PL-19-1059Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
LrC111n -Nlf
Issue Date: 07/02/2019
Location Address Parcel Number
535 NE 95TH ST, Miami Shores, FL 33138 1132060140730
Contacts
Permit NO.: PL-05-19-1059
Permit Type: Plumbing - Residential
Work Classification: Pool - Private
Permit Status: Approved
Expiration: 11/06/2019
GARRETT & NAYLA MOFFETT Owner
535 NE 95 ST, MIAMI SHORES, FL 33138
Mobile: 3054092770
GRAY DOLPHIN POOLS & CONSTRUCTION Contractor
INC
RAONEL LOPEZ
16225 SW 117 ST D14, MIAMI, FL 33177
Business: 3052070606
Description: POOL PLUMBING Valuation: $ 1,200.00 Inspection Requests:
305-762-4949
Total Sq Feet: 0.00
.j
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
Check # 37356
05/10/2019 $50.00
Check # 2460
07/02/2019 $112.35
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 cogs4wstion and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature:
r / Applicant / Contractor / Agent
Date
July 02, 2019 Page 2 of 2
Miami Shores Village
Building Department MAY 1 2 19
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 20 BUILDING Master Permit No.-�- 0S- 1 — (Os8
PERMIT APPLICATION Sub Permit No. L
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
12'PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: �3 /v 1 ��� SfgPe r
City: t Miami Shores County: Miami Dade Zip:
Folio/Parcel#: L �3���— �% 4 — 0 730 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: U FFE:
OWNER: Name (Fee Simple Titleholder): M kYL A�- 7KO FFe fi Phone#: ? -- Tlog—
Address:: ��J 5� A) E
City: * PYN is ! ShAr- S State: rl0 tL C-0 A- Zip: 3 3 l 3 FS
Tenant/Lessee Name: Phone#:
Email: %%����
CONTRACTOR: Company Name: V�A'�/�Ul.pi�-r U 1�DU�i `t �wlS%n Phone#:
Address: 16zzs Sw 117 )Cf
City: D�AM State: 1: 0 1 to A- Zip: '-�>3 1-77
Qualifier Name: ,P6ague i_ LoN- L Phone#:
State Certification or Registration #: CPC IyS_7S3I Certificate of Competency #:
DESIGNER: Architect/Engineer: 7Yl o a(,, M /t U L�IJ� Phone#:
Address: I�3liZ Sc.J S�`Z St`ttttt City: State: �� Zip: 3 31
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: uyu i� M Cr
Specify color of color t�ru tile:
Submittal Fee $ S A Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ I (� • 25
(Revised02/24/2014)
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 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 1�4 1 J��
NERorAGENT
The foregoing instrument was acknowledged before me this
day of 6 (l Z_ , 20 19 by
*/4 )Ad Iftli-- , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
RICHARD P
CONTRACTOR
The foregoing instrument was acknow me this
day of�^ 7 20 y by
�A=cL Ld p Z who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Commission N GG 046773 Seal:
My Comm. Expires Nov 14, 2020
Bonded through National Notary Assn.
Commission N GG 046773
My Comm. Expires Nov 14, 2020
Bonded through National Notary Assn.
as
APPROVED BY oe�9 114 Plans Examiner v I� (Ci Zoning
Structural Review Clerk
(Revised02/24/2014)