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PL-17-1031�` yttoees L� L�GOR11D Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit NO. PL -4-17-1031 Permit Type: Plumbing - Residential erlI I' W©rkClassifrcation: Addition/Alteration Permit Status: APPROVED Parcel Number Issue Date: 4124/2017 1 Expiration: 1012112017 Applicant 1460 NE 103 Street 1132050310060 Miami Shores, FL Block: Lot: CHRISTOPHER SAVITS Owner Information Address CHRISTOPHER SAVITS 1460 NE 103 ST MIAMI SHORES FL 33138-2626 Contractor(s) Phone Cell Phone CLIVE G NELSON PLUBING INC (954)934-5151 Type of Work: REMOVE AND REINSTALL FIXTURES IN MA Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $5.40 DBPR Fee $4.73 DCA Fee $4.73 Education Surcharge $1.80 Penalty Fee $100.00 Permit Fee $315.00 Scanning Fee $3.00 Technology Fee $7.20 Work without Permit Fee $315.00 Total: $756.86 Cell Valuation: $ 9,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -4-17-63688 04/24/2017 Credit Card $ 706.86 $ 50.00 04/13/2017 Credit Card $ 50.00 $ 0.00 mvanaoie 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 and zoning. Futhermore, I authorize the above-named contractor to do the work stated. April 24, 2017 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy April 24, 2017 %g6� 3�7 Zs�� Miami Shores Village APR 13 2017 Building Department BY:_ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 .� I INSPECTION LINE PHONE NUMBER: (305) 762-4949 � l FBC 20N� BUILDING Master Permit No. I 2-S-0 0 PERMIT APPLICATION Sub Permit No. ?L ' i 6,3 i BUILDING ❑ ELECTRIC ROOFING REVISION ❑ EXTENSION 7RENEWAL 21(LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 10B ADDRESS: /`tE70 Ilj I03 ' "- City' Miami Shores County: Miami Dade Zip: 331 39 Folio/Parcel#: � I— 3 ; - - Q 31 - C30(,0 Is the Building Historically Designated: Yes NO ✓ Occupancy Type: Load: Construction Type: Flood Zone:)4 e- BFE: FFE: OWNER: Name (Fee Simple Titleholder): m- 2 1�IZA c.L, Phone#: 30 A_--4 - f 4 s A Address: I 6o PEE to -1-4 S� -Q-�- City: V ,n;.A � �4 State: zip: 33 N P, Tenant/Lessee Name:�ee ' 4- • Phone#: Email: Qq+G6y-ofat-j'�q 0-01-C-004 CONTRACTOR: Company Name: %� "�y-We-Phone#:, �))S Address: 1622 J12 a'LZ Z-? � City: I�°� moi'► State: /y�r%4r_b A Zi p: 33 o ZS Qualifier Name: CG0VIIc- q,�y/�� Phone#:9��'-�� State Certification or Registration #: �rc a -r6 ®1) Certificate of Competency #: / DESIGNER: Architecctt/En/gineer:Jal� - --f Phone#: Address: y- &3'I- r-e4"� u.> Q ) City: 60L State: Zip: 3X010 Value of Work for this Permit: $ ,Ok±VZ lbw' Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration El New ❑ Repair/Replace El Demolition Description of Work: ikeowy-C a-"Vj, r -c i & S�a �G r T v v -e f i h.' 1-1,4 5 1'E'e 1oC r �che ". Abw Specify color of color thru tile: Submittal Fee $ Permit Fee $3 (� ' 00 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ otary $ Technology Fee $ Training/Education Fee $ Double Fee � �(-t�' 0) + (� Structural Reviews $ Bond $ TOTAL FEE NOW DUE $06 (Revised02/24/2014) G7 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 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 a reinspection fee will be charged. Signatur Signature 2&�i OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The fore ggiag instrument was acknowledged before me this Q.day of tt�l2 l ii 120 1-7 by n�d �C day of /%� f 20 , by (1\11dtK SiIU1 rC who i ersonally know to C� ��✓'G j�"L who is personally known to me or who has produced as me or who produced�4a , 73 " `S © F as as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: --/ — - / =o`""�``�e: S ON TERR`! NELSON P ' ( Print: *i Y COMMISSION #FF061120 JAY S GOLDMAN Seal: ""a o,►�" Poen., Seal: '�!iF ... -oma°'' EXPIRES October 8, 2017 ,a, o; Notary Public -State of Florida •.,,��,..�� Commission # FF 228649 (407),39 -0153 FloridallotaryService.com Poc pM��yComm. Expires May 10, 2019 •'.,Eor fin.• APPROVED BY � Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)