PL-17-288Lfc
Miami Shores Village
`sh".!R
"
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
FLORIDA
Permit NO. PL-2-17-,2$$
■ Permit Type: Plumbing - Residential
' Work Classification: Addition/Alteration
Permit Status: APPROVED
Issue Date: 318/2017 1 Expiration: 09/04/2017
Project Address Parcel Number Annlirant
10504 NW 2 Avenue 1121360020010
Miami Shores, FL 33150-1227 Block: Lot: NORMA CHACON
Owner Information Address Phone Cell
NORMA CHACON 10504 NW 2 Avenue (786)252-2232
MIAMI SHORES FL 33150-
10504 NW 2 Avenue
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone
DECONEX INC (305)817-8777
Type of Work: LEGALIZE BATHROOM WORK PLUMBING
Type of Piping:
Additional Info: LEGALIZE BATHROOM WORK PLUMBING
Bond Return :
Classification: Residential Scanning: 3
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.25
DCA Fee
$2.25
Education Surcharge
$0.20
Permit Fee
$150.00
Scanning Fee
$9.00
Technology Fee
$0.80
Work without Permit Fee
$150.00
Total:
$315.10
Valuation: $ 500.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-2-17-62820
03/08/2017 Credit Card $ 265.10 $ 50.00
02/03/2017 Cash $ 50.00 $ 0.00
Avanaole
Inspection Type:
Top Out
m
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 t t II the oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermo , I q6ttprize the above -named contractor to do the work stated.
Authorized
/ Applicant / Contractor / Agent
March 08, 2017
Building Department Copy
March 08, 2017 1
L l r.�,%�
Miami Shores Village
Building Department BY (hf
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201�--(
BUILDING
Master Permit No. RC 1 : '7&Co
PERMIT APPLICATION
Sub Permit No. P (
- ('-4 " 2<-S S
❑BUILDING ❑ ELECTRIC
❑ ROOFING
❑ REVISION ❑ EXTENSION
❑RENEWAL
VPLUMBING ❑ MECHANICAL
❑PUBLIC WORKS
[:]CHANGE OF ❑ CANCELLATION
❑ SHOP
CONTRACTOR
DRAWINGS
A.-) Al etiUr-
JOB ADDRESS: �n�
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO
Occupancy Type: Load:
Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder):
a �Constructionn�Type:
/te a/ �st/4r7
�i
w&oll _l Phone#:
Address: /0.5D r /Ua'l
_&J'r--
City:
State: Zip:
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name:
C�
e#: 79 6 �4 —q'F*S? U
Address: 2 `-3 4 M c_ & P i Va S 7
City: C. (` � P-'O' State: Zip:
Qualifier Name: Doi V P-D -O Phone#: IF6
State Certification or Registration #:C�C I+ 2V`2-3 i Certificate of Competency #:
DESIGNER: Architect/Engineer:
Add
hone#:
City: State: Zip:
Value of Work for this Permit: $ SO V Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
LCC,41, 2 ._B7.�y17o6,0-1 AXkK
Specify color of color thru tile:
Submittal Fee $ � --' •Permit Fee $ %�� CCF $ • �C>!� CO/CC $
Scanning Fee $ v 1 Radon Fee $ 2 • Z s DBPR $ % Z 5 Notary $
Technology Fee $ ' f70 Training/Education Fee $ 0 Z Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ /,�� . '
(Revised02/24/2014)
j +ti h
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 bb
promise in good faith that a copy of the notice of commei
whose property is subject to attachment. Also, a certified c
for the first inspection which occurs seven (7) days after
inspection will not be approved and areinspection fee will)
Sign
OWNER or AGENT
ig permit with an estimated value exceeding $2500, the applicant must
lent and construction lien law brochure will be delivered to the person
of the recorded notice of commencement must be posted at the job site
building permit is issued. In the absence of such posted notice, the
The foregoing instrument was acknowledge befor /m Itpis
1 day of N�%�f /b by
/1,lC.��jT/9 ('%/��y , who is personally known to
me or who has produced 61 as
identification and who did take an oath.
NOTARY P
Sign:
4g?'. •., MAGGIE GARCIA
Print: z+I my rommisSION # FF 048923
EXPIRES: October 20, 2017
Seal: �a • Bonded Thru Notary Public Underwriters
Signature f-b/VV
CONTRACTOR
The foregoing instrument was acknowledged before me this
( Z day of �Au et k �� , 20 q by
—b>A-Q J=P who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
I/ MYCOtd 4N#Miw4S
xts n,, 2018
as
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)