PLC-19-1565Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
D
Issue Date: 07/09/2019
Permit NO.: PLC-07-19-1565
Permit Type: Plumbing - Commercial
Work Classification: Septic
Permit Status: Approved
Expiration: 01/06/ 2020
Location Address Parcel Number Project
9723 NE 2 AVE, Miami Shores, FL 33138 1132060134210 NE 2 AVE SEWER CONNECTION
Contacts
GATOR 9723 NE 2ND AVE, LLC Owner GATOR 9723 NE 2ND AVE, LLC Applicant
1595 NE 163 ST 1595 NE 163 ST
MR C'S PLUMBING AND SEPTIC INC Contractor
MATTHEW COCKING
Business: 7865867473
Description: SEPTIC TANK ABANDONMENT Valuation: $ 5,000.00 Inspection Requests:
305-62-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$3.00
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$1.00
Permit Fee
$100.00
Scanning Fee
$3.00
Technology Fee
$3.75
Total:
$165.00
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$165.00
Credit Card
07/09/2019 $115.00
Credit Card
07/09/2019 $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 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 above named contrActor to do the work stated.
Authorized Signature: Owner
/ Applicant / Contractor /
Date
July 09, 2019 Page 2 of 2
Miami Shores Village RECEIVED
Building Department L 09 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972 "(]�
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 26
BUILDING Master Permit No. i L, I U -1008
PERMIT APPLICATION Sub Permit No.y� C_ O ff_ 19 - 5&6
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: *o 5-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): 4 AT07- COILS ► C- 2 Jky a U..C— Phone#: (3) V V- 1 lo-►O
Address: "t YS0 0W Ihla 4"r
City: MIctNn 1 t-AVES State: yt- Zip: -6-S0l &V
Tenant/Lessee Name: Phone#:
Email: M VAZC2 V I Z _ fiAToRI N 1i• cotes
CONTRACTOR: Company Name: S $a�j<<. T,ac_ Phone#: 'tS(Cei 5$(0--T,473
Address: t �l�'S2 00 2 A ,0Q
City: KLamk State: f -. Zip: '>314o9.
Qualifier Name: MOf" C-t tin Phone#:
State Certification or Registration #:
Certificate of Competency #:
DESIGNER: Architect/Engineer: N� Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ t quare/Linear Footage of Work:
Type of Work: ❑ Addition El Alteration New ❑Repair/Replace ❑Demolition
Description of Work:
t
Specify cd'jor of color thru tile:
Submittal Fee !-5bk ( Permit Fee $ .
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
CO/CC $
Notary $.
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
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// ondition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith thbt a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is suby' ct to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspects which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not b pproved and a reinspection fee will be charged.
Sign
OWNER or AGENT
Signature z&
i
CONTRACTOR
The fore oing insJuen�twacknowledged before me this The foregoing instrument as acknowledged before me this
day o20 l `i' byk• day of �� 20 I"f by
� who is personally known_to u1— who is -personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY P
Mike Vasquez
Sign:
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: A 2M Print:
i KEMeLE EMICK
Seal: '� Seal: :,�,,.�A NotaryPubiK-5tmofFIKIH
• i Commission 4 GG 14170d
.,
I My Comm. Expires Sep 19, 2021
',hoc r. B,,ded tbmLN+ National NOWY Assn.
****************************************************************** * * * ***************************
APPROVED BY C"""'E'c,,..���
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)