PL-19-1221Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 07/24/2019
Location Address Parcel Number
1421 NE 104TH ST, Miami Shores, FL 33138 1122320320060
Contacts
Permit NO.: PL-05-19-1221
Permit Type: Plumbing - Residential
Work Classification: Pool - Private
Permit Status: Approved
Expiration: 01/20/2020
Henry Dow Owner
1421 104
FLORIDA POOL PATIO CORP Contractor
CLAUDIO SEBASTIAN VALERO
12241 SW 99 ST, MIAMI, FL 33186
Business: 3058150181
Description: PLUMBING POOL Valuation: $ 700.00 Inspection Requests:
305-762-4949
Total Sq Feet: 465.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Plumbing - Pool - Residential
$100.00
Scanning Fee
$3.00
Technology Fee
$3.75
Total:
$161.55
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$161.55
Credit Card
05/29/2019 $50.00
Check # 9014
07/24/2019 $111.55
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 /
July 24, 2019
Date
Page 2 of 2
MId1111 JI IUI CJ V IIIcIgC
RECEIVED
Building Department Mt 29 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 '
Tel: (305) 795-2204 Fax: (305) 756-8972 BY:
INSPECTION LINE PHONE NUMBER: (305) 762-4949 ( U
FBC 20 !-=)
BUILDING Master Permit Nc.� ice- 0S- ( q- I2Zo
PERMIT APPLICATION Sub Permit No.1pt_-oS- i q- 12-Z 1
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[PLUMBING
❑ MECHANICAL [:]PUBLICWORKS
❑ CHANGE OF ❑ CANCELLATION
❑ SHOP
CONTRACTOR
DRAWINGS
x I1 �/
` //�� 2-1 (C)4 5T
JOB ADDRESS:/
I
City:
Miami Shores County:
Miami Dade Zip:
3 3 F5
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO
Occupancy Type:
Load: Construction Type:
Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): N -A L Phone#: 61 SDI —111 S— 2-648
Address: it, I I �j e • / oil S�
City: 1-1I AvN I S�.or "S State: F i
Tenant/Lessee Name:
Email
one#:
ip: 3 3 1 i 19
CONTRACTOR: Company Name: -Tl 0'd' aboL LL:::)fiz) Phone#:
Address(: *VS �—CO / 1 >r`qc--
City: I 1 iFC> > State: I Zip:
Qualifier Name: C� po-�l 0-'IpAe-1 Phone#: 3 2(5%(4 Z1
State Certification or Registration #: 1`IpC Id D) SZ Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ --7/l D Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition
Description of Work:
rYlbl o 6) 1.-
Specify color of color thru tile:
Submittal Fee $ 4,6 - OO ' Permit Fee $
Scanning Fee $
Technology Fee $
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
CO/CC $ _
Notary $
Double Fee $ _
Structural Reviews $ Bond $
TOTAL FEE NOW DUES
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 a ce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature All'
S
OWNER or AGENT
The f regoing instrument was cknowledged before me this
21 day of 20 by
} tQA ( who is personally known to
me or who has produced cq-rc—� - as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: C�L
Print:
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of , 20 % , by
C1C-Wd (0 Q 1'J, who is personally known_
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: 0L
Print: ( lr C
as
Seal- Seal: NApitt PD GG p7
NADINE AQUAS 11), NP # 2021
N MY COMMISSION # GG090407 i MY COp1REg APB% 04
EXPIRES A*prll 04, 2021 �•• EX
APPROVED BY C'L f - t Of Plans Examiner Zoning
Structural Review Clerk