PL-16-1243Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit No. PL-5-16-1243
Permit Type: Plumbing - Residential
Perill'it Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 12/21/2016 1 Expiration: 06/19/2017
Project Address Parcel Number ADolicant
121 NE 96 Street 1132060132580
Miami Shores, FL Block: Lot: CK PROPERTY SOLUTIONS LLC
Owner Information Address Phone Cell
CK PROPERTY SOLUTIONS LLC 209 NE 95 Street (305)758-3133
MIAMI SHORES FL 33138-
209 NE 95 Street
MIAMI SHORES FL 33138-
Contractors) Phone Cell Phone
CLIVE G NELSON PLUBING INC (954)934-5151
Type of Work: PLUMBING WORK FOR ADDITION OF NEW M
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$5.40
DBPR Fee
$4.50
DCA Fee
$4.50
Education Surcharge
$1.80
Permit Fee
$300.00
Scanning Fee
$3.00
Technology Fee
$7.20
Total:
$326.40
Valuation: $ 8,600.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-5-16-59709
05/09/2016 Credit Card $ 50.00 $ 276.40
12/21/2016 Credit Card $ 276.40 $ 0.00
Avanaoie
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 and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
December 21, 2016
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
December 21, 2016 1
Af we
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
FBC 20N 0
BUILDING Master Permit No. f� - I G- `
PERMIT APPLICATION Sub Permit NoT. L 1 h— 12
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS: - _1 _ Z ` la f1 � 7
DRAWINGS
City: Miami Shores County: Miami Dade Zip: Zi -:? / 3
Folio/Parcel#:�%/ �Z 6 - 3 - Z 5 J�d Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: « S Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): (-A 7- Phone#: �v 5•` i5 �r �/ �3
Address:Z a y A, % S �7 T #1 7
City: 5 /State: Zip: / 7i
Tenant/Lessee Name: ! Phone#:
Email: i// �rC/ 02 /1 ��4 /-lo -l-vs - 6 t3 4'
CONTRACTOR: Company Name: L�L✓k Y• ���5� �'�` -✓q 1�C- Phone#:9� -3? •--S,-5/
Address:'/&Z%'? -9 - -2 /, 2-3
City: ' ' J..+r.'4v•—
Qualifier Name:
Zip:
D A) Phone#:
State Certification or Registration #: �r L-- Certificate of Competency #:
DESIGNER: Architect/Engineer: /V- 41-914 /`%%/114 i prt� A1.19 Phone#:
Address: /S- 2 /2- 4,?//E City: IW41 ''w /J Late:JCC- Zip: 7i C'Z
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: [5 Addition ❑ Alteration ❑ New Add [�tepair/,Replace El Demolition /
Description of Work: d d Ii. e DyI
w alActr b e fi Gi✓1 Gl room r c rp3 d d e T
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ �tTdo CCF $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ LAIJ
--
(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
State
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
day of 20, by
who is personally known to
me or who has produced I � L�L as
identification and who did take an oath.
NOTARY PUBLIC:
nn
Q'A4� ��t
Print:
4nn
°; JI D. PAMPLIN
Seal: 2 • ; , ° Notary Public - State of Florida
9j to My Comm. Expires Jan 13, 2017
OF Commission # EE 864892
Signatur 2%Ag�
CONTRACTOR
The foregoing instrument was acknowledged before me,;his
day of Al`� . 20 �t7, by
0;4�z_✓rG (�F, ti334COAJ, who is personally known to
me or who has produced �S-��7�i4 a as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
SHARON TERRY NELSON
,A�;-'' My COMMISSION#FF061120
;Foil"sy`1.153
; ' tXQ
PIRES c
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53
FloridallotaryService com
APPROVED BY �- �o� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)