PL-03-19-675, 1275 NE 103rd StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
1275 NE 103RD ST, Miami Shores, FL 33138 1132050200080
Contacts
Jacques Nijankin Owner AQUATIC ENVIRONMENTS Contractor
1275 103 LUIS ESPINOSA
11767 S DIXIE 203, PINECREST, FL 33156
Business: 7863909029 aquadesignl@bellsouth.net
Inspection Requests
Description: POOL REMODELING RELOCATE PLUMBING NEW Valuation: $ 750.00
POOL PUMP & FILTER
INS Total Sq Feet: 1,450.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Plumbing - Pool - Residential
$100.00
Scanning Fee
$12.00
Technology Fee
$3.75
Total:
$170.55
Payments
Date Paid Amt Paid
Total Fees
$170.55
Check# 4540
03/29/2019 $50.00
Check # 4678
06/05/2019 $120.55
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 all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent j/ Date
June 05, 2019
Page 2 of 2
r
Miami Shores Village
Building Department 9tlig
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.aPP03 4q-(CT`1
PERMIT APPLICATION Sub Permit No.?L03 �q' (o-11
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
>dPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: )� stfe-'`�
City: Miami Shores County: Miami Dade Zip: 39 (:NB
Folio/Parcel#: I l^310S-020 —00 &D Is the Building Historically Designated: Yes NO 1"
Occupancy Type: Cl�fg— Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Q L4'eS I Z74 0 U &[ Phone#:
Address: l��j � �C I C) 3 slyee t
City: ! ► 1idiMr 7YUl State: � Zip: 33)
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Aq U aA�C e-k-U 1 1(U PNwA45 Phone#: -T Oyr —3qU
Address: `'�`i� �O 2-O
City: 1,-� '1 oe C'fe__ � State: Zip:
l_ / q
Qualifier Name: ( 1�-, U/ I�(�� Phone#:
State Certification or Registration #: C-Tr— CD 54 21&-2 Certificate of Competency #: r&
DESIGNER: Architect/Engineer: Phone#:
Address: tt �1 City: State: Zip:
/y
Value of Work for this Permit: $ ! ✓to• to Square/Linear Footage of Work:
Type of Work: ❑ Addition
Description of Work:
C' Alteration
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
(Revised02/24/2014)
Permit Fee $
Radon Fee $
❑ New no Repair/Replace
Training/Education Fee $
CCF $
❑ Demolition
CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 1 Z0 , 55
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 commen ent must be posted at the job site
for the first inspect'a hich occurs seven (7) days after the building permit is iss d. In e bsence of such posted notice, the
inspection will n e ap oved and a rei pection fee will be charged.
Signature �� _ Signature
or AGENT NTRACTOR
The fgy4going instrument was acknowledged before me this �/` �2 day of V 20 1 ? , by
lS/Lniho is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print
Seal:
APPROVED BY
The foregoing instrument was acknowledged before me this
T'2-Z yv ` day of 6LVA , 20 tC, by
� C
l t �7 �cAwho is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: v.Z ,v. m -
�
AaP
Print: 'i�f;Cilc':j Fu I NFlorlda
c' • (: ^remission # FF 924095
Seal: � 'FOFF� My . •mm. Expires Dec 13, 2019
Bes a.rough National Notary Assn.
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk