PL-17-2101Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
CORIDA
Permit NO. PL-8-17-2101
Permit Type: Plumbing - Residential
Per
i t
Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 8/24/2017 1 Expiration: 02/20/2018
Project Address Parcel Number Applicant
1111 NE 91 Terrace 1132050010120
Miami Shores, FL 33138- Block: Lot: ANDREA & UWE KREUTER
Owner Information Address Phone Cell
ANDREA & UWE KREUTER 1111 NE 91 Terrace
MIAMI SHORES FL 33138-
5161 COLLINS Avenue
MIAMI BEACH FL 33139-
Contractor(s) Phone Cell Phone
RAUSA BUILDERS CORP (305)554-5711 (305)970-7253
Type of Work: ADDITION NEW BATH AND MASTER
Type of Piping:
Additional Info: ADDITION NEW BATH AND MASTER
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$3.00
DBPR Fee
$4.50
DCA Fee
$4.50
Education Surcharge
$1.00
Permit Fee
$300.00
Scanning Fee
$3.00
Technology Fee
$4.00
Total:
$320.00
Valuation: $ 5,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-8-17-64930
08/18/2017 Check #: 016358 $ 50.00 $ 270.00
08/24/2017 Check #: 016433 $ 270.00 $ 0.00
Hvanaoie inspections:
Inspection Type:
Top Out
Final
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 A certify that all the foregoing in ation is accurate and that all work will be done in compliance with all applicable laws regulating
cons ion and zoning. Futhermore I ove-named contractor to do the work stated.
�! August 24, 2017
u rized-Signature D� ner /�a Contractor / Agent Date
Building Department Copy
August 24, 2017 1
Miami Shores Village
ECEivED
Building Department AUG 18 2017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138An
Tel: (305) 795-2204 Fax: (305) 756-8972 \
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC
BUILDING Master Permit No. QCI(o — 32(do
PERMIT APPLICATION Sub Permit No. V I-4 - z/ Q l
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: 4114 1-1" t N 1i 1I j T-16 Ll Ce►'
City: 1Miami Shores nl1.t ,1 County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): jc "-'i Phone#:
Address: Ili t PL'' 11 -t &M
City: I .A.4 L a$ i �7�e.�.� S State: P( Zip: 13I 3 S
Tenant/Lessee Name: 4C)r-f.a. 4 -•c1 v w Ctt' 6y»-C� Phone#:
Email:
CONTRACTOR: Company Name: QG.y$g �, v i ` � L Qr� :7 Phone#: 3 / �Sti%� 7
Address: ?( l ( e. --v �, Z— S ).-
City: NA/i �_: State: �l Zip: 371 S—�
)
Qualifier Name: �EkSov% ��` � a �lqZ. Phone#:
State Certification or Registration #: e- r�-C Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Value of Work for this Permit: $-sd�''� Square/Linear Footage of Work:
Zip:
Type of Work: 0 Addition ❑11 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 4 -DrtT.4w%o% / ✓L E'w y1.?� -t,tiL
Specify color of color thru tile:
Submittal Fee $_
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $ 3�6 CCF
Radon Fee $
Training/Education Fee $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ G---� O - CID
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
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 in5pectiqAi which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not bi dp roved and a reinspection f ill be charged.
Signa ure Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of X4
20 / % by
who ' ersonally known t
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: z, /
The foregoing instrument was acknowledged before me this
_`r day of 4V 20 / 7 by
IlJ�r1 Soti► �r�lalw.ti.��` who i ersonall to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign:
Print: Print:
MARTA HERNANDEZ =+�`' '`'Fi;: MARTA
Seal =•• Seal ="•
HERNANDEZ
MY COMMISSION # GG005090 �•" MY COMMISSION # GG005090
EXPIRES July 02, 2020 °r,! �` , EXPIRES Jul
(407) 3%-0153 FlorldalloteryService.com (407) 3>>9 O153 y 022020
FlorWalloteryServlce,com
**************************************************************************************** ********
APPROVED BY Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk