PL-18-1303 (2)y��
Miami Shores Village
�5HO1�s
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795 2204
tORION
Permit NO. PL-5-18-1303
Permit Type: Plumbing - Residential
Per it
Work Classification: Pool - Private
Permit Status. APPROVED
Issue Date: 9/14/2018 1 Expiration: 03/13/2019
Project Address Parcel Number Applicant
1201 NE 96 Street 1132060143830
Miami Shores, FL 33138-2553 Block: Lot: POL ZAZADZE
Owner Information Address Phone Cell
POL ZAZADZE 1201 NE 96 Street (305)790-2785
MIAMI SHORES FL 33138-
1201 NE 96 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
MIAMI CUSTOM SWIMING POOL 305-592-8066
Type of Work: HOOK-UP OF PUMP & HEATER
Type of Piping:
Additional Info: HOOK-UP OF PUMP & HEATER
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.25
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$158.85
Valuation: $ 1,000.00
Total Scl Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-5-18-67554
09/14/2018 Check #: 5075 $ 108.85 $ 50.00
05/16/2018 Check #: 4937 $ 50.00 $ 0.00
Avanaoie
Inspection Type: I
Main Drain
Final
Rough
Review Plumbing
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 accuratend that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-na contractor o do the work stated.
September 14, 2018
Authorized Signature: Owner / Applicant /( ontractor '/ Agent Date
Building Department Copy
September 14, 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
aY 16 18
BY: -- aU
FBC 201 ? GTE
Master Permit No. VPP is -)3o I
Sub Permit No. ? L tD " 1 d3
❑ REVISION ❑ EXTENSION ❑ RENEWAL
'[PLUMBING
❑ MECHANICAL ❑PUBLIC WORKS
❑ CHANGE OF ❑ CANCELLATION
❑ SHOP
DRAWINGS
JOB ADDRESS: fa`LO%
G/
/(% L.- �'i /3¢�ti//
�C/ONTRACTOR/
S,tfD/2ES,, f L 3313,r
City: Miami Shores County:
Miami Dade Zip:
Folio/Parcel#: / l
— 3,;1- O 6 — 6 f36
Is the Building Historically Designated: Yes
NO
Occupancy Type:
Load: Construction Type:
Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder):7tz G �� 1�} ��'�riv ZH c� 1)Zc Phone#:
Address: /-�- O /
/y•• , f4 s
City: A/~/
-'> o e S State: %�L
Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name
Address:
2 /,Oj
City
Qualifier Name:` ,/052 d=--
State Certification or Registration #:
/ U su'/ f lu1 hone#: 0o5- 0o fO66
� O a
State: Zip:
Phone#: 3 U 5 A6)6
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $�OQ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New / ❑ Repair/Replace ❑ Demolition
Description of Work: WbO L U6 a F Po kn.8 E/ r ¢f�✓�
Ske ify colgr of color bt u tile:
C_
Submittal Fee $ DA I Permit Fee $ �/ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ (09 • E)5
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
r
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 su fisted notice, the
inspection will not be approved and a reinspection fee will be charged. \/)
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
-/Oday of 20 / 6 , by
% 0& -7- Q off ti L' V41ho is personally known to
me or who has produced //D dSe �CZ as
identification and who did take an oath.
NOTARY
Sign:
Print: �'�vn�'°` 7ERIIITApUINpNEB
My MMIS61ON # GG 078130
Seal: N, c` EXPIRES: March 1, 2021
OF 0-G Bonded Th^r Budget Notary SeMces
Signatu
The foregoing instrument was acknowledged before
me this
day of 20/ O by
\.l 050- whoisq2ersonally kno to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print: �O
Seal: *� „ MY COMMISSION # GG 076110
��a� EXPIRES: May 14, 2021
°Of f4op Bonded Trn Bud* NoWy S«vim
APPROVED BY 'Gv� Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)