PL-18-1530y�`
Miami Shores Village
`gNoREs
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
toatvA
Permit NO. PL-6-18-1530
Permit Type: Plumbing - Residential
Pen m i Work Classification: New
Permit Status: APPROVED
Issue Date: 6/8/2018 1 Expiration: 12/05/2018
Project Address Parcel Number Applicant
910 NE 99 Street 1132060143410
HANS & URSULA KRAUSE
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
HANS & URSULA KRAUSE 910 N 99 Street (305)751-6529
MIAMI SHORES FL 33138-
910 N 99 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
WESTLAND PLUMBING CORP (305)863-6223 (786)236-0198
Type of Work: NEW PLUMBING SYSTEM
Type of Piping:
Additional Info: NEW PLUMBING SYSTEM
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$12.60
DBPR Fee
$11.03
DCA Fee
$7.35
Education Surcharge
$4.20
Permit Fee
$735.00
Scanning Fee
$3.00
Technology Fee
$16.80
Total:
$789.98
Valuation: $ 21,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-6-18-67801
06/05/2018 Check #: 19096 $ 50.00 $ 739.98
06/08/2018 Check #: 19103 $ 739.98 $ 0.00
Availaoie Inspections:
Inspection Type:
(Final
Water Main
Review Plumbing
Underground
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 ertify tall the going information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and fonina. utbarro re I aut on the above -named contractor to do the work stated.
June 08, 2018
AOMMred Signature. er / Applicant / Contractor / Agent uate
Bui ding Department Copy
June 08, 2018 1
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
[7UN 5 2 18
BY:
FBC 201A
Master Permit No. RC-5-17-1288
Sub Permit No. P L �' j — I S30
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING [:]MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: 910 NE 99th Street, Miami Shores FL 33138
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-014-3410 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Halls -Joachim Krause Phone#: (786) 554-6128
Address:4720 North Bay Road
City
Miami Beach
State: FL Zip: 33140
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: /A., d / /J� 7)'1 or Phone#: •3oS' —5'67— 6 Z Z 3
Address: /0 / lc% 2y .SVrCG)�-
City: f� / 4/G�'//� State: I��• Zip: -730\�
Qualifier Name: ""-4,!oS 4<04.os Phone#: 766—dR36-0l ieF
State Certification or Registration #: ,, 15G O 3 7 110 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ 21 t�W Square/Linear Footage of Work:
Type of Work: ❑ Addition
Description of Work:
teration ❑ New ❑ Repair/Replace
Zip:
❑ Demolition
Specify color of color thru tile:
ego
Submittal Fee $ Sa Permit Fee $_ "/ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ ( Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Double Fee $
Bond $ Gj Q
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 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 appr9f ed and a reinspection fee will be charged.
Sign
ER or AGENT
The foregoing instrument"was acknowledged before me this
day of F(j0 e� (V 20 i� by
wosua"�cwho is�personally known to
me or who has produced r>64 ✓6 L Le CNS�C_ as
identification and who did take an oath.
NOTARY PUBLIC: T�L(dLo�41D3$5$3'0
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 /8 by
who is personally known to
me or who has produced V---O L_ as
identification and who did take an oath.
NOTARY PUBLIC:
s6n- N C"k /L/�—� -
Sign:
C�
Print: (-1 e_ Ne_
Print,
Seal: Notary Public State of Florida
Michelle Toste
Sea I:
O`OyY,,,"w
�M
Notary Public State of Florida
eda
Barbara E P r, GG
Coms.'onGG 168674
` MY Commission GG 076930
%or n Expire. 02/M021
+?d►,
of
Expire. 04/30/2022
APPROVED BY iD' �� �0
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)