PL18-3331Location Address
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
P 1 L-A- -- Il 6t
Issue crate: 11/20/2018
Parcel Number
371 NE 103RD ST, Miami Shores, FL 33138 1121360130270
ontacts
Permit No.: PL -10-18-3331
Permit Type: Plumbing - Residential
Work Classification: Poul - Private
Permit Status: Approved
Expiration: 04/29/2019
Description: NEW POOL Valuation: $ 2,000.
00Ins
ection Requests:
305=762-4949
Total Sq Feet: 299.00J----
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 50.00
Scanning Fee 3.00
Technology Fee 3.75
Total: 112.35
Building Department Copy
Payments Date Paid Amt Paid
Total Fees 112.35
Check # 15157 11/20/2018 62.35
Check# 15151 10/31/2018 50.00
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 certip that all the foregoing information is accurate a5q that all work will be done in compliance with all applicable laws
r in on and z Ing. thermore, th ' the above na `ed for to dot a work ated.
A thori d Signature: Owner / pplicant / Contractor / Agent Date
November 20, 2018 Page 2 of 2
Miami Shores Village RECEIVED
Building be'partment;. OCT 31 2018
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 201-4
BUILDING Master Permit No. i' O—S
PERMIT APPLICATION Sub Permit No. I "3 I
BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
UMBING MECHANICAL PUBLIC WORKS CHANGE OF [:]CANCELLATION SHOP
1 C I
CONTRACTOR DRAWINGS
JOB ADDRESS:3*1 I h e . 10 V+'.
City: Miami Shores County: Miami Dade Zip: 3313$
Folio/Parcel#: It Oa -70 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): (QOh?L<<O N C&elc Phone#: "[a " 7--5:sAddress:Jn I •
QL •
lO3 "• _
City: State: Zip:331
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: I `S` ' _LI'lC • Phone#:?C6 c=i l %Cly
Address: l b`
tt •
c3 d C 1 3
City: \ Starter Zip: 36J
Qualifier Name: Lkskl "-C.i'! .dC Q Ali' . Phone# -A0 LB I g.;'
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/EEsngineer: -''
ff (_ \
s' Phone#: •x l "' `
Address:
f
S + .C U• vii ' . t I) City: } c,Q(i l
f
State:'T(, Zip: _3315
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Addition Alteratio]nJ (
New Repair/Replace Demolition
Description of Work:
Scanning Fee $
Technology Fee $
Structural Reviews $
Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Specify'"color of color thru.,tile: 1
r
Fee $ C&
Scanning Fee $
Technology Fee $
Structural Reviews $
Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
t City Si
ti
Mortgage Lender's Name (if applicable)
Mortgage Lender's Adpress
City G : f State
R
P-1
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. s ,
WARNING T, 'bWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR,0RO0ERTY""1F YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a co
promise in good faith that,a
whose property iss bfect'to
for the first inspection whic
inspection will not b`e approq
Signature `
ion to the issuance of a building permit with an estimated valueaezceeding $250O,.the applicant must
y of the notice of commencement and -construction lien law brochure will be delivered {to••thq person
achment. Also, a certified copy of the recorded notice of commencement must be posted'at *the job site
ccurs seven (7) days after the building permit.is• issued. In the absence of such posted notice, the
and g reinspection fee will be charged.
1WNEI34or AGENT
The foregoing instrument wa acknowledged before me this
d4 Of c'J
L
20 19 by
CQolln?lp oat s who is personally known to, 3.
me or v K, has produced pEr59ryC h l i(,10 -06s
t 1J. e !
identification and who did take ari/bath. `
NOTARY P
Print: b'-4lZ-W(
7P, DORIS ANAYS MARTINEZSeal:
ry Public State of Florida
ommission t GG 250751
omm. Expires Feb 14, 2021
Signatun
The foreL
i,
day
oft —
20 1g , by
Wltf r. 0 CL1X4 r. , , who is personally known to
me or who has -produced I6`l Lf XrG'i as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: •' '
Print: Z---6k6
Seal: °:
DORIS ANAYS MARTINEZ
Notary Public - State of Florida
Commission # GG 250751
My Comm. Expires Feb 14, 2021
APPROVED BY tl'—t' Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)