PL-19-1451Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 08/13/2019
Parcel Number
92 NW 100TH TER, Miami Shores, FL 33150 1131010180370
Contacts
Permit No.: PL-06-19-1451
Permit Type: Plumbing - Residential
Work Classification: Pool - Private
Permit Status: Approved
Expiration: 02/ 10/2020
JORGE AND FELISA PADILLA Owner
92 NW 100 TERR, MIAMI, FL 331501208
Other: 3057568523
ROSMEL POOLS INC Contractor
WILFREDO 1R LEIVA
9300 NW 25 ST 103, DORAL, FL 33172
Business: 3055927900
Description: NEW POOL Valuation: $ 2,000.00 Ins ection Requests:
305-762-4949
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
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 # 15277
08/13/2019 $162.35
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
regulati on uctioq and zoning. Futhermore, I authorize the above named contractor to do the work stated.
/1.
Owner / Applicant / Contractor / Agent
Date
August 13, 2019 Page 2 of 2
Miami Shores Village
t
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
FBC 200 //;;I
BUILDING - Master Permit No. • o �(`�I H3(,
PERMIT APPLICATION Sub Permit No.FL b(0-1 I �( t{ 'S)
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: l� �• K/ • (� Te- r
City: Miami
Shores County: Miami Dade Zip:
Folio/Parcel#: 'J 1t71-101 bc/ -o3-'z( l Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): �e���c� �( iCicl Phone#:
Address: °k} (�� �� Te- r.
City: Ml,cimL State: - I ft, Zip:
Tenant/Lessee Name: f I`�lt'i Phone#:
. r
Email
CONTRACTOR: Comps y Name; ^�-��°�-') ��`� 16C Phone#: 0-Sa rC0
Address. 96W .11). C�" Cam-.J (;�L3{k io-6
City: Dpr-al State:: Zip:
Qualifier Name:0 l rc& Wljn Jr .
i L !-�y State Certification or Registration #: s Fe 'I Certificate of Competency #:
DESIGNER: Architect/Engineer: A rr0J (0 , Phone#: —off
Address: -N V5 S 4 .kD - �4 4 - City M "' (' A State: 'f(" Zip:261e6
Value of Work for this Permit: $ e7&0�%00 Square/Linear Footage of Work:
Type of Work: ❑ Addition [ ❑ Alteration p[J (( New ❑ Repair/Replace ❑ Demolition
Description of Work: ��, �c3o.% '
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
' ,$_ _ , _ Co/cc $ t
DBPR $ Notary $
D uble Fee $
Bond $ .
TOTAL FEE NOW DUE $ I:a '2• 3G
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Ad Jress
City tQl A State
Al
Zip
Zip t d
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. 1 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 valve exceeding $2500„t¢e 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 post&U 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 Signature
OWNER or AGENT CONTRAfTOR
The foregoing instrument was acknowledged before me this The foregoing instrument -was acknowledged before me this
ff day -of. T4inua 20 w'� by `�C0 , da/y of��l(k%2.2i 20 l by
Il�l� who is personally known to who is personally to
me or who has produced as" � ' me or -who Chas produced pa-�.�,i✓l ft_ A as
identification and who did take an oath. ✓ ' identification a4who did take an oath.
n . . A.
NOTARY PUBLIC: n �� NOTARY
Sign: v Sign:
Print: S Print:
Seal: ;'ti►iiY oii •. DORIS ANAYS MARTINEZ Seal:
Notary Public - State of Florida
;•� Commission # GG 250751
My Comm. Expires Feb 14, 2021
****************** *************************
APPROVED BY all Plans Examiner
Structural Review
DORIS ANAYS MARTINEZ
Notary Public . State of Florida
off':
Commission # GG 250751
My Comm. Expires Feb 14 2021
Zoning
Clerk
(Revised02/24/2014)