PL-18-2017BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N. end Avenue, Miami 5hore5, Florida 33130
fielt (305) 705-2�04 Fox; (305) 756-8972
INSPECTION LINE PHONE NUMBER; (305) 70-040
Sub P@rmit No:
EcE-IVED
Fit
A�� 2 4�2019
M.
(07t L
FOC 20 I-�
0BUILDiNQ 0 ELECTRiC ® ROOFING M REVISION ® EXTENSION []RENEWAL
EIPLUMBiNO ® MECHANICAL CIPFIBLIC WORKS C] CHANGE OF IN CANCELLATION 0 SHOP
CONTRACTOR DRAWINGS
JOB ADDRE55t
1147 NE 97 Street
Cat Miami Shores County: Miami Dade zip:
Folio/Par€el#; i5 the Building Niatori€ally Designated= Yet NA X
gceupanq Type: --- — Load; - — — Construction Type: -- - -- -Flood Zeno: _i Off;--- FFF:
OWNER; Nam@ (Fee 5implo TitlohPIdor) Irineau Romano Phone#:
Address; 1147 NE 97 Street
Miami Shores state° FL 7,1p; 33138
T@nant/I-es§ee Name: NA Phone#°
Email:
CONTRACTOR; Company Name:Mr. Cs Plumbing &Septic Phone#; 305-651-7859
Address 19932 NW 2 Avenue
aty; Miami State: FL zip; 33169
Qualifier Name: Kemble Ettrick Rhone#: 305-651-7859
state Certification or Registration #: SR061538 C€rtifi€ate of Competency #:
DE51ONER; Archite€t/Engineer: NA Phone
Address: City: State: Zip;
Value of Work for this Permit; Square/Nnear Footage of Work;
Type of Work; 0 Addition El Alteration New M Repair/Replace 0 9@m9litien
Dwirlptlon of work: _T j N 0 1_ �' T�--M I l 17 '� -y y r f 1
Specify color of color thriu tilo;_ ._
Submittal Fee $ — Permit Fee 41
5€anning Fee 0
Radon Fee $
Technology Fee $ Training/€du€anon Fee
Structural Review§
CCF CO/CC $
DBPR 0
Notary
Double Fee $
Bond $
(ft@NI§@ 0040914)
TOTAL FEE NOW DUE $
Bonding CPmpany'§ Nam@ (if appliP@hl@)
@ending €ompany'§ Addr@§§ _
City I MAP _ zip
M@rtgag@ L@nd@r'§ Nam@ (if appli€able)
Mortgag@ L@nd@r'§ Addr@ss
pity `hate --- zip -------
Application i5 h@r@by mad@ to Main a p@rmit to do th@ work and installation§ a5 indi€at@d: I certify that no work or installation has
€Pmm€n€@d prior to th@ i§§Nan€@ of a p@rmit and that aR work will b@ p@rform@d to mQ€t th@ standards of all Iaw§ r@gulating
€@n§tru€ti@n in this iiuri5d1€ti@n, I and@r§tand that a 5@parat@ permit must be §@€ur@d for ELECTRIC, PLUMRIN0, 5ION5, POOLS,
FURNACES, MAILERS, HEATERS, TANKS, AIR CONDITIONERS, €TF:::::
OWNER'S AFFIDAVIT: I €@rtify that all the for@going information i5 accurate and that all work will h@ don@ in €Pmplian€@ with all
appli€abl@ Iaw§ r@gulating €@n§tru€t1Pn and ?@ning:
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE 9F COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY, IF YOU INTEND
T9 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT,"
Noti€@ to AppliE-@nt; A5 0 condition to th@ 44ygn€@ of A building p@rmit with on e4tirngted vela@ €?r€leading $2500, thg oppli€@nt must
promi5g in good faith thot o copy of thg noti€g Pf €ommgn€gmgnt and €on§try€tion li€n lgw bra€home will b@ dglivgrgd to thg per§on
who5g propgrty 4Sybjg€t to ottgrhmgnt. Also, o €ertifigd copy of thg rg€ordgd notice of €ommgn€gmgnt my§t bg po5t@d gt th@ job Sit@
for thg first in5pg€tion which o€€yr4 Sgvgn (7) dgy5 Aftgr thg building p€rmit 4 155ygd, in thg 05gn€g of Su€h pASted noti€g, the
in5pg€tion will not bg approved and R r@Insp€€V@n fog will bo €harg@d.
Th@ f@r@going in5trum@nt wa§ a€kn@wl@dg@d before me thi§
day /pof A 20 by
� KPIA H I'l LKA N o , who N p@r§Pnally known to
m@ or who ha§ Produi @d i�,iye ice h a§
identifiEatiPn and who did tak@ an Path:
NOTARY PUBLI€r
signature
CONTRAUCIR
Th@ foregoing in§trument wa§ a€kn@wl@dg@d b@for@ m@ this
1 day of_✓;
_ _4 zA _ _� by
who i§ p@r§@Wally known to
m@ or who has produ€@d
id@ntifi€Mi@n and who did take an Path:
NOTARY PUBLIC;
Sign: Sign:
Print: 9 N al VAv6 n print'. / GHat.
A
liF' n
DONALD MARTIN ;0�� °° DONALD MARTIN
deal:
MY COMMISSION # GG102743 ate.' MY COMMISSION # GG10274.
EXPIRES May 08, 2021x9l?� EXPIRES May 09, 2021
Of *I#
APPRQV€D BY — �--� /� Plan§ Examiner _ _ zoning
Structural R@vi@w Cl@rk
(RPvjsed9?1?4/?014)
It
April 24, 2019
Mr. C's Plumbing & Septic Inc.
19932 Nib 11," Avennn
Ra flgx 69-3239. NIlnjnl, Florida 33269-0239
Dnt1e: (301) 611-785915652 Fa: (305) 651-5610
Blow;(954) 029-2140
Village of Miami Shores
Miami Shores
92
ThI@ I@tt@F @@Fifrm th@t th@ ownw mF geftd th@ job th@F@for@ w@ did not do th@ W®Fk W th@ pF@p@Fty:
Best regards,
�Owr
Kemble Ettrick
Operations Manager
License SR061536
Miami Shores Village
Building Department RECEIVED
10050 N.E.2nd'Avenue, Miami Shores, Florida 33138 JUL 2 % 201
t(j,
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBCc20 n
Master Permit Noll' l
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
ME PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1147 NE 97 Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3205-017-0040 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Irineu Romano Phone#:
Address.1147 NE 97 Street
City: Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: NA Phone#: _-,
Email:,&M -
CONTRACTOR: Company Name: Mr. C's Plumbing & Septic Phone#: 305-651-785 '
Address. 19932 NW 2 Avenue
City: Miami State: FL Zip: 33129
Qualifier Name: Kemble Ettrick Phone#: 305-651-7859
State Certification or Registration #: SR061536 Certificate of Competency #:
DESIGNER: Architect/Engineer: NA Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 3500.00 Square/Linear Footage of Work: 300
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition
Description of work: Install septic tank and drainfield
Specify color of color thru tile:
Submittal Fee $ J0
J Permit Fee $ ��`� �' CCF $ CO/CC $
Scanning Fee $ Ly Radon Fee $ 00 DBPR $ - Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
COS
TOTAL FEE NOW DUE $ G C� — `
613.66
Bonding Company's Name (if applicable) NA
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
NA
State
Application is hereby made to obtain a permit to do the work and instal
commenced prior to the issuance of a permit and that all work will
construction in this jurisdiction. I understand that a separate permit
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
Zip
Zip
lations as indicated. I certify that no work or installation has
be performed to meet the standards of all laws regulating
must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
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 brochurepp be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commenceme hosted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the obs �clf t d notice, the
inspection will not be approved and a reinspection fee will be charged. «cz
Signature
OW or AGENT
The foregoing instrument was acknowledged before me this
��1;4 day of _ /u �� 20 lo' by
e4) who is personally known to
me or as
identification and who did take an oath.
Signature avit
CONTRACTOR
The foregoing instrument was acknowledged before me this
,V day��o'�f`` Jµ 6� , 20 �� by
. 441e vwr-c,6— who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
1)Sign: Sign: 'Do
Print: Ca t,Ipt MA ;' Print: �vGialot y(Rr{��
Ly
YDONALD MARTIN
Seal:DONALD MARTINSeal:MY COMMISSION# GG102743
MYCOMMISSION # GG1^ EXPIRES 02743 'r;,;; EXPIRES May 09, 2021
May 09, 2021
*********************** ***********************************************************************
APPROVED BY, Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)