shores County:
Miami Dade
zip: 33/38
Folio/Parcel#: — / / 3 . 0 0/ y 3/ 00 Is the Building Historically Designated: Yes NO
City:
Tenant/Lessee Name: Phone#:
Email:
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
/
OWNER: Name (Fee Simple Titleholder): JO. d1.4190 rcl c V) (y�(--1 k Phone#: Q `q
7j gsC/0
Address: 9
,4612E 51ote4 State: Zip: a 31 a?
CONTRACTOR: Company Name:
Address: [ ((,)
City: /vC t A
Qualifier Name: Tidy
State Certification or Registration #:
?)(i.,14L
State:
lr ✓ram Phone#:
Certificate of Competency #:
Phone#:
City: State: Zip:
/110 _
DESIGNER: Architect/Engineer:
Address:
Phone#: JCS ')1'
zip: / r
Value of Work for this Permit: $ I 5-Da • OD Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
pl p/Y1G' 1054 11ct -lOr,
Description ofWork: 19V C
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ W Permit Fee $ d
CCF $ I • 20
CO/CC $
Q'ar�
Scanning Fee $ 3 Radon Fee $ _2) - 38 DBPR $ 3 - 3 8 Notary $
Technology Fee $ I • -/ O Training/Education Fee $ ().10 Double Fee $ i?Q
Structural Reviews $ Bond $ {�
TOTAL FEE NOW DUE $ I Q
(Revised02/24/2014)
. 96
CONTRACTOR
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
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. 1 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 condition to the issuonce 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.
Zip
OWNER AGENT .
The foregoing instrument was acknowiedged before me this
31 rAd��a(ypf.7 20 ,, by
ho is personally known to
me or who has produced b1 9.4&xis L. Q,a,U.csJi.
identification ar j, ho did take an oath.
NOTARY + B
S
Pri
Seal:
•r.
y::C,s , RENE DIOVANY ILLA MARTINEZ
MY COMMISSION # GG 034114
;4 EXPIRES: September 27, 2020
Under*liteis
as
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
EN A
r ri e ft , w•ersonally no
me or who has produced
identification and
01 ,20 ,i"7 by
NOTARY
Si
Print:
Seal:
as
obiedt opiate,- ` •
i`►'ar"'�.,, ROBERTO SANCHEZ
;� `'• Notary Public - State of Florida
Commission # FF 245271
,.g' My Comm. Expires Jun 29, 2019
Bonded through National Notary Assn.
APPROVED BY F
(Revsedo2/24/20i4)
Plans Examiner - Zoning
Structural Review Clerk