PL-19-1637r
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
269 NW 111TH TER, Miami Shores, FL 33168 1121360010360
Contacts
Blessed Management Group Owner ECO -TECH PLUMBING CORP Contractor
269 111 MARIA ASUNCION TIMIRAOS
13291 SW 71 ST, MIAMI, FL 33183
Business: 3059695486
Description: ADDING A BATHROOM IN GARAGE (GARAGE Valuation: $ 1,500.00 Inspection Requests:
CONVERSION) r --762-4W4
Total Sq Feet: 646.00
Fees
Perlt No.: PL -0,7-19-1637
i
Permit Type: plumbing - Residential:
1U
Work Classification: Addition/Alteration
DBPR Fee
Penni€Status: Approved
Issue Date: 07/19/2019
Expiration: 01/15/2020
Location Address Parcel Number
269 NW 111TH TER, Miami Shores, FL 33168 1121360010360
Contacts
Blessed Management Group Owner ECO -TECH PLUMBING CORP Contractor
269 111 MARIA ASUNCION TIMIRAOS
13291 SW 71 ST, MIAMI, FL 33183
Business: 3059695486
Description: ADDING A BATHROOM IN GARAGE (GARAGE Valuation: $ 1,500.00 Inspection Requests:
CONVERSION) r --762-4W4
Total Sq Feet: 646.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.10
Check # 634
07/17/2019 $50.00
Check # 638
07/19/2019 $61.10
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. r
I
/ Applicant / Contractor / Agent
Date
July 19, 2019 Page 2 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
}-ECEIVED
JU 1 7 2019
BY: �{�.
L"
FBC 20 ���
BUILDING Master Permit No. — (( 1
PERMIT APPLICATION Sub Permit No. �-
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Z&1J Lam`' T -e r
City: Miami Shores
County:
Miami Dade
Zip:
Folio/Parcel#: lk--213 (e- C>01-05 (,&O
Is the Building Historically Designated: Yes NO
Occupancy Type: 5 Vk Load:
Construction Type: Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 3�Qs � 6nan.
G' m 0-� G-4-0�Phone#:
�1�(✓-4-23 119 1
Address: ug5-S o r— Ak-
2r 395 A
City: (IJI M�s
State:
FL
Zip: 3 3 ) (o Z
Tenant/Lessee Name:
Phone#:
Email:
CONTRACTOR: Company Name: ��
���
��rll$/��q
Phone#: 5 _ 9 - 6 -
Address: / 7DP7 A-4
City: �� /�i/7'l /
-State:C
Zip:
Qualifier Name:
s
Phone#:
State Certification or Registration #: ����i�? Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Add
Value of Work for this Permit: $ 150 O
Type of Work: r Addition ❑ Alteration
State: Zip:
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace
Description of Work: '05q- '4
❑ Demolition
Specify colorof color. thratile:
4 } f£ �� : iY14 t ,';f;.(• � ' Ig Si 4v. s�:a G'J i, 41 ')f.!".vi�;.! Yt,4 .•� {�
� 1 11
Submittal Fedje Permit Fee $ '> CCF $
S{ ' _ " i". j.!tS .; �. 1s.i•y.�j It
Scanning F66 $ �. ,r, •+•vlam w tA. •'r . Radon Fee.$ �? DB�R'$t' �� = •-Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $
s I..hf,,/, IF i 4 r
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
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 ` ::� , Signature
ci
OWNER or AGENT
The foregoing instrument was acknowledged before me this
%-14'"day of a%' 1!5 20 L9 by
Gn•A 9.0&,e who is personally known to
Me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: ��
Print: �C'� �a.� S o c -o I
CONTRACTOR
The foregoing instrument was acknowledged before me this
/t'144'day of 20 � by
who is personally known So
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: Y2
as
Seal: Seal:
i !r ORITTANY SOCOL ++�
W COMMISSION 0 GG 232035 ......... �BRITTANY SOCOI.
_sly
,oi � r Bonded Toru Pubpc tJndenwax ??. o• EXPIRES: June 26,2M
IRM Ow" TMu Wtwy Putdc Uftd&WW kers
APPROVED BY /00, Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)