PL-16-755Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit NO. PIL.-3-16-755
Permit Type: Plumbing - Residential
Mork Ciassifrcatfon: Addition/Alteration
Permit Status: APPROVED
Issue Date: 3/24/2016 1 Expiration: 09/20/2016
Project Address Parcel Number Applicant
10420 NW 2 Avenue 1121360161050
Miami Shores, FL Block: Lot: WILFRED JEAN
Owner Information Address Phone Cell
WILFRED JEAN 10420 NW 2 AVE
MIAMI SHORES FL 33150-1226
Contractor(s) Phone Cell Phone
A-B REMODELING INC (305)613-9881
of Work: PLUMBING FOR SINK.
of Piping:
onal Info:
Return :
ification: Residential Scanning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.25
DCA Fee
$2.25
Education Surcharge
$0.20
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$159.10
Valuation: $ 685.00
Total Sq Feet: p
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-3-16-59109
03/24/2016 Check #: 287 $ 109.10 $ 50.00
03/22/2016 Check #: 286 $ 50.00 $ 0.00
Avanaoie i
Inspection Type: i
Underground
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 accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. FuthermoRe,il authorize the aAve-named contractor to do the work stated.
March 24, 2016
Authorized Signature:
/ Agent
Building Department Copy
March 24, 2016 1
CF1rV1FP
Miami Shores Village i M R 22 2016
Building Department BY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 T
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201
BUILDING Master Permit Nok, 16 ^ ICZ
PERMIT APPLICATION Sub Permit No.
❑ BUILDING ❑ ELECTRIC ROOFING ❑ REVISION EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Folio/Parcel#: r� s. �-•• V`b --10t>U Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titlehol
Add
City: State:
7`
ne#: � � ��' 2, O
Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Phone#: 4
Address: S (0 D LJ 12 ga-
N
city:
p: 3�a/2'
Qualifier Name: G Ui5 4 °3 6yt -�� Z . Phone#: ((��
State Certification or Registration #: C PC i!ZY &e"7 Certificate of Competency #: l /
DESIGNER: Architect/Engineer': Phone#: _
Address: r ,. City: State:
Value of Work for this Permit: $9� zb A Square/Linear Footage of Work:
Type of Work: ❑ pAddition ❑ Alteration ElNew ❑ it/Replace
Description.of Work: 1.J C .3. �...L� QQ 'LJ� C �`1 / Rep
k V_ i- v---' /' n_ n 1 _. l
Zip:
❑ Demolition
-, j
s y q
t ..3'kJa1# i � P. r' � � L•,Ex. i 2.. .,^. n , Y _ �,a�f ,�1 �.. a Y (.n ..
id
ColoColoKthru-t/le'' ' rw r'iof 94±Iax1 °Y, *•,l
Scanning Fee $ '--3 .0�
Technology Fee $
Structural Reviews $
Permit Fee $ CCF $ CO/CC $
Radon Fee $. ' �T DBPR $ r/ �� Notary $ (�
Training/Education Fee $ n ' �� Double Fee $
Bond $ Y�
TOTAL FEE NOW DUE $ I O 9 '
(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 reinspection fee will be charged
Signature C)
OWNER or AGENT
The foregoing instrument ^as acknowledged before me this
420 day of 20 by
l� �QiJ who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
M
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
I day of� 20 by
JAJ" c 6 f0f-J;I�P)I6,7who is personally known to
me or who has produced .......t.. .1 as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: '~-�� Sign, -
Print: Print:
Seal: _ . MY COMMISSION # FF241289 Seal:
i
EXPIRES September 05, 201t
Ie7]98.C�51' F'IaiaallotarvSwvks.tam .:.._: ..
LAURA UGUETO--
My COMMISSION # FF241289
EXPIRES. September 05, 2014
rpriAalloti�9 �-- - • —
APPROVED BY Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk