PL-20-558 (2)Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 03/24/2020
Parcel Number
142 NW 111TH ST, Miami Shores, FL 33168 1121360030440
Contacts
Permit 0.:
Permit Type: Plumbing - Residential
Work Ctossi}icatron: Alteration
Permit Status:
Expiration: 09/21/2020
MEDEROS INVESTMENTS L.L.C. Owner
13873 SW 41 TER, MIAMI, FL 33175
Business: 7863381385 promax4@yahoo.com
BUILDING SERVICE TEKS LLC Contractor
JESUS CARMENTE
5323 MILLENIA LAKES BLVD, ORLANDO, FL 32839
Business: 3059862217
Description: PLUMBING Valuation: $ 2,500.00 Ins ection Requests:
3t15=�-4�49
Total Sq Feet: 1,070.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.80
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.60
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Work Without Permit Fee
$100.00
Total:
$211.90
Payments
Date Paid Amt Paid
Total Fees
$211.90
Credit Card
03/24/2020 $211.90
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. 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. Futhermore, I authorize the ab"med contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor
Date
March 24, 2020 Page 2 of 2
Miami Shores Village
r
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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
ENTERED
MAR 13 2020
BY:
_<aD_
FBC 20i=i
Master Permit No.
Sub Permit No.1 - 03 - 2C�
❑ REVISION ❑ EXTENSION ❑RENEWAL
['PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: N7, �JV4 III S*
City: Miami Shores County: Miami Dade Zip: 33 l L &
Folio/Parcel#: I /- 1 --ao3 -O O Is the Building Historically Designated: Yes . NO X
Occupancy Type: oQtf Load: Construction Type: C 135 Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): IVtt LIOS 'IA44^AWt�S L"— Phone#:���0
Address: /?R -13 Sv-1 y i t t,-
City: WI; &"
Tenant/Lessee Name:
Email:
State:
hone#:
p: 3 3 1 "S
CONTRACTOR: Company Name: [ j. A, NA �eirVl (L k2 kS L-C6
c— Phone#: (3-06) 01A-a21 -4
Address: ri % ?1 1 1 1 I'0Ni a 1�G V'.S pwa -1:�-3rp
City:
Qualifier Name:
Zip: 3 R 3 ��
one#:
State Certification or Registration #: 'C FC `49_c\0%1o3 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ X Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $
Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $
Technology Fee $,
Training/Education Fee $
DBPR $
Notary $
Double Fee $ 0 Q$ . (2k�_
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ 311 - 9 a_
Bonding Company's Name (if applicable)
Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City State 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 Signatu
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
4 day of ®®a/ 20 zy by
�I�DtC.t`D who is personally known to
me or who has produced 7G Z>4L . as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instr ent was acknowledged before me this
day of Mr- �L 20 94, by
who is personally known to
me or who has produced r,( l CcT,(G as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Sign:
Print:
i
Print: A L"7Ctrc c,
Q
Seal: try Aim6e de la Yncera Garcia
_ _ — _ —
Seal:
Al NOTARY PUBLIC
* STATE OF FLORIDA
o ; PubliDAVIc
: ,��, Notary Public - State of FlJ
Gtate o
2 Comm# GG057433
o�i?i Commission N GG 25069
M Comm. Ex i es 0
*I'******ilirfu �1*
APPROVED BY
��l�G
Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)