PL-18-377Miami Shores Village
�s�!O1tSy��
10050 N.E. 2nd Avenue NE
"
Miami Shores, FL 33138-0000
Phone: (305)795-2204
F�ORLDp'
Permit NO. PL--18-377
Permit Type: Plumbing - Residential
ri Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 2/1612018 1 Expiration: 08/15/2018
Project Address Parcel Number Applicant
1569 NE 104 Street 1122320320160 ALAIN &CARLY GONZALEZ
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
ALAIN & CARLY GONZALEZ 1569 NE 104 Street (786)277-9756
MIAMI SHORES FL 33138-
1569 NE 104 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
ORIGINAL PLUMBING, INC
of Work: REMODEL KITCHEN, UPSTAIRS BATHROOM
of Piping:
onal Info: REMODEL KITCHEN, UPSTAIRS BATHROOM
Return :
ification: Residential Scanning: 3
Fees Due
Amount
CCF
$9.60
DBPR Fee
$8.40
DCA Fee
$5.60
Education Surcharge
$3.20
Permit Fee
$560.00
Scanning Fee
$9.00
Technology Fee
$12.80
Total:
$608.60
Valuation: $ 16,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-2-18-66443
02/16/2018 Credit Card $ 558.60 $ 50.00
02/13/2018 Credit Card $ 50.00 $ 0.00
Avauame inspections:
Inspection Type:
Top Out
Final
Review Plumbing
Underground
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 regulating
construction agd,zonjnA Futhermore, I autroriAe the above -named contractor to do the work stated.
February 16. 2018
Au�No�ized Signature: Ofr / Applicant / Contractor / Agent
Building Department Copy
February 16, 2018 1
Miami Shores VillageIRE
Building Department EBY:2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (30S) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949FBC 201
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No. & Ig- 371
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[t�/ PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
C S t
r CONTRACTOR DRAWINGS
JOB ADDRESS: �, 6 ►V C , ��
City: 1Miami Shores County:
p Miami Dade Zip:
Folio/Parcel#: / t — 2-• .2 ^l�� L — d / b [/ Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: C�Flood Zone: _ l BFE: FFE:
OWNER: Name (Fee Simple Titleholder): At �-i v`t 6 L;yj 2 ,A.-( C 't Phone#: % Q C - -277— `7SR
Address: -?C)
City: ( SC Stater . Zip: 33l�
Tenant/Lessee i ame: Phone#:
Email:
14 CONTRACTOR: Company Name: l
Address: 1
! �Jy %l
City: " ��� <�G� S
Qua IifierName: Qf�(�IS L7l�l
State Certification or Registration #: C
DESIGNER: Architect/Engineer:
ate:
��1,KR'hone#: ?50--a 3'D`fl
zip:�^3S/ �I
one#: �S4
S r0 6 Certificate of Competency #:
Address: City: State: Zip:
Value of Work for this Permit: $ 1 /,9 , 6d� Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: �� i s Dt.�, �% ti. C �► �✓► G( ✓l,S+lni ✓S �Gt f ti boa 6(6 qz I
Specify color of color thru tile:
Submittal Fee $ dpoidPermit Fee $ 0 CCF $ CO/CC $
Scanning Fee $ Radon Fee $ S ' 00 DBPR $ V Notary $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ )
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 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
OWNER or AGENT
The foregoing �instrument was acknowledged before me this
OVr day of MID ID 20 1 J , by
�1 li+(ln����%yvho i ersonally know
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day ofD�&� . 20 /7 by
,w/'h-o is personally known to
me or who has produced Fky I�f��1 M�I
identification and who did take an oath.
Seal: , otit�g, CLARISSA A. RODRIGUEZ Seal °°ki
:..•, `s MY COMMISSION # GG 041376CIfL.Mn"
MY * COMMISSION t FF 07M61
eP EXPIRES: December 30, 2020 EXPIRES: March 10, 2016
Bonded 7bru Notary Pubk Urxlerwriters`oa\pr Bonded Tnru Bud Nola Sery
******* ******************* oqe Bon****** ***�**
APPROVED BY
Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)