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PL-19-2911Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address hij Issue Date, 01/02/2020 Parcel Number 715 NE 91ST ST 4A, Miami Shores, FL 33138 1132060440060 Contacts Permit NO.: PL-12-19-2911 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Expiration: 06/30/2020 RAFAEL IRA Owner 715 NE 91 ST 4A, MIAMI SHORES, FL 33138 G.Q.M.INC Contractor JOHN VILLAMIZAR 10496 NW 50 ST, SUNRISE, FL 33351 Business: 3054870071 Description: THE SCOPE OF WOPRK IS TO REPLACE THE Valuation: $ 2,445.00 Inspection Requests: BATHTUB, TOILET AND SINK FAUCET IN MASTER BATHRROM r-762-4949 NO FIXTURES WILL BE MOVD, NO PIPE LINES WILL BE Total Sq Feet: 40.00 EXTENDED. NO ELECTRICAL WORK WILL BE DONE Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.90 Payments Date Paid Amt Paid Total Fees $111.90 Credit Card 12/09/2019 $50.00 Credit Card 12/16/2019 $61.90 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. Futhermore, I authorize the above named contractor to do the work stated. Owner / Applicant / Contractor / Agent — '-- 20 Date January 02, 2020 Page 2 of 2 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 0 ROOFING ENT,PRED DEC 0 9 2 art _ FBC 20 1i- Master Permit No. Rc— 1 2-- 291 D Sub Permit No.p L- 1 2-- I `" I - Z9 1 1 ❑ REVISION EXTENSION ❑RENEWAL 0 PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 715 NE 91 STREET #4A City: Miami Shores County: Miami Dade Zip: -53 111 3S Folio/Parcel#:11-3206-044-0060 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): PENSCO TRUST COMPANY LLC FBO RAFAEL FELIZ IRA Phone#: C1e�>�OZ - 0392 Address: PO BOX 173859 City: DENVER State: CO Tenant/Lessee Name: Phone#: Email: m,5a(\che7- 6 (Ac- CONTRACTOR: Company Name: G.Q.M., INC. Address: 10496 NW 50 Street City: Sunrise Qualifier Name: John Villamizar Zip: 80217 305-487-0071 ate: FL Zip: 33351 Phone#: 305-487-0071 State Certification or Registration #: CF;ci't000tu Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 2 . �� 5 Square/Linear Footage of Work: LJC)SF Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition Description of work: The scope of work is to replace the bathtub, toilet, and sink faucet in Master Bathroom. No fixtures will be moved. No pipe lines will be extended. No electrical work will be done. Specify color of color thru tile:, Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee Structural Reviews $ Training/Education Fee $ CCF $ CO/CC $ _ DBPR $ Notary $, Double Fee $ _ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien low 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 th sence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNE or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of r 20 19 by 22 day of November 20 19 by -o.Fo,al Feli2 John Villamizar who who is personally known to personally known to me or who has produced as me or who has produced identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: as Sign: T1 Sign: Print: AIQJCA6co C&4,1 n Print: Alejandro Castillo 7 Seal: =� ;�` Expires August9,2022 Seal: •'~:ta F g• Bonded Thru Troy Fain Insurance 800JVW5.7019 ::0R^aY . ALEJANDRO CASTILLO Commission # GG 247537 'V: Expires August 9, 2022 �d��`n*lr�sl�ir�n*c�`!�-r*11��*********************************************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)