PL-18-3223Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
1421 NE 104 ST, Miami Shores, FL 33138-2663
Contacts
Permit NO.: PL -10.1&3223
Permit Type: Plumbing -Residential
UW Work Classification: Addition/Alteration
Permit Status: Approved
issue Date: 10/23/2018 Expiration: 04/17/2019
Parcel Number Project
1122320320060 <NONE>
HENRY DOW Owner HENRY DOW Applicant
1421 NE 104 ST, MIAMI SHORES, FL 33138 1421 NE 104 ST, MIAMI SHORES, FL 33138
Other: 3056612533 Other: 3056612533
MG EXCELLENT SERVICES CORPORATION Contractor
MICHEL GARCIA
Business: 7862477067
Description: INTERIOR RENOVATIONS Valuation: $ 5,700.00
Inspection Requests:
2 BEDROOMS AND 2 BATHROOMS 3f}5-762-4949
Total Sq Feet: 875.00
Fees Amount
Application Fee - Other 50.00
CCF 3.60
DBPR Fee 2.99
DCA Fee 2.00
Education Surcharge 1.20
Permit Fee 149.50
Scanning Fee 9.00
Technology Fee 4.99
Total: 223.28
Payments Date Paid Amt Paid
Total Fees 223.28
Credit Card 10/23/2018 $173.28
Credit Card 10/23/2018 $50.00
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 and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. Aaccepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permi re required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
construction and zoning. Futhermore, I authorize the above naated contractor KUo the wft stated.
d `'1 a
re: Owner / Applicant / Contractor / Agent Date
October 23, 2018 Page 2 of 2
C
Tenant/Lessee Name: Phone#:
Email:' 0
CONTRACTOR: Company Name: c W ( V 11,4J Q Phone#: CJS " OGI v
Address: W
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Add
t
01 IgZT
Zip: -37017,
Phone#: aZg4 bbh
Certificate of Competency #:
Phone#:
City: State: Zip:
Value of Work for this Permit: $ S% d o Square/Linear Footage of Work:
Type of Work: AdditionAlteration New Repair/Replace Demolition
Description of Work: _[-me%
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Revised02/24/2014)
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Miami Shores Village
r,
Building Department RECEIVED
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Ott # o v
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. Q - C.` .1 ' 1 C.
PERMIT APPLICATION Sub Permit No -PL I -= 322-3
BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
jPLUMBING MECHANICAL PUBLICWORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
u K ) ( JOB ADDRESS: \- J .
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): N M '`, Phone#:_
Address: (-\Z l Jti r (D—X, s
City: !I'l i +^+1 s or' S State: L Zip: 2313?
Tenant/Lessee Name: Phone#:
Email:' 0
CONTRACTOR: Company Name: c W ( V 11,4J Q Phone#: CJS " OGI v
Address: W
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Add
t
01 IgZT
Zip: -37017,
Phone#: aZg4 bbh
Certificate of Competency #:
Phone#:
City: State: Zip:
Value of Work for this Permit: $ S% d o Square/Linear Footage of Work:
Type of Work: AdditionAlteration New Repair/Replace Demolition
Description of Work: _[-me%
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Revised02/24/2014)
Radon Fee $
Training/Education Fee $
CCF $ 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 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature / Signature ZAR
OWNER or AGENT CO T TOR
The foregoing instrument was acknowledged before me this The foregoinginstrument.was knowledged before me this
day of QG(O&-#,,- 20 by
UIC Zj
J110 daay of Lj(? 20 1 pby
f/ nrt who is personally known to who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARYLLIC:
Sign: Sign:
Print: 04 y / /%_ Print: E L-
Seal: Seal: JVUTG PEREZ
oF Notary Public State of Florida ;;' ; r c
Elsa Ambnz MY COMMIS -$ION # GG092521
g My Commission GG 148205 EXPIRES April 10, 2021
iC* IV Expires 01/3012022
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)