PL-19-874Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 05/24/2019
Parcel Number
1225 NE 93RD ST, Miami Shores, FL 33138 1132050270030
Contacts
Permit NO.: PL-04-19-874
Permit Type: Plumbing - Residential
Work Classification: Pool - Private
Permit Status: Approved
Expiration: 11/20/2019
MARK & DARLENE HUTCHINSON Owner
9125 N BAYSHORE DR, MIAMI SHORES, FL 33138
Other: 7867122347
ROSMEL POOLS INC Contractor
WILFREDO JR LEIVA
9300 NW 25 ST 103, DORAL, FL 33172
Business: 3055927900
Description: NEW POOL PIPING Valuation: $ 2,000.00 Inspection Requests:
305-762-4949
Total Sq Feet: 0.00
Fees
Application Fee - Other
CCF
DBPR Fee
DCA Fee
Education Surcharge
]An
Plumbing - Pool - Residential
Scanning Fee
Technology Fee
Total:
Payments
Date Paid Amt Paid
Total Fees
$162.35
Check # 15150
04/22/2019 $50.00
Credit Card
05/24/2019 $112.35
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFID T: I certify that all the f9regoiiig information is accurate and that all work will be done in cojanwith I applicable laws
regulating co stru do and zoning. Fuk4Trfiore, I authorize the above named contractor to do the work stated.
/ Applicant / Contractor / Agent
May 24, 2019
Page 2 of 2
Miami Shores VillageTBY:
ED
Building Department 19
10050 N.E.2nd Avenue, Miami Shores, Florida 33138Tel: (305) 795-2204Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 1
BUILDING Master Permit No. � - ` 1� Ja-)
PERMIT APPLICATION Sub Permit No. L- _ l J - g-7 I
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
V(PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
r CONTRACTOR DRAWINGS
JOB ADDRESS: lao 5 N • �• 9�S-•
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1-►or {shown Phone#:
Address:l�45 l .E �73 c3+'•
City: �AICArT l I �VlQre`J State: TEL Zip: B513$
Tenant/Lessee Name:
Email: N
A.11A
1
i"
CONTRACTOR: Companrr1�l pCQ
y Name: �00!* kS � , Phone#:
Address: 9�� /ll.. jei %Lfk ir) >
City: borat State: 'E(/);1 Zip: �17a
Qualifier Name: WIM—edo yy��yea zir • Phone#: 3g9 _1P1 9.2
State Certification or Registration #:CRM^ lI45$CtlI 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 (( u New ❑ Repair/Replace ❑ Demolition
� 1
Description of Work: Nil TW
Specify Zol
Submittal tie,,
Scanning Fee $
or of r color �ru tile::
V G?"1 mil , o ....:.
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
..�°.sex'.�:t.-i..:,•s....M:J...�..%a.�...,rM;,.+�!r..p-
-••--���a•..s,.•.��/:Cry �
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's dress
City t A- State
Mortgage Lender's Le (if applicable) I
Mortgage Lender's Address) Ill
City
State
il�
Zip
Zi
a1
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 -PROPERfy.`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 $2560, the applicant must
promise in good faith .that a copy of the notice of commencement and construction lien law brochure will be deliver2d to,'the person
whose property is subject to attachment. Also, a certified copy of the Pe'corded notice of commencement must be postWat the job site
for the first inspection which occurs seven (7) days afteilding• permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspectio will be charged.
.,, .
1.
Signature
or AGENT
The foregoirgl!ilstrument was acknowledged before me this
day of 20, by
Mark who is personally known to
me or who has produced.l1kY'5"IW V nQJ21 as
identification and who did take an oath.
NOTARY PU
Sign:
Print:
Seal: " ' • DORIS ANAYS MARTINEZ
Notary Public - State of Florida
Commission # GG 250751
My Comm. Expires Feb 14, 2021
***********
APPROVED BY
Signature
CCINTR CTO
The foregoing• instrument was acknowledged before me this
t4.
r ,,day of 20, by
W li�T �D V�VG who is p/e'rsonally known to
me or who has produced DO-6W(A (N�As�i as
identification and who did take an oath.
NOTARY PUBLJf�: ^ n
Print: C.t I-' "t
Seal: ��Y °& DORIS ANAYS MARTINEZ
'� Notary Public - State of Florida
Commission # GG 250751
My Comm. Expires Feb 14, 2021
******************
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)