PL-18-1116Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. PL-4-18-1116
Permit Type: Plumbing - Residential
Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 7/9/2018
Expiration: 01/05/2019
Parcel Number
Applicant
1421 NE 103 Street
Miami Shores, FL 33138-2625
1132050310150
Block: Lot:
VILMA QUINTANA
Owner Information
Address
Phone
Cell
VILMA QUINTANA
1421 NE 103 Street
MIAMI SHORES FL 33138-
(305)527-3904
1421 NE 103 Street
MIAMI SHORES FL 33138-
Contractor(s)
CORAL REEF PLUMBING INC
Phone Cell Phone
(305)361-6769 (786)298-6853
Valuation:
Total Sq Feet:
$ 11,000.00
0
Type of Work: NEW GAS LINES FOR W/H AND RANGE WAT
Type of Piping:
Additional Info: NEW GAS LINES FOR W/H AND RANGE WAT
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Penalty Fee
Permit Fee
Scanning Fee
Technology Fee
Work without Permit Fee
Amount
$6.60
$5.78
$3.85
$2.20
$100.00
$385.00
$3.00
$8.80
$385.00
Total: $900.23
Pay Date Pay Type
Invoice # PL-4-18-67321
07/09/2018 Credit Card
04/26/2018 Check #: 1161
Amt Paid Amt Due
$ 850.23 $ 50.00
$ 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 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. F thermore, I authorize the above -named contractor to do the work stated.
Au horized Signature: Owner / Applicant / Contractor / Agent
July 09, 2018
Date
Building Department Copy
July 09, 2018
1
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
jtj.P..1,11JMBING MECHANICAL
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
RECE.iVEU
APR 2 6 2016
ctA4.1
FBC 201,
Master Permit No. ITV le - I (l"I
Sub Permit No.
❑ ROOFING ❑ REVISION
PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: 142_ JV G \DC. .
City: Miami Shores
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Address: IK\E ko �r�� S� •
County: Miami Dade
Construction Type: Flood Zone:
P� l8-II1(P
❑ EXTENSION 0 RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
Zip: 33k 38
NO
BFE: FFE:
Phone#:
City: `� �YY�\ram C -�� State:
Tenant/Lessee Name: Phone#:
Email:
Zip:
CONTRACTOR: Company Name: C(4a\ V.2.4 J'tr\b\ Phone#:
Address: P� ))( 1 Z
5 yc� City: Pk. 2\ � ..\ State: FL-- Zip: ,3
�\�Z
Qualifier Name: � v�fUG�S3\1
ve _Q!� Phone#:
State Certification or Registration #: C 1� ( (I 2.6)..6114 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: City:
Value of Work for this Permit: $
Type of Work: ❑ Addition
Description of Work:
l.4u04,'
(1,a0a• DO
Phone#:
..•M. +gyZ)p (, State: Zip:
4. ,tom , quare/Linear Footage of Work:
❑ Alteration ❑ New ) Repair/Replace
( tS 1��' ✓,ems
n Demolitionn�,,
G�k
167
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $
3-Es
CCF $
DBPR $
co/cc $
S•-19 Notary$
Training/Education Fee $ Double Fee $, is • 00
Structural Reviews $ Bond $
TEDNAX -r : (�J.
(Revised02/24/2014)
c
TOTAL FEE NOW DUE $
8SO • 2,3
\\'*3 (6i\ds'Ork(6
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 be approved and a reinspection fee will be charged.
nature
y
WNER or AGENT
The foregoing instrument was acknowledged before me this
``�( day of)\ka(C L , 20 1S , by
rsonally known to
O
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of ,Ja(C.L ,20 !V by
`N yC�`LJ 0 v 1°( Leiiiwho
who has produced as who has produced as
identification and ho did take an oath.
NOTARY PUBLI
Sign:
Print:
Seal:
CID
•� i MY COMMISSION # CSC 121619
EXPIRES: September 2, 2021
44N .fit t Bonded Thru Nolmy Public Underwriters
identification and who did take an oath.
NOTARY PUBLIC: i
Sign:
Print: �$4�••'4' D
__.: .,,? MY COMMISSION # GO 121619
Seal: 1 t ; � _ 4.1 EXPIRES: September 2, 2021
.°..;,.4°`''� Bonded Thru Notary Public Undenfaisers
*************************************************$****************************$*****************************
APPROVED BY
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)