PL-18-887NO!%v LT Miami Shores Village
CCF
10050 N.E. 2nd Avenue NE
DBPR Fee
Miami Shores, FL 33138-0000
DCA Fee
Phone: (305)795-2204
toRtvA
0.20
Project Address Parcel Number
280 NE 91 Street 1132060190410
Miami Shores, FL 33138- Block: Lot:
Permit NO. PL -4-18-887
Permit Type: Plumbing - Residential
I It Work Classification: Pool - Private
Permit Status: APPROVED
issue oate.-5/412018 1 Expiration: 10/31/2018
nt
KIRSTIN INCELLI
Owner Information Address Phone Cell
KIRSTIN INCELLI 280 NE 91 Street (786)801-8654
MIAMI SHORES FL 33138-
280 NE 91 Street
MIAMI SHORES FL
Contractor(s) Phone Cell Phone
PARKWOOD POOLS AND PAVERS LL (954)583-3355
Type of Work: POOL PIPING
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential Scanning: 1
Fees Due Amount
CCF 0.60
DBPR Fee 3.38
DCA Fee 2.25
Education Surcharge 0.20
Permit Fee 225.00
Scanning Fee 3.00
Technology Fee 0.80
Total: 235.23
Valuation: $ 850.00
Total Scl Feet: p
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL -4-18-67051
05/04/2018 Credit Card $ 185.23 $ 50.00
04/05/2018 Credit Card $ 50.00 $ 0.00
Avaname i
Inspection Type:
Main Drain
Final
Rough
Review Plumbing
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. l. uther ore, I authorize the above-named contractor to do the work stated.
S May 04, 2018
Authorized ign ure:Owner / Applicant / Contractor /Agen Date
Building Department Copy
May 04, 2018 1
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
A 0 5 "
FBC 20
BUILDING Master Permit No jy--A (o "-RGy'C:)
PERMIT APPLICATION Sub Permit No. 1PW9 _` 9 -
BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
jj
CONTRACTOR DRAWINGS
JOB ADDRESS: -zzo Kc 1
City: Miami Shores ,
cam t
County: Miami Dade Zip:
Folio/Parcel#: \ - ! L 19 - nq ! nIs the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder)) %L-IK—r.2(, jUVV U INC -t -j I 1 Phone#: i/11•- z9 Y-`'/
Address: -
City: 'Mkok State: Zip:
Tenant/Lessee Name: Phone#:
Email: Il n,\U\•Cl _ _----
CONTRACTOR: ((Co`mpany Name: V,W 1 V U Qy.IC Phone#`7
Address: 7" ('-) tiliri2jc, ?Avd
City:rState: Zip:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Phone#:
Certificate of Competency #:
hone#:
Address:
pp
City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Addition Alteration New Repair/Replace Demolition
Description of Work: ` 21 QUA 6
Specify color of color
rtthru
tile:
Submittal Fee $ . vv Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Revised02/24/2014)
Radon Fee $
2 ItSr
a.Z115
Training/Education Fee $
CCF $ CO/CC $
DBPR $ 3• Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 18 S • 2-3
W
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.
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of (--L 20J by day of fTNC 20 (g by
re tOrd lJlY1(',¢ who is personally known to who is personally known to
me or who has produced b Itij-ytT as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
1Sign: Sign:
Print: Print:
yr
Seal:
Notary Public State of Florida
p Adrlana Rojas Pierrend
My Commission GG 183868
rSeal: " NotaNotary Public State of Florida
Adriana Rojas Pierrend
ja a Expires 02!07/2022 d My Commission GG 183868
M1d' Expires 02/07/2022
APPROVED BY I ! Plans Examiner Zoning
Revised02/24/2014)
Structural Review Clerk