PL-19-831Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
68 NE 91ST ST, Miami Shores, FL 33138 1131010200020
Contacts
Permit No.: L-04-19--831
Permit Type: plumbing - Residential
Work Classification: Pool - Private
Permit status: Approved
Expiration: 10/14/2019
Floyd Gonzales Owner ROSMEL POOLS INC Contractor
68 NE 91 ST, MIAMI SHORES, FL 331382808 WILFREDO JR LEIVA
gonzalesf@aol.com 9300 NW 25 ST 103, DORAL, FL 33172
Business: 3055927900
Description: NEW POOL Valuation: �2,000.00 Inspection Requests:
305-762-4949
LL. Total Sq Feet:
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Plumbing - Pool - Residential
$100.00
Scanning Fee
$18.00
Technology Fee
$3.75
Total:
$177.35
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$177.35
Check # 15212
04/29/2019 $177.35
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;
that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
Fdthermore. I authorize the above w2ned contractorto do the work stated.
April 29, 2019 Page 2 of 2
Miami Shores Village L-r-iJED
Building Department A 15 J019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 A-VIL
FBC eon
BUILDING Master Permit No. CAI O� I'O
PERMIT APPLICATION Sub Permit No.?L-04-19-- 1
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �Q� (W e ot k . G
City: Miami Shores County: Miami Dade Zip: 33l 3SS
Folio/Parcel#: llfi0'CQ;bo Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name
Address: �A
Simple Titleholder): o��d Cocl(Q�tlL L Phone#:
M�
City: K, Ck i m s' i�r� State:
Tenant/Lessee Name:
Email
hone#:
331,3 7
CONTRACTOR: Company Name: k6 rte 1 ��(��' Phone#:
Address: q �co � 'W 0�5 - Sol—k- 1D3
City: �'i _State: �L Zip:
Qualifier Name: W&�cV(il -,1
State Certification or Registration #: (_ ru. —
of Competency #:
305 S % Cl 10 I S -
DESIGNER: Architect/Engineer. Kz- rr) i Phone#:1�?�o1�j5—o
Address:y1g5 sw, XU al City: l��"n� State: Zip: 33IRq
Value of Work for this Permit: $ c), 5quare/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Work:
s
Specify.'color Of/
Submittal.Fee.$ .. `
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
I\/CIK/ l`VFV � .aa._.er... s.r.r kw-•;
thru tile:
Permit.Fee $
Radon Fee $
Training/Education Fee $
CCF $ r. x- CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
'Bonding Company's Address
City _ State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Addres
City A/ State
W
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 ai��N
Sign atur e
1-0
OWNER or NT CONTRACTOR
The foregoing instrument was acknowledged before me this
'�-I day of "1'&r U 20 _ 19 b
"1 op4j Gam+ ►WA16Z who ispersonally known to
me or who has produce yT!r"((IL► 1�7 as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
oZi day of 20 1 by
LJ IIfrlr� L VCt�who iserso'nlally known to
me or who has produced' .�+ USI (�-Y teas
identification and who did take an oath
NOTARY PUBLIC:
Sign:
Sign:_
Print:
Print: S
S
r -A
Seal:
=`;wY P0' ' DORIS ANAYS MARTINEZ
• �e Notary Public - State of Florida
Seal:
• DRI
aip DORIS ANAYS MARTINEZ
Commission # GG 250751
Notary Public - State of Florida
M
My Comm. Expires Feb 14, 2021
� d�'-°�
Commission „ GG 250751
.
My Comm. Expires Feb 14, 2021
APPROVED BY
gf� e_/ Z� �g
Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk