PL-18-3039Miami Shores Village �j
10050 2 Ave
Miami Shores FL 33138
Y
305-795-2204
Issue Date:
Location Address Parcel Number
560 NE 107TH ST, Miami Shores, FL 33138 1122310140030
Contacts
Permit NO.: PL4048-3039
Permit Type: Plumbing - Residential
Work Classiffeation. Poem - Primate
Permit Status: Approved
Expiration: 09/ 23/2019
LAWRENCE CIANCIO Owner EPOCA CORP Contractor
560 NE 107 ST, MIAMI SHORES, FL 331387139 DAVID BRADLEY
Other:3057836307
Business: 3057785103 ana@infantryconstruction.com
Inspection Requests:
Description: LEGALIZE PLUMBING EQUIPMENT FOR POOL Valuation: $ 400.00
13OV, q2-449
TotalSq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Plumbing - Pool - Residential
$50.00
Scanning Fee
$9.00
Technology Fee
$3.75
Work Without Permit 1st Offense
$100.00
Work without Permit 2x Permit Fee
$100.00
Total:
$317.55
Payments
Date Paid Amt Paid
Total Fees
$317.55
Credit Card
03/26/2019 $267.55
Credit Card
10/03/2018 $50.00
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, 1 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.
OWNEW AFFIDAVIT: certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulati constyaF . an zoning. Futhermore, I authorize the above named contractor to do the work stated.
(I� L
/ Applicant / Contractor / Agent Date
March 26, 2019 Page 2 of 2
Miami Shores Village
REOEIVED
Building
Department
OCT 0 3 10i8
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 �1
INSPECTION LINE PHONE
NUMBER: (305) 762-4949 (J b
FBC 201'-4
BUILDING
Master Permit No. DPP iS—�:3
PERMIT APPLICATION
Sub Permit No. �I " e�03q
❑BUILDING ❑ ELECTRIC ❑ ROOFING
❑ REVISION ❑ EXTENSION ❑RENEWAL
[PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
^ `
JOB ADDRESS: b 1 V� �� t�-M' V—
City: Miami Shores County:
Miami Dade Zip: gS1101
Folio/Parcel#:
Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:
Flood Zone: BFE: FFE:
ff
OWNER: Name (Fee Simple Titleholder))::V_� W'Aj �� C�
((11
CA G� d Phone#: �� �b2
Address: a c) N)i S y1 1 qe 'r
City: �Ak \y Yk S State: %
li Zip: c7 f b
Tenant/Lessee Name:
Phone#:
Email:
CONTRACTOR: Company i% O
Phone#:
�Name:
L"
Address:
City: ,``v''
Zip:
,� , ^State:
Qualifier Name: ��V, 1� Y �l��x�!)
Phone#:
,
State Certification or Registration #: C oc
1
Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address:
City: State: Zip:
Value of Work for this Permit: $ :!� 0o
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑
New Repair/Replace ❑ Demolition
Description of Work: t p A CkA _ Z 12 MU XX\b k_ n C�
Q CA" WffiQ (1t -2 r CC6
f...»!`.. :ie.4C .�yR. Ya, .. k•.:,aY :r7 'slt7.
specify color of color thru' die:
Submittal Fee $ Sn A� Permit Fee $ I V O
$ C / � $
F CCF�sy~wf CO C
Scanning Fee $ Radon Fee $
DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $ 160
Structural Reviews $
Bond $
�'1 ®O
^7
TOTAL FEE NOW DUE $ �� 1 SS
(Revised02/24/2014) 1 ` h ij
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if. applicable) _
Mortgage Lenders Address
City State
Zip
Zi
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 S PIR-%kPr 120 by
-UwrPn[p C1 Gnat a , who i p rsonally known o
me or who has produced
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 i by
� rnv 16 6r(J\ t J who isqiiisonall to
as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
as
Sign: ��L ` Sign: (,,,*AU&�
Print: Q ` a Print: -o \
�J& Notary Public - State of Florida y. �: s ? Notary Public - State of Florida
Seal: �; Seal: : CommissionGGt79596
Commission # GG 179596 €'.
': t> • `M Corrm. Expires May 21. 2022 My Comm. Expires May 2 t. 2C22
cam'' Y
•"•••.1:° - Bcrded tro,;ch Na,xna Nc:ary Assn. ••....,..`•' Sdreec :'r_,;cr, �.a�ena Nc:ary As<.c.
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)