PL-19-130Location Address
478 NE 92ND ST, Miami
r'nntartc
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
FL 33138
Issue Date': 02/06/2019
Parcel Number
1132060140020
Permit No.: PL-01-19-130
Permit Type: Plumbing - Residential
Work Classification: Pool - Private
Permit status: Approved
Expiration: 08/05/2019
THOMAS ROGER & CHRISTINA
478 NE 92 ST, MIAMI SHORES,
Mobile: 3054392855
Other: 3055461030
WHITE Owner
FL 33138
5 STAR PLUMBING SERVICES CORP Contractor
MANUEL PAMPIN JIMENEZ
11710 SW 180 ST, MIAMI, FL 33177
Business: 3057963607
Inspection Requests:
Description: PLUMBING FC R NEW SWIMMING POOL AND SPA Valuation: $ 1,600.00 305-762-4949
Total Sq Feet: 420.00
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
$3.00
Technology Fee
$3.75
Total:
$162.35
Payments
Date Paid Amt Paid
Total Fees
$162.35
Credit Card
01/17/2019 $50.00
Credit Card
02/06/2019 $112.35
Amount Due:
$0.00
Building Depa ment 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 pe mit 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 cgrtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
requlatipg ns ruction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Signature: Owner / Applicant / Contractor / Agent
Date
February 06, 2019 Page 2 of 2
Miami Shores Village RECEIVED
BUILDING I
PERMIT APPLICATION
Building Department N 1,7 zo,s
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY. I
Tel: (305) 795-2204 Fax: (305) 756-8972 T j1
INSPECTION LINE PHONE NUMBER: (305) 762-4949 1 � l
FBC 20
Master Permit No.v
Sub Permit No. i�� �� ` 1 S b
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
dPLUMBING ❑ ECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: '(
Folio/Parcel#: / Z� — b 00 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: "" Construction Type: ' I , / /Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
C jr S`4^-�-- 'v���^e- Phone#: �FO S
Address: /) ` 2YI p
City: • i /#*'L State: zip:
Tenant essee Name: Phone#:
Email:
CONTRACTOR: Compa
Address: /0 70 c
City:
Qualifier Name: /
State Certification or R
DESIGNER: Architect/E
Value of Work for this
Type of Work: ❑
Description of Work: _
Name: J �/ 12 Xy/n Phone#:
LA / d'� S'tf
aZ Zip: 3 3 3
t7 r/a 74'-Y'F�7 rail Phone#: _
istration #: C AG ,., `r ZOp 9 3 Certificate of Competency #: _
ineer: Phone#: _
City: State:
�rmit: $ 10 60, 0 0 Square/Linear Footage of Work:
dition ❑ Alteration ❑ New ❑ Repair/Replace
Specify color of color thru tile:
Submittal Fee $ t.::U
Scanning Fee $
Technology Fee $
Structural Reviews $_
Permit Fee $ It9b, a CCF $_
Radon Fee $ DBPR $
_ Training/Education Fee $
Zip:
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 2- • -:7J S
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Add
City
State
Mortgage Lender's Nam (if applicable)
Mortgage Lender's Add
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 th issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this juri diction. 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 WNER: 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 th t a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subjec 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 apj iroved and a reinspection fee will be charged.
The foregoing instru
a day of _
/"Ar5A/L4
me or who has
identification and
NOTARY
Sign:_
Print:
Seal:
ER or AGENT
t was acknowledged beforemethis
A) 20 _LSL� by
who is rs nally wn to
did take an oath.
AMME
MY
OMMISSKNI Y GG 159953
='» 'oV
••;
IRES: March 12, 2022
•... •°r
TAM Notary Na tw MI1MA S
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me�this
_ day of '�t9 1�"'�'Y 20 by
Yia,q v a 12a "n p ,�l who i rson known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
! 11YCOMMISSION 0 GG 15m
Seal: EXPIRES: March IZ 2022
•,mdw T} M Notary putt Wft"IW,
as
###########################################################################################################
APPROVED BY r / v 319 Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk