PL-19-624Permit NO.: PL-03-19-624
Miami Shores Village Permit Type: Plumbing- Residential
10050 NE 2 Ave1'0
Miami Shores FL 33138 } Work Classification: Pool -Private
305-795-2204 1 Permit Status: Approved
Issue Date: 04/15/2019 1 Expiration: 09/18/2019
Location Address Parcel Number
970 NE 94TH ST, Miami Shores, FL 33138 1132060350030
'ontacts
DAVID & MELINA ROBINSON Owner ROSMEL POOLS INC Contractor
970 NE 94 ST, MIAMI SHORES, FL 33138 WILFREDO JR LEIVA
Other: 3052130319 9300 NW 25 ST 103, DORAL, FL 33172
Business: 3055927900
Description: POOL PIPING ROUGH Valuation: $ 2,000.00 Ins section Requests:
Total Sq Feet: 648.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Plumbing - Pool - Residential
$100.00
Scanning Fee
$3.00
Technology Fee
$3.75
Tota I :
$162.35
Payments Date Paid Amt Paid
Total Fees $162.35
Check # 15220 04/15/2019 $112.35
Credit Card 03/22/2019 $50.00
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 AFFID IT: I certify th t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
re ulatin o st ction a z nm uther e, uthorize the above named contractor to do the work stated.
Signature: fayvfierx, ,� Applicant !/" Contractor' / Agent Date
April 15, 2019 Page 2 of 2
BUILDING .;
PERMIT APPLICATION
❑ BUILDING
PLUMBING
❑ ELECTRIC
Miami..Shores Village
Buildingbepartment P2_ECEIv--.,.:�
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 MAR 2 2 20;3
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE.NUMBER: (305) 762-4949 vk-py:
FBC ill
Master Permit No. 6 9V -0;-1 "I
Sub Permit No. 2-�
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ MECHANICAL OPUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: OI to k e • q `
City: Miami Shores County: Miami Dade Zip: 3 a /.se
Folio/Parcel#: l )—- 05 J —100W Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: 1 Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):( �V L4 �1/'1 n Phone#:
Address: C1 i C) 9.� � 4 mot' -
City: Ai.6y6 i cokore;:' State: Zip: 3_5
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: �rT�GI ��''J �i�„ Phone#: 30r✓ -S�I� "!�
Address: �\ N..�� �:+ �' sc, [J-e 110,2"
City: l '�,,11��/� TState: Zip: �Ja V7 Z
Qualifier Name: W, f i�iyG� a [ Phone#:.. .
.. � - :. ,..ry�,� per; > • - � rx .
State Certification or Registration #A:�t �,7 �a;—�1Certificate of Competency #: `
DESIGNER: Architect/Engineer: LAPhone#:L
Address: ��S ��J ;711.� �t �. I �` ( City: �lfin 11 x + State: Zip:
Value of Work for this Permit: $ a40M -(DP Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration Ne❑ w ' ^Repair/Replace ❑ Demolition
r
Descri tion of Work:
r
' �;?=.....a., 'FY .X ww.,.'i.:. +.h'A...: s:,Ax n:4 .-"`i1'.✓ ., t .:P.�.t04+1f':a.RT�::?." ..r .. �1:.��.�. .e. ..
Specify color of color thru tiler
Submittal Feel$ t^ x w -wPermit'Fee $
Scanning Fee $ Radon Fee $ _
Technology Fee $_
Structural Reviews $
Training/Education Fee $
CCF $ TCO/CC $vim.--kk
DBPR $ Notary $
Double Fee $
Bond $ ( �j
TOTAL FEE NOW DUE $ 1 �J
(Revised02/24/2014)
Bonding Company's Name°(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Addre s
City State
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.....
y
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.-1IF' 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 commencemerit`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.
. 11t
Signature x Signature
! OWNER or AGENT CONTRACT
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged• before me this
t day of A(Ati UJIr 20 101J by . �°� d�Y of J l%6i C I • 12011 by
who is personally known to. r �t �Ezo Tr•• who is personally known to
me or who has prodiuceclD�r� `i ~ V( b-y"17as me or who has produced �c 1 �11 �� Iicrx>_s
identification and who did take an oath. identification and who did'take'an oath.
NOTARY PUBLI
NOTARY PUBLIC:
1
Sign:
L
Sign:
Print:
Print:
:'k►wY °�"
Seal: 'o �":
? a �'
DORIS ANAYS MARTINEZ
Notary Public •State of Florida
<`wr P��l.
Seal: =�r:_
�:
DORIS ANAYS MARTINEZ
Notary Public State of Florida
Commission GG 250751
'�
Commission = GG 250751
gyp:
My Comm. Expires Feo 14, 2021.",errMy
Comm. Expires Feb 14, 2021
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APPROVED BY
-3 Z aa�_Plans
Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)