PL-20-832Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
258 NE 100TH ST, Miami Shores, FL 33138
Contacts
die I
Issue Date: 05/06/2020
Parcel Number
1132060134460
Permit NO.: PL-04-20-832
Permit Type: Plumbing - Residential
Work Classification: Alteration
Permit Status: Approved
Expiration: 11/02/2020
ANNE MENNES Owner CHAMPAGNE PLUMBING INC Contractor
258 NE 100 ST, MIAMI SHORES, FL 33138 LEONARD GEORGE CHAMPAGNE
Mobile: 3054581190 1775 BLOUNT 411, POMPANO BEACH, FL 33069
Business: 9543306921 corsev@hotmail.com
Inspection Description: REMODEL KITCHEN REMODEL BACK PORCH Valuation: $ 400.00 Inspection Requests:
4949
Total Sq Feet: 225.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2•00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3•00
Technology Fee
$2.50
Total:
$110.30
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
05/06/2020 $110.30
Amount Due:
$0.00
COV I D 19
Applicant Copy
For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/.
Requests must be received by 3pm for following day inspections.
NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
additional restrictions applicable to this property that may be found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS,
public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES.
May 06, 2020 Page 1 of 2
w X.
Miami Shores Village
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
BUILDING
PERMIT APPLICATION
[—]BUILDING ❑ ELECTRIC ❑ ROOFING
RECEIVED
Ap 2 7 2020
BY'
FBC 20
Master Permit No. Oi l 9 2-1 kk
Sub Permit No L()q - -zo a �!)2_
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING
❑ MECHANICAL
❑ PUBLIC WORKS
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
46 /Gb
J
Sf(Q2T
City:
Miami Shores
County:
Miami Dade Zia• 33)g
Folio/Parcel#:
Is the Building Historically Designated: Yes NO
Occupancy Type:
Load:
Construction Type:
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
�fGir11� Gi�/7/zPS
Phone#:� a(�/
Address: 02—.:2;6
/k— mr.) Sf1`wP
r—
3 W, 49�
Tenant/Lessee Name:
Email: �=f.,._ /Z
State: lr/oL zip:
CONTRACTOR: Company Name: 44 h �\O\✓V0 Phone#: 9.5ij— 3,30/.921
Address: 1775
City: 0.,a v. State: ��o r1 o� Zip: 33 U b
Qualifier Name: "_o "I-Ir Cih O—*,Y\O LyJL.. Phone#:
State Certification or Registration #: CFt=
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Ad
uebf*orlrfoF•this Permit: $
A' itAO+w'ed:,'•� i
Ty0e of Work:'%,0 Mddition ❑ Alteration
ti" r t- V (vl t311`� G
Def rip'ion�of Work:x
Slfl'c�fy9.`�ol'oi
Submittal Fee $_
Scanning Fee $ _
Technology Fee $
of color thru tile:
Structural Reviews $
Permit Fee $
Radon Fee $
State: Zip:
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace ❑ Demolition
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $ ��
TOTAL FEE NOW DUE $
(Revised02/24/2014)
OEM
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 on 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 Signature •�
OWN'ER rAGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
'2 1 day of Ff-- Z 20 :�j by
AN 0— )-0 k N-J(7 -) who is personally known to
me or who has produced C= Q D tajyrA- as
identificatior-and who did take an oath.
NOTARY PUBLIC: \\`\\�Ol� ��g4ciLVe
Sign: o S�
Print: :* �• ,�9 'r
Seal: '%�c.7•."°�;•��
jj'IM l51 �`•`
The foregoing instruments was acknowledged before me this
day of A t,1 L _ 20 ZU by
LQ.OI'1Cl ' is personally known to
me or who has produced
identification and who did take
NOTARY PUBLIC:
r
Sign:
Print:
Seal:
APPROVED BY � Plans Examiner
Structural Review
as
Zoning
Clerk
(Revised02/24/2014)