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PL-18-2398Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 FD" Issue Date: Location Address Parcel Number 119 NW 110 ST, Miami Shores, FL 33168-4320 1121360030550 Contacts Permit No.: PL-9-18-2398 Permit Type: Plumbing - Residential Work Classification: Pool - Private Permit Status: Approved Expiration: 05/07/2019 PRISCILLA BRANCO HAISLEY Owner PRISCILLA BRANCO HAISLEY Applicant 119 NW 110 ST, MIAMI SHORES, FL 33168 119 NW 110 ST, MIAMI SHORES, FL 33168 Other:9546485602 Other:9546485602 ROSMEL POOLS INC Contractor WILFREDO JR LEIVA 9300 NW 25 ST 103, DORAL, FL 33172 Business: 3055927900 Description: NEW POOL, NEW SPA & NEW DECK Valuation: $ 2,000.00 Inspection Requests: Inspect-4949 Total Sq Feet: 2,000.00 Fees Amount CCF $1.20 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.45 Payments Date Paid Amt Paid Total Fees $160.45 Credit Card 09/10/2018 $50.00 Check # 15128 11/08/2018 $110.45 Amount Due: $0.00 Building Department Copy 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. OWN S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws gulatin onstruct'. and zoning. Futhermore, ],authorize the above named contractor to do the work stated. A orized Sign re: Owner / Applicant / Contractor / Agent Date November 08, 2018 Page 2 of 2 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 .,VED S P 10 2018 BY: FBC 201-1 BUILDING T Master Permit No. 'E�P to _ �i39i PERMIT APPLICATION Sub Permit No. erL 16 `23 S ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: oc, N'Lo• tlo City: Miami Shores County: Miami Dade Zip: 3&QA Folio/Parcel#: i�-�� --�0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: ?40' Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): `1Cl -brcM© - 'CLI6 l Phone#:91S`4 0(4g-5c� Address: Ilq 1 •l'l,.�,, tic) � , City: KIC '11'l �` "� State: s V_ Zip: BS KO Q Tenant/Lessee Name: Phone#: MIA, Email: CONTRACTOR: Company Name: f�7(TC�1t PhA5 � • Phone#: �-- -Si,-)"7� Address: 19; ��%• oZs Cam-. 'GLp NLf-- lea City: CAI (` - State: Zip: 33� ( Qualifier Name: ��i� ��V�JI -IV Phone#: 2,51O5-•M (4113 State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: �TTn�A!'t-fi:- t�C(.1i1� � /� ., T.�� Dctq Phone#: Address:N1S &W- ;W �• �vH�G 11( City: lam tate::�Zip: �(SS Value of Work for this Permit: $ e?.'O-� Square/Linear Footage of Wo �CIYJ�� Type of Work: ❑ Addition Alteration New Repair/Replace n Demolition Description of Work: Specify color,.of.color thru.tile: Submittal Fee $ M ' Q� Permit Fee $ kq;r-� • CCF $ CO/CC $ Scanning Fee $ Technology Fee Structural Reviews $ Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ T(Q� (Revised02/24/2014) Bonding Company S Name (if applicable) Bonding Co;71� 'Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Addr s City /fit' State Zip / o-oh A- 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 40: 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, thri 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 propertyris subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at, the rJob 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�wroved and a reinsDection fee will be charged. t� Signature C41� I : OWNER or AGEMT The foregoing instrument was acknowledged before me this may' .. ° • day of •��V� 20 f' by 1SG6�Cc L�f C.ir% I&I"ho is personally known to me or whohas produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Signature CONTRACTOR The foregoing instrument was acknowledged before me this cla�� of .20 by N0I1 WVCA at who is personally known to me or who has prodd uce�(1(t%N i .t9n as identification and who did take an oath. NOTARY PUBLIC: _ /1 Si Print: Z�C+{S Notary P& c - Sibs e` F gr0 } Comrrss.oia001,5i;77ji E Seal: My Comm E»a ,es fe9'i ?Ef, 11vto y r uou - Q-v v Commission GG IH732 My Comm. Expires Feb 14. K21 APPROVED BY <Z_ P Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)