PL-19-2893Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
1f-l--nf 11 ft�
Issue Date: 01/17/2020
Location Address Parcel Number
1085 NE 97TH ST, Miami Shores, FL 33138 1132050170080
Contacts
Permit NO.. PL-12-19-2893
Permit Type: Plumbing - Residential
Work Clossecotion: Alteration
Permit Status: Approved
Expiration: 07/ 15/2020
CHAD MASON Owner REGOSA ENGINEERING SERVICES INC Contractor
1085 NE 97 ST, MIAMI SHORES, FL 33138 GUSTAVO VELEZ
Home: 9542431064 15700 NE 2nd AVE, MIAMI, FL 331624267
Business:7862622964 CONTRACTORWORK@GMAIL.COM
Other:7863448720
Description: REPLAVE SHOWER VALVE, SINK AND FAUCET. Valuation: $ 1,200.00 Inspection Requests:
305-62-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.10
Credit Card
01/07/2020 $111.10
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 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 theme. aboye named contractor to do the work stated.
Authorized Signature: Owner
/ Applicant / Contractor / Agent
Date
January 17, 2020 Page 2 of 2
REC IVZD
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
DE 0 b 2019
BY: L rJ—
11A
FBC 20 14
BUILDING Master Permit No.-i l`- k2,- IG?
PERMIT APPLICATION Sub Permit No.�L
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS: , S
6T QC?aT
City: Miami Shores
County:
Miami Dade Zip:
3 -Z) ( 3�
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO
Occupancy Type: Load:
Construction Type:
Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): OL'z v _l it S'orr— Phone#:
Address: to€S A!,C q7* T-i -
City: A,-.K % S'l ref State: r4o' d 0, Zip:
Tenant/Lessee Name: / All' Phone#:���
Email: 444fdk C// ^ c� I (O" QA4 t,-/ Cow
CONTRACTOR: Company Name: k?�6oSA G—"o 6 fQ r-F Cef UfCCS Phone#: 3 0'5/-2 9 �) )
Address: A 00 fJ I=- 2°'� /�✓ /
City: !-& Ao,"o State: -P L Zip: 3 3 1 6 9
Qualifier Name: 60 STD V O V C—La iz Phone#: 3 051/ z QT 1,3 y l
State Certification or Registration #: G 4� G 1 q 2 2 9 Z Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑New Q,)tepail[/,F ep(ace,,,.,,....,[],Demolition
Description of Work: 1�?E7 P64ic—r-- 5LNO W6; — J Aryl
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Training/Education Fee $
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I
iu-vD
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 71 be delivered to the person
whose property is `subject to attachment. Also, a certified copy of the recorded notice of commenceme m st be posted at the job site
for the first inspecJoprovedoacnd
hi
urs seven (7) days after the building permit is issued. In the abs nce such posted notice, the
inspection will be a reinspection fee will be charged.
Signature\ /l/ I Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of L6CE M RG2 20 ) O) by
KAT A Q-y r1 H A who is personally known to
me or who has produced
as
The foregoing instrument was acknowledged before me this
day of 20 101 by
who personally known
me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
/ e.1110. ADRIANACECILIAVALENCIABORJA /% /�
Sign:AI•• = MYCOMMISSION�Gti318346 Signer"
`• : on
EXPIRES: Apra /. 2023 N
Print: A V Print: 4.4k 1l/f ` Ilan
Seal: Seal: !! IgI, LM Edith Girald0
Ooan6011111 #402005
E Iron: March 22 2023
APPROVED BY �4 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)