PL-18-1239Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Parcel Number
Permit NO. PL-5-18-1239
# Permit Type: Plumbing - Residential
' Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 6/11/2018 1 Expiration: 11/07/2018
Aoplicant
141 NW 101 Street 1131010220170
Miami Shores, FL 33150- Block: Lot: COLBY NEUMANN
Owner Information Address Phone Cell
COLBY NEUMANN 141 NW 101 Street (786)210-9004
MIAMI SHORES FL 33150-
141 NW 101 Street
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone
HOME OWNER
Type of Work: PLUMBING WORK FOR KITCHEN & BATHROO
Type of Piping:
Additional Info: PLUMBING WORK FOR KITCHEN & BATHROO
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$1.20
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.40
Notary Fee
$5.00
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total:
$165.45
Valuation:=1,500.00Total Sq Fee
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-5-18-67486
05/11/2018 Credit Card $ 115.45 $ 50.00
05/09/2018 Credit Card $ 50.00 $ 0.00
Hvauame inspections:
Inspection Type:
Top Out
Final
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 AFF VIT: certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction onin uthermore, I authorize a ove named co tr or to do the work stated.
6\ N� W Gl1 May 11, 2018
Authori d Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 11, 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
MAY 0 g Ole
BY• dam
FBnC 2011C/ 'l`IK
Master Permit No.
Sub Permit No. TIL is — Q39
❑ REVISION ❑ EXTENSION ❑ RENEWAL
ETIPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I `i I IV V � I� I W u
City: Miami S,1 Shores County: Miami Dade Zip: O V
Folio/Parcel#: I I — A I M " u I + 0 Is the Building Historically Designated: Yes NO V /
Occupancy Type: 1l(Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name
(Fee Simple
imple Titleholder): wltt A I)nOn n Phone#: (;) N i 1, t n
- 100
Address: `mol WVV 10I Jtt� 1
City: VV%1U1YY\1
Tenant/Lessee Name:
Email: 0/ f l
State: t'l/ Zip: 3 3 I Sy
1 An r) Phone#: (2( Tru� 0-9 ON
gM,61 I- Cbre--1
CONTRACTOR: Company Name: _6—r—m 0writy Phone#:
Address:
City: State: Zip:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
one#:
Certificate of Competency #:
Phone#:
Address: City: State: Zip:.
Value of Work for this Permit: $k Pt1 ) q�—�FlNew
quare/Lin�ar F otage�o
Type of Work: ❑ Addition ❑ Alteration ❑Repair/R,place 1 ❑ Demolition
Description of Work: ?IVMb;1)C' W orK i"OV %�� Ck%tV1 ? bG�1%,r0O M _
Specify color of color thru tile:
Submittal Fee $ i Permit Fee $ i'JCCF $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
CO/CC $
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 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
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
9t4 day
of 20 LJ by
Ukb-,.k.'' `• who is personally known to
1
me or WQ has produced f 1N& \p NN%94 as
identificati n an ho did t e an
NOTARY UBLIC:
Sign:
Print:
Seal:
YANADY PRIETO
MY COMMISSION # FF 214031
EXPIRES: March 25, 2019
APPROVED BY
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 by
, who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
Structural Review
as
Zoning
Clerk
(Revised02/24/2014)