PL-18-883�sNO1S °�i
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
�YORtOp`
Phone: (305)795-2204
Peer NO. PL-4-18-883
Permit Type: Plumbing - Residential
t er' Wark classification: Pool - Private
Permit Status: APPROVED
Issue [date: 51412018 1 Expiration: 10/31/2018
Project Address Parcel Number Applicant
157 NE 101 Street 1132060131951
Miami Shores, FL Block: Lot: RACHEL & COLIN RILEY
Owner Information Address Phone Cell
RACHEL & COLIN RILEY 157 NE 101 Street (716)807-1312
MIAMI SHORES FL 33138-
157 NE 101 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
PARKWOOD POOLS AND PAVERS LL (954)583-3355
Type of Work: POOL PIPING
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$3.38
DCA Fee
$2.25
Education Surcharge
$0.20
Permit Fee
$225.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$235.23
Valuation: $ 800.00
Total Sq Feet: 0
Pay Date Pay Type Annt Paid Amt Due
Invoice # PL-4-18-67047
05/04/2018 Credit Card $ 185.23 $ 50.00
04/05/2018 Credit Card $ 50.00 $ 0.00
Avaname inspections:
Inspection Type:
Main Drain
Final
Rough
Review PIS
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 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 zoni=uthe'rreIauthorize the above -named contractor to do the work stated.
INoa c'n0, jZo`pS May 04, 2018
Authorized Sig ture:Owner / Applicant / Contractor / Agen Date
Building Department Copy
May 04, 2018 1
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 20v-::)
BUILDING Master Permit No. - t3p I�) - 962-
PERMIT APPLICATION Sub Permit No.:2 6 -683
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
-OLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS: Nta � L 10 f s .
City: Miami Shores County: Miami Dade Zip•
Folio/Parcel#: `�� • ��`� �� 1 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple
�Titleholder): M Im IE'V Phone#:7&-_ O(� -} - I&
Address: 1ST ME 10 t ;�A • c .
City: V i\ `� i � State: j Zip: 3--M (�
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: l (>,C1C� �F Phone#:954-s 3 - &�
Address: �ac, (a j 1
City: 3%aimw State: oy L Zip:
Qualifier Name: �j r(l5 Phone#: "1 �y
State Certification or Registration #:
Certificate of Competency #:
DESIGNER: Architect/Engineer: 1J (a Phone#:
Address: City: State
Value of Work for this Permit: $_ 9m , — Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition ❑ Alteration EX New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ `✓� ' Permit Fee $.. CCF $
Scanning Fee $
Technology Fee $
Radon Fee $
Training/Education Fee $
DBPR $
CO/CC $
Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
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
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 th# notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to at ach t. Also! ertified copy of the recorded notice of commencement must be posted at the job site
for the first inspection w occ s se J days after the building permit is issued. In the absence of such posted notice, the
inspection will no 'rove cj> d spection fee will be charged.
Signature
OWNER or
The foregoing instrument was acknowledged before me this
�L day
of 01andAz 2018 by
who is personally known to
me or who has produced CVVue IiQ4&A.e� as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: e v l
Seal:
�-0y N Notary Public State of Florida
Adrian Rojas Pierrend
My Commission GG 183868
or Expires02/07/2022
Signature All--Pdoel —
CONTRACTOR
The foregoing instrument was acknowledged before me this
c2 day of �-&- 20 IT by
R,twict /' d4n s who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: ,n I I
Seal:
a4���
ao
*********************
APPROVED BY / Plans Examiner
Structural Review
Notary Public Statfi of Florida
Addana Rojas Plerreno
My Commission GG 18C,e6a
Expires 02/07/2022
as
Zoning
Clerk
(Revised02/24/2014)