PL-18-1044CIA
JOB ADDRFc
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
F�oni"vA
Phone: (305)795-2204
Permit NO. PL-4-18-1044
Pe
Permit Type: Plumbing - Residential
r m it work Classification: Drainfield
Permit Status: APPROVED
Issue Date: 7/6/2018 1 Expiration: 01/02/2019
Project Address Parcel Number Applicant
175 NW 100 Street 1131010230320
Miami Shores, FL 33138- Block: Lot: CHRISTIAN LANSER
owner mrormation Address Phone Cell
CHRISTIAN LANSER 175 NW 100 Street
(305)772-4313
MIAMI SHORES FL 33150-
175 NW 100 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
Type of Work: EXTEND / MODIFY EXISTING DRAIN FIEL
Type of Piping:
Additional Info: EXTEND / MODIFY EXISTING DRAIN FIEL
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$1.20
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0,40
Penalty Fee
$0.00
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$1.60
Work without Permit Fee
$0.00
Total:
$160.45
Valuation: $ 2,000.00
Total Sq Feet: 375
Pay Date Pay Tvi3e Amt Paid Amt Due I
Invoice # PL-4-18-67231
07/06/2018 Credit Card
04/20/2018 Credit Card
$ 110.45 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
HRS Approval
Final
Review Plumbing
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
constru n zoning. Futhermore, I authorize the above -named contractor to do the work stated.
�{ Cslis July 06, 2018
Au on ign r wrier / Aoplicant / Contractor / Agent Date
partment Copy
July 06, 2018
Miami Shores Village RECEIVED
Building Department APR 2 2018
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 0 ti
BUILDING Master Permit No. Pk l I 24 7Z
PERMIT APPLICATION Sub Permit No. i 1 . ` logo
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS: 1 15 N W 100 ST
City: Miami Shores County: Miami Dade Zip: 33 Sd
Folio/Parcel#: 11 —'3I 0 1 - 0 2 3" O 3 2 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Ch ri TI i Q n L Gyl.7cr Phone#: 30 S' 7-7 2,4313
Add
City: M� Q mi SV10r�.� State: Zip: S51 SO
Tenant/Lessee Name: Phone#:
Email: (,�
CONTRACTOR: Company Name:_SJTe� i • �i GO" I~ Phone#: 7 9%sg 4'c1'e b
Address: 1) C, ft WW Am& 4143
t .
City: 0M �Q State: ft.,Zip: 33os4
Qualifier Name: P.r'C�G 43 G 1 O yn'o" Phone#:
State Certification or Registration #: �M-1 l lu 2• Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 20 00 '- Square/Linear-FFootage of Work: 7 3S
Type of Work: El Addition ❑ r
Addition Alteration New � Repair/Replace ❑ Demolition
Description of Work: if;i�� Onin field
'1-0 40- aI 79 nCh
Specify color of color thru tile:
Submittal Fee $' e Permit Fee $ � 60 CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
Notary $
Double Fee
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
v
W3.ys
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
NER or AGENT
The foregoing instrument was acknowledged before me this
day ofril , 20 M by
Chris-�-i(3V)- f AD t-LQn,SS-tC who is personally known to
me or who has produced I)r; Ay �i C` .9f as
identification-a-?kLwho did take -an oath.
NOTARY PUBLIC:
Signature Q�-—t-
CONTRACTOR
The foregoing instrument was acknowledged before me this
ZOt11" day of A- Sri 1 20 18 by
'0M who is personally known to
me or wh as produced 1 )feV�IY 1 C�ns-f as
identification aAd-wbo did
NOTARY PUENLIC:
Print: Print: - A
Seal: Seal:
YANADY P 0
YA Y PRIETO
r'.,,,,,,a A'MiSSION # FF214031
*; MY COMMISSION # FF 214031 MY
_
EXPIRES: March 25, 2019 EXPIRES: March 25, 2019
Bonded Thro Notary Puh c UndOtwdte'3 J•'.$,lyd Bonded ded 1 hro No4^ry Pch' c Unuenr 3r6
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)