PL-18-3651Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 03/29/2019
Location Address Parcel Number
1168 NE 101 ST, Miami Shores , FL 33138 1132050190240
Contacts
Permit NO.: PL-12-18-3651
Permit Type: Plumbing - Residential
Work Classification: Addition
Permit Status: Approved
Expiration: 06/10/2019
CHRISTOPHER & MARGARET SMITH Owner CHRISTOPHER & MARGARET SMITH Applicant
1168 NE 101 ST, MIAMI SHORES, FL 33138 1168 NE 101 ST, MIAMI SHORES, FL 33138
REGOSA ENGINEERING SERVICES INC Contractor
GUSTAVO VELEZ
1S700 NE 2nd AVE, MIAMI, FL 331624267
Business:7862622964 CONTRACTORWORK@GMAIL.COM
Other:7863448720
Description: PLUMBING WORK FOR GARAGE CONVERSION Valuation: $ 1,500.00 Requests:
Inspection F762-4949
Total 5q Feet: 300.00
.j
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Payments
Date Paid Amt Paid
Total Fees
$111.10
Credit Card
03/29/2019 $61.10
Credit Card
12/11/2018 $50.00
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
regulating construction and zoning. erm re, I authorize the above named contractor to do the work stated. //
Owner / Applicant / Contractor / Agent
March 29, 2019
Date
Page 2 of 2
BUILDING
PERMIT APPLICATION
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
FBC(�20
��� L� 7
Master Permit No. ! - /
Sub Permit No. f L 18 -3(,st
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
�PLUMBIN� ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1168 NE 101 STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3205-019-0240 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Christopher & Margaret Smith Phone#:
Address:1168 NE 101 STREET
City: MIAMI SHORES
Tenant/Lessee Name:
Email:
State: FL
ne#:
p:
33138
CONTRACTOR: Company Name: REGOSA ENGINEERING SERVICES, INC Phone#: 786-262-2964
Address: 15700 NE 2 AVE
City: MIAMI State: FL Zip: 33162
Qualifier Name: GUSTAVO VELEZ Phone#: 786-262-2964
State Certification or.Registration #: CFC-1427292 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ ���e Square/Linear Footage of Work:
Type of Work: ❑ Addition 0 Alteration
Description of Work: GARAGE CONVERSION.
❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color hru tile:
Submittal Fee $ S6?0{ Permit Fee $ 1 D V CCF $ CO/CC $ ,
Scanning Fee $ Radon Fee $ Z DBB�PR $ Notary $
Technology Fee $ Z . SO Training/Education Fee $ 0 • —1 o Double Fee $ _
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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 $ 0 the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will a del ered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement m st be osted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absenc of s h posted notice, the
inspection will not be approved and a reinspection fee will be charged.
/Z
Signature/ 4 !< ` Signatu
OWNER or AGENT
The foregoing instrument was acknowledged before me this
02%T day of 20, by
�/ ��7' vri� yinrho is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: G� /Y/>�
The foregoing instrument was acknowledged before me this
22 day of MAY
GUSTAVO VELEZ
me or who has produced
20 18 by
who is ersonally know
as
identification and who did take an oath.
NOTARY PUBLIC:
Sig n:o" r L
Print: L ,60Q- e
Seal: Seal: p•�*••� LUZ EDITH GIRALDO
Twil's1w,
Jodi Ellis CeidlR�, NOTARY PUBLIC • STATE OF FLORIDA
NOTARY PU13LJC COMMISSION 9 FF203466
STATE OF FLORA °' MyCommisslonExpkuMarch22,2019
*601FSRExpires V14MI
APPROVED BY 73 /�_ Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)