PL-18-3126Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
101 NW 102ND ST, Miami Shores, FL 33150 1131010220050
Contacts
Permit NO.: PL-10-18-3126
Permit Type: Plumbing - Residential
Work Classification: Pool - Private
Permit Status: Approved
Expiration: 04/08/2019
JACQUES BARBARA Owner ROSMEL POOLS INC Contractor
101 102 WILFREDO JR LEIVA
9300 NW 25 ST 103, DORAL, FL 33172
Business: 3055927900
INS
Description: NEW POOL PIPPING Valuation: $ 2,000.00 Inspection Requests:305-762 4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee (Manual)
$50.00
Scanning Fee
$3.00
Technology Fee (Manual)
$2.50
Total:
$111.10
Payments Date Paid
Amt Paid
Total Fees
$111.10
Credit Card 10/24/2018
$61.10
Check# 15140 10/10/2018
$50.00
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regula , construq 'on d zoni . Futher e, I aut ze a above named contractor to do the work stated.
o o�
A ri rid ature: O nere / ppl' �,-Cont-ractor / Agent Date
October 24, 2018 Page 2 of 2
✓'x:I�
Miami Shores Village
OCT 10 20 8
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
FBC 20
BUILDING Master Permit No. ?)P P I � - ?)
PERMIT APPLICATION Sub Permit No.? L 1 p- 312.E
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
tt [
CONTRACTOR DRAWINGS
JOB ADDRESS: IOi I ,W • 1CQ�. c> • �' S� "I: C( q I
City: Miami Shores ,.�County: Miami Dade zip: 361 `5
Folio/Parcel#:11-3%oi'cQz-,c�� Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): enarb" Phone#,--�C&` ,1_ /-%
Address: 10k � • W- ��a-Si-•
City: M 6Um 1 5r i State: ��_ Zip:
Tenant/Lessee Name: /�/ Phone#: ' K
Email:
CONTRACTOR: Company Name:
Address: cl3ac n. • (o. ;Lcb %� , W 1 to
Phone#: -39�1�'• MOOD
City: )=g-aL '' ^^� (- Q State: -- Zip: � 1-7Q-
Qualifier Name:W 1 Vr('�-& V'(t1 i^.�j Phone#:.�3� U�
State Certification or Registrations#:: �� � Certificate of Competency #:
DESIGNER: Architect/Engineer: y��( i1 O �Gu'1C `T •� • Phone#:J'
Address: City: KC.IGn I State: TL- Zip: 155
Value of Work for this Permit: $
Type of Work: ❑ Addition
Description of Work:
❑ Alteration
aA.) '�CO(
near Footage of Work:
❑ Repair/Replace El Demolition
�IQ ( nX' -
1 f Fv
ti
Specify color of color thru tile:
Submittal Fee $ 4 r Permit Fee$,Jb'3 J 00 CCF $ ki �•Z�w• � "'emc.$�"''
n�..• .«
Scanning Fee $ - Radon Fee $ mac. CQ)7 DBPR $ Notary $
Technology Fee $ �' ' �� Training/Education Fee $ G � �� Double Fee $
Structural Reviews $
Bond $ P
TOTAL FEE NOW DUE $ - to
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
0
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.j.
;
"WARNING TO`'OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR�PROPERTY. "1KYOU 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 $250d,.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`sutiiect to attachment. Also, a certified copy of the recorded notice of commencement must'be" posted at th86' job site
for the first inspectiorl. which occurs seven (7) days after the building permit is.issued. In the absence of such posted notice, the
insnprtinn will not he onnrovpd and n rpinsnprtinn fpp will ha rhnrged
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day o(f� l�"�' 20 19 by
ECG' Il.'�3 !`�T.l(1crGs who is personally known to
me or who has produced
,1''ciY�l
identification and who did take an oath. G
NOTARY PUBLIQ') A `A~ ,
Signature
CONTR TOR
. . I I . , . '/ . . -
The foregoing instrument was acknowledged.before me this
�day,
of 20 It by
U�I�C�SLJ r"C,1VC1, f • .., who is personally known to
me or who has- produced '�DC-�"G(�LV V,00-A�n as
identification and who did take an oath.
NOTARY
`r
Sign:
Sign:
Print:
Print:
% C4
�NtY P° DORIS ANAYS MAIRINEZ
Seal:
Seal:
►�'� P
DORIS ANAYS MARTINEZ
Notary Public State of Florida
Commission N GG 250751
Notary Public •State of Florida
Commission 8
•••••• My COMM. Expires Feb 14, 2011
^°`."•••'•
GG 250751
M y Comm. Expires Feb 14, 2021
************** ** * *
********************
** ***********
APPROVED BY--� ('e
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)