PL-19-8Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 02/14/2019
Location Address Parcel Number
550 NE 102ND ST, Miami Shores, FL 33138 1132060171041
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Permit NO.: PL -01-19-8
Permit Type: Plumbing - Residential
Work Classificaftar Pool - Prh ate
Permit Stcaus, Approved
Expiration: 07/01/2019
IRENE HEGEDUS Owner NATIONAL POOL DESIGN LLC Contractor
550 NE 102 ST, MIAMI SHORES, FL 331382455 ALFREDO RODRIGUEZ
Other: 3057250672 2423 SW 147 AVE SUITE 212, MIAMI, FL 33185
Business: 3055591020
Mobile: 7862675595
Re
Description: PLUMBING FOR POOL Valuation: $ 1,000.00 nests:
305-762-4Inspection ion Re
Total Scl Feet: 160.00
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
$100.00
Scanning Fee
$9.00
Technology Fee
$3.75
Total:
$167.55
Payments
Date Paid Amt Paid
Total Fees
$167.55
Check # 1537
01/02/2019 $50.00
Credit Card
02/14/2019 $117.55
Amount Due:
$0.00
Building Department Copy
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 annrict ' conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. Ina pti grmit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are re uireCTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFID I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating co str do an mg. Futhermore, I authoriizz-etlthe ab a named contractor to do the work stated.
7TH Z- 2-/`/. 101
Autl or ignature: OwnV/ Applicant / Contractor / Agent Date
February 14, 2019 Page 2 of 2
Miami Shores Village RECEIVED
Building Department pN 02 2019
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.�
PERMIT APPLICATION Sub Permit No.T' I 1 —6
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores -1 County: Miami Dade Zip: 33130
Folio/Parcel#: 11— 3 2ID6 - ®/ ` 091 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): _T� if GD Phone#:
Address: 5576 N 6 0 2 J
City: m4m �S 1ft P-65 State: � Zip:
Tenant/Lessee Name: _
Email: :�a'C-K
S
ne#:
CONTRACTOR: Company Name:/�� Ds42l `-" Phone#: 3. 5 J / 'L o ��
Address: Z1 Z -S S� < YI�
City: 1414y-1 l n- n, State: Zip:
Qualifier Name: A L�i "O Pd d e � l)6Z Phone#: 3'-55;9. /� 2
State Certification or Registration #: (wi- lq 37? Certificate of Competency #:
DESIGNER: Architect/Engineer:
ne#:
Address:City: State
4Value of Work for this Permit: $ O Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
uv ti 31 rv(r 7-7) 2 00® t
Specify color of color thru the:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $,
DBPR $
Zip:
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ i{
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.
Signatu
W
OWNER or AGENT
The fore Voi irig instrument was acknowledged before me this
Zd
day �f�0 , 20 A_, by
l�
�E'G `1 V`J who is personally known to
me or who has produced P L_ as
identification and who did take an oath.
NOTARY PUBLIC:
` ."'Y'P��•.,, CRiSTINARObf11Gi1Crt!.
;a t NotaryPublic - State ofFlorida
• : Commission n GG 105164
Sign: t ires May 16, 2021
Bcrded thrcugh Nalioral Notary Aw,
Print: swq
Seal: fedVJA-
4ZJJ7_JfV,4
. 1 I rj
Signature A --,I
CON ACTOR
The foregoing instrument was acknowledged before me this
day of 06 '6*1 O � , 20 15" , by
Ae-fa-f1oa �OG Q IZ L;U2, who is personally known to
me or who has produced ® I _ as
identification and who did take an oath.
NOTARY PUBLIC: ; tPRY'P� •. CRISTINA RODR GUEZ
o
Notary Public - State of Florida
Commission GG 105164
My Comm. Expires May 16, 2021
OP,Fl`" BondedthrcucFNtBcralNewyAsw
Sign:
Print:
Seal:
APPROVED BY .� �/ L�— Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)