PL-19-50Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 0 /09/2019
Location Address Parcel Number
9730 NE 5 AVE, Miami Shores, FL 1132060171470
Contacts
Permit No.: PL-01-19-50
Permit Type: Plumbing - Residential
Work Classification: Gas
Permit Status: Approved
Expiration: 07/08/2019
JOHN & MARIE PERIKLES Owner JOHN & MARIE PERIKLES Applicant
Other:7862360254 Other:7862360254
5 STAR PLUMBING SERVICES CORP Contractor
MANUEL PAMPIN JIMENEZ
11710 SW 180 ST, MIAMI, FL 33177
Business: 3057963607
Inspection Requests:_
Description: INSTALLATION OF A NEW TANKLESS WATER Valuation: $ 2,500.00 Inspec i n Re
HEATER, NEW GAS STOVE, AND EXISTING GENERATOR. TO
49
REPLACE PERMIT#PL16-189 Total Sci Feet: 4,073.00
Fees
Amount
Payments
Date Paid Amt Paid
Application Fee - Other
$50.00
Total Fees
$100.00
Permit Fee
$50.00.
Credit Card
01/09/2019 $100.00
Total:
$100.00
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, MECHAhQCAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the for oing info ation is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermor I authorize he above named contrac do the work stated.
Authorized Signature: Owner / Applicant / lContractor / Agent Date
January 09, 2019 Page 2 of 2
Miami Shores Village RECEIVED
Building Department JAV o 9 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY.
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 20
Master Permit No.T Q (� - 2 3 6 IT
Sub Permit NO.— "b
❑ REVISION ❑ EXTENSION RENEWAL
�LUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
p� _./ CONTRACTOR DRAWINGS
JOB ADDRESS: �-'//__.7 �I u tom€ i 1` \�+ acki-•
City: Miami Shores County Miami Dade Zip- 3 i 3
Folio/Parcel#:IL -5 -) n l O 111 � � 0 Is the Building Historically Designated: Yes NO
Occupancy Type: _ Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
Address: "!
r
City:
Tenant/Lessee Name:
Email:
State:...
Phone#:
CONTRACTOR: Company Name: C' �C //i % P!
Address: 1 SvQ I S4—
City: ,(i & Stat
Qualifier Name: Alin AJ �i
�
State Certification -or
or Registration #: I
cate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ ����' 4� Square/Linear Footage of Work:
Type of Work: ❑ Addition
Description of Work:
Zip:
❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile: ,,
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee $,
Structural Reviews
Radon Fee $
Training/Education Fee $
CCF $
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 reinsp ctio'nn-ee`will be charged.
Signature----. Signature
6 OWNER or AGENT CONTRACTOR
The foregoing instrumQnt, was acknowledged before me this
day of 1 + 20 t, by
41
IN s personally knowYn to
me or who has pr duced';
The fo
day of
me or wfio has broduced
was acknowledged before me this
identification a d who dH take an oath. identiVationn1 d who did take an oath.
N TARY PUB C: NOTAC:
Sign: Sign.
1
Print: � • L � Print: AN�
known
by
as
�oRr °°
Seal: *° ; •• :
LOAETTACOMh5
# FF 954
Seal: °��
LORETfACOMES
* *
My COMMISSION
EXPIRES: Match 21, 2020
o�*A:
* *
MY COMMISSION I FF 9 54664
EXPIRES: March 21, 2020
.°`
OFF`0P
gondeol►weie►NaaryS�ry
°���
BonMThruButetNotary ServkK
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************s****s*s* *s*s***s*ss******s*s*s*s******* t**s**** *****01FV ************ **sx *****************
APPROVED BY
( ��
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)