PLC-19-1588Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: PLC-07-19-1 SM
�- Permit Type: Plumbing - Commercial
Work Classification: Alteration
Permit Status: Approved
Issue Date: 07/11/2019 F Expiration: 03/23/2020
Location Address Parcel Number
1700 NE 105TH ST 514, Miami Shores, FL 33138 1122300500900
Contacts
CHRISTOPHER SWARTZ Owner
1700 N. E. 105 ST. #513
PLUMBING BY SALOMON Contractor
SALOMON PALACIOS
1060 NE 212 TER, NORTH MIAMI, FL 33179
Business: 3059359214
Description: PLUMBING FOR KITCHEN AND TWO BATHROOM Valuation: $ 1,600.00 Inspection Requests:
UPDATE 305-762-4949
TotalSq Feet: 400.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
Change of Contractor
$110.00
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:
$221.10
Payments
Date Paid
Amt Paid
Total Fees
$221.10
Credit Card
07/11/2019
$61.10
Credit Card
07/09/2019
$50.00
Credit Card
12/10/2019
$110.00
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 alWhe foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction agd.aoniFiithermore, I authorize the above named contractor to do the work stated.
ature:
/ Applicant / Contractor / Agent
Date
December 10, 2019 Page 2 of 2
Miami Shores Village
Building Department
10050 N.E. 2No Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Change of Contractor/Architect or Engineer
A change of contractor, architect or engineer must be done under a permit number. There is a$75.0A charge
for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized
signatures. If the signature of the previous contractor cannot be obtained the owner must send a certified
letter/return receipt notifying the previous contractor, architect or engineer the reason for the change. The
owner must allow 10 business days for the contractor, architect or engineer to respond. A permit application
must accompany the change of contractor form, with the information and signature of the new
contractor. The new contractor must be registered with the Village or must submit the required documents
to register with the Village.
1. Change of Contractor form completed, signed and notarized.
2. Permit application by new contractor.
3. Required fees.
4. Copy of original letter sent via certified mail along with the returned receipt.
In addition to the requirements above the architect or engineer of record must authorized the new architect
or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed.
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Permit N.
Owner's Name (Fee Simple Title Holder): CN1aK00% hLJ'Wl--
Owner's Address: 1 10 O 0 C Ids 15T . 51 +
city: t-NM" N 5"400"45
Job Address (Of where work is being done):
City: Miami Shores
I
Phone #: �Of' -)j00-1000 -
State : FIL Zip Code: 331
State: —Florida Zip Code:,
Contractor's Company Name: flke�6031--= Phone #: '3 as =.s
Address: 'ZA-"'% O t" tb •
City: State: Ft- Zip Code: 3 31 h-lo
Qualifier's Name: ii�hv.) i Lic. Number:
Architect/ Engineer of Record Name:
Address:
City:
State:
Describe Work: Y-ITw IAA 2' 5A11A f4.)-r4s
Phone #:
Zip Code:
hereby certify that the work has been abandoned and/or the contractor/architect
is unable or un i ing to omplete the contract. I hol a 'Iding Official and the
Mia Shores harmless of all leg 1Z?!
.
Signature Signature
Owner or Agent Contractor or Architect
The foregoing instrument was aknowledged before me
this 10 day of POJ 20101,by OMP47 110A-f r71'
Who is personally known to me or who has produced
as indentification.
The foregoing instrument was aknowlednged before me
this 1 b day of t-' 20►"qy 40Uta Wllb
who is personally known to me or who has produced
indentification.
Notary Public:
Notary Public:
Sign:
Sign:
Seal: i41aCf F(�
U1ZARpALVAREZ
Seal: 411'f
UkZAR0ALVAREZ
a,
CmlWm # FF 946879
am
Expires January 17, 2020
+Q ••"'•• �'
• •
ConnnMm # FF 946879
o.
d
ExOres January 17, 2020
4OF F�dQ'
Bonded TINY k*d Notary S0*66
Miami Shores Village
Building Department
100SO N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 20
BUILDING Master Permit No. 0,C C L 141 -,447
PERMIT APPLICATION Sub Permit No. O, 1 a t053
❑BUILDING
❑ ELECTRIC
❑ ROOFING
❑ REVISION ❑ EXTENSION
[-]RENEWAL
PLUMBING
❑ MECHANICAL
❑PUBLIC WORKS
VCHANGE OF ❑ CANCELLATION
❑ SHOP
CONTRACTOR
DRAWINGS
10B ADDRESS:
o o t� K
1 0 ST.
's-1 g-
City:
Miami Shores
County:
Miami Dade Zip:
"331 3 C8
Folio/Parcel#:
" 'LZal0 - ID5b— 0ok 0 0
Is the Building Historically Designated: Yes
NO >C-
Occupancy Type:
Load:
Construction Type: Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): L44139ko ' S t.'a P�j�'z_. Phone#: -x05-- 3o0-`j d o b
Address: 1 0 0 iJ 4 0!-k;7 -.5 1. S S. A -
City: 1-1 1 PM � 'j'lACiA*f-S State: � Zip: '33l 3
Tenant/Lessee Name:: , IA ) A, Phone#:
CONTRACTOR: Company Name: PGA M 13 (n 4 �X �0 L-0-ftO4ne#:
Address: t Q �<—h b& !2j��, : I �'R— I% 1/Ct C� --
City: t A-r'i State: r r— Zip:
Qualifier Name: 'Cpl�a�,�sQ Phone#:
State Certification or Registration #: CFG 0� O 'i'Or Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ l / Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: �rJ� %' Fb-k I" '°`' +,j1 z a4tLb ly-4 dP r1
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
(Revised02/24/2014)
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Training/Education Fee $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ _
r
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 whi occurs seven days after the building permit is issued. In the absence of such posted notice, the
inspection will not be app ved and a rein a ion fee will be charged.
'f—
Signature ture
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
10 day of 20 %' by
C:FtMSPP+d—. who is pel§o-Wally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print:
The foregoing instrument was acknowledged before me this
I day o`f) t 44^1 Q e- --20 I c by
*to $A P� G ho iersonall s o
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
as
Seal: PT
k Notary Public State of Fkxida Sea 1:
# Jorge
y Comm Commission GG 193011 Ni r Pu fc State of Florida
oJorgeRo,sseau
spires 05/04/2022 My COMM si0n GG 193011
Vres 061OZ022
************************************************************************************************************
APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk