PL-17-2667Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
4
Permit NO. PL-11-17-2667
Permit Type: Plumbing - Residential
Penni"t Work Classification: Pool - Private
Permit Status: APPROVED
Parcel Number
Issue Date:1/2612018 1 Expiration: 07/25/2018
Applicant
161 NE 106 Street 1121360060380
Miami Shores, FL 33138-2036 Block: Lot: JEAN ROY
Owner Information Address Phone Cell
JEAN ROY 161 NE 106 Street (786)483-7782
MIAMI SHORES FL 33138-
161 NE 106 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
ESSIG POOLS INC 305-949-0000
)e of Work: PLUMBING FOR NEW POOL
)e of Piping:
ditional Info: PLUMBING FOR NEW POOL
nd Return :
issification: Residential Scanning: 1
Fees Due
Amount
CCF
$1.20
DBPR Fee
$3.38
DCA Fee
$2.25
Education Surcharge
$0.40
Permit Fee
$225.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total:
$236.83
Valuation: $ 1,500.00
Total Sq Feet: 0
Available Inspections:
Inspection Type:
Main Drain
Final
Rough
Review Plumbing
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-11-17-65605
01/26/2018 Check #: 301941 $ 186.83 $ 50.00
11/08/2017 Check #: 301866 $ 50.00 $ 0.00
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 al/the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction an4, 2fz nirag. F,ljthomore, Vauthorize the above -gamed pontractor to do the work stated.
1/2
Auth rize Signare.—Owner / Applicant
BuildinV Department Copy
/ Agent
January 26, 2018
1
Miami Shores Village EI�-�.1 ��r
Building Department NOVQ 8 �01
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 LBY_
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 C�
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 2011
Master Permit No._ B PPn -26�jh
Sub Permit No. PL I 1 -?-6b]
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: \ AV G 0 (e 5'1"
City: Miami Shores County: Miami Dade Zip: 3
Folio/Parcel#: ) \ - 7- 13 (.. • 6 cG - 0W L? Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): !:::"� Phone#: 186- 463 r 78Z
Address:_ _ 1(e.1 tiC- )p(, S-r
City: M Z ti ; 5%_,,,. -a S State: 1- ( Zip: -33135f
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: Essig Pools, Inc
Address: 1800 NE 151 St
City: North Miami State: FI
Qualifier Name: Daniel Essig
hone#: 305-949-0000
Zip: 33162
hone#:
State Certification or Registration #: CPC052505 Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace
Description of Work: wluM'S
w
Zip:
❑ Demolition
Specify color of color tharu tile:
Submittal Fee $ Permit Fee $ �aJ J CCF $ CO/CC $ _
Scanning Fee $ Radon Fee $ 2 _ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $ _
Structural Reviews $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE
Bondinj 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 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 Signature
�� NER or AGENT CONTRA
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
( ' --fir' day of 20 1-7 by I0*'t day of 20 ( , by
�' L✓vG_ ��---d who is personally known to Daniel Essig who
me or who has produced-
identifiication and who did taken oatt�����* •,.
No 11� 6 PUBLIC:( A / . / � O� •��'
Print:
Seal:
( as me or who has produced
1% identific tion and who did take
�•?'.�_ OTAR PUBLIC: n A
$Print:
.A\� Seal:
j.. FvJr*
.� 41L
• ;0
0
OF
APPROVED BY f� �I" 4� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)