PL-17-2707Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. PL-11-'I 7-2707
Pemlit Type: Plumbing - Residential
it Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 11/1612017 1 Expiration: 05/15/2018
Project Address Parcel Number Applicant
114 NE 106 Street 1121360050070
Miami Shores, FL 33138-2037 Block: Lot: JACQUELINE IRWIN
Owner Information Address Phone Cell
JACQUELINE IRWIN 114 NE 106 Street
MIAMI SHORES FL 33138-
II IM�l49
114 NE 106 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
PSG PLUMBING SERVICES, INC (305)796-7304
Type of Work: PLUMBING INTERIOR RENOVATION AS PER
Type of Piping:
Additional Info: PLUMBING INTERIOR RENOVATION AS PER
Bond Return :
Classification: Residential Scanning: 1
Fees Due Amount
CCF
DBPR Fee
DBPR Fee
DCA Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
$6.60
$0.00
$5.78
$0.00
$3.85
$2.20
$385.00
$9.00
$8.80
$421.23
Valuation: $ 11,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-11-17-65651
11/16/2017 Credit Card $ 421.23 $ 0.00
Available Inspections:
Inspection Type:
Review Plumbing
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 ass 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 AAFf�D� IT: I ify t egoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructiorl1ar�� z n th authori the above -named contractor to do the work stated.
November 16, 2017
Authorized atu ner / Applicant / Contractor / Agent uate
Buildin\ epartment Copy
November 16, 2017 1
Miami Shores Village CF--I VFD
NOV 22017
Building Department I
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 201�
BUILDING Master Permit No. •1` C- 1 % I S
PERMIT APPLICATION Sub Permit No. PL 0 -DO)
❑BUILDING
❑ ELECTRIC ❑ ROOFING
❑ REVISION
❑ EXTENSION RENEWAL
PLUMBING
❑ MECHANICAL ❑PUBLIC WORKS
❑ CHANGE OF
❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS: )
11✓ % d /per
City: Miami Shores County:
Miami Dade
Zip: (�
Folio/Parcel#: j (
-Z 7 3.4 •- CDs— 60 7T
Is the Building Historically Designated: Yes NO �
Occupancy Type:
Load: Construction Type:
Flood Zone: BFE: FFE:
OWNER: Name (Fee
Simple Titleholder): 2 w i
Phone#: (4 k o- r'
Address:___
City: _"::eA c u LA4 a State: )—
Zip:
Tenant/Lessee Name:
Email
ne#:
CONTRACTOR: Company Name: 5 C /���. rti Si k (' Phone#:U�^ -770 y
Address: 3 3 q7Z, W L.J 1 Z S-
City: &) l!
Qualifier Name:
Zip: J-q
'
Phone#: r 6
_ 3/S=
State Certification or Registration #: Certificate of Competency #: a
DESIGNER: Architect/Engineer: cct of t3 Sr(( Phone#:
3 7 lc,ic �� s
Address: City:.-aful" r S/CcfLs State: C` I Zip:
Value of Work for this Permit: $ I I1 0—&"0 Square/Linear Footage of Work: 7 07D '—,
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: %� ��' ti'1 eU L/ c- a 7 & �' l
riY1S Y 1 c) r "l'1UVCA
vb
Specify color of color thru tile:
av
Submittal Fee $ Permit Fee $ _S ' '� CCF $ (010CJ CO/CC $
Scanning Fee $ �•Q Radon Fee $ 3• 4'-S DBPR $ �' Notary $ '0"
Technology Fee $ V Training/Education Fee $ 2, %-*"' Double Fee $
Structural Reviews $
Bond $
C-.
TOTAL FEE NOW DUE $ Li 7-1 • 23
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City Stahl
Mortgage Lender's Name (if applicable)
Mortgage Lenders Address
City _ I State
Zip
zip
Application is hereby made to obtain a per6t to do the work and instaf!I tions as indicated. I certify that no work or installation has
commenced prior to the issuance of a peirmit and that all work will He performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit ust 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 acul�rate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TOEREC I D A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWI& FOR IMPROVEME S TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LEN ER OR AN ATTORNEY BEFORE RECORDING
YOUR -NOTICE OF COMMENCEMENT." II
Notice to Applicant.• As a condition to the issuance of a building permit Ian estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and c�� istruction lien low brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the reco ed notice of commencement must be posted at the job site
for the first Inspection which occurs seven (7J days after the building permit is issued. In the absence of such posted notice, the
Inspection will not be approved and a reinspeition fee will be charged.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
2 -- day of 120 1 by
I-AQV LIoJ1. I1LWs�who ispersonallyknown to_
me or who has produced as
identification and who did take an oath
"'L6NTRACTOR
The fc J� ring instrument was acknowledged before me this
day of _ 10 ,90 b Y1 , M 20 / ? , by
I 2' who is personally kaaWn to
me or ho has produced as
identiff cation and who did take an oath
o�n.. i'
-- \J J : I Sign
Print: G Ifir�b �: C-F4Mt�/5 L �,L
Print:
�: CHASE CAMPBELL
Seal:' MY COMMISSION i FF 200055 Seal:
nF EXPIRES: February 17, 2019
APPROVED BY
(RWiSed02/24/2d14) -
Plans Examiner
C
Structural Review
LAURA FARMY,
* * MY,ISSION II FF 188027
#SPIRES: March 16, 2019
+��n�•`� ad;¢ihtu.BWptNot rySerrkes
Zoning
Clerk