PL-05-19-1115, 1420 NE 101st StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
1420 NE 101ST ST, Miami Shores, FL 33138 1132050230050
.ontacts
MATTHEW ALLEN Owner VAN KIRK & SONS INC Contractor
1420 NE 101 ST, MIAMI SHORES, FL 33138 ROBERT P VAN KIRK JR
Other: 3056732847 3144 SW 13 DR, DEERFIELD BEACH, FL 33442
Business: 9547554402 esandoval@vankirkpools.com
Other:7863262747
Inspection Requests:
Description: PIPING FOR POOL, SPA, GAS HEATER Valuation: $ 1,000.00 T62 449r
a �
I Total Sq Feet: 0.00
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
$3.00
Technology Fee
$3.75
Total:
$161.55
Building Department Copy
Payments Date Paid
Amt Paid
Total Fees
$161.55
Check # 110068 08/01/2019
$111.55
Check # 43392 05/16/2019
$50.00
Amount Due:
$0.00
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 accur4e and that work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above na ontractor do; he work stated.-/
Authorized Signature: Owner / Applicant / Contractor Ul' Agent I Date
August 01, 2019 Page 2 of 2
Miami Shores Village
�vA Y 6 20 9
Building Department BY:
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 20
BUILDING Master Permit No ?-pe oS-Y] - j
PERMIT APPLICATION Sub Permit No. L� U s `
QBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1420 NE 101 Street
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-3205-023-0050 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): Matthew & Elizabeth Allen Phone#:
Address: 1420 NE 101 Street
City: Miami Shores State: Florida Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Van Kirk & Sons Inc. Phone#: 954-755-4402
Address: 3144 SW 13th Drive
City: Deerfield Beach State: Florida Zip: 33442
Qualifier Name: Robert P. Van Kirk Jr. Phone#: 954-755-4402
State Certification or Registration #: CPC-045956 Certificate of Competency #:
DESIGNER: Architect/En sneer: / i
g 1�d✓1cy�p �,P� a'U—F c�SUC��;�Phone#:�a� ?05'
Address: City:Cu—A,A 10 a 1State:1L' Zip: cs'i
Value of Work for this Permit: $ It 6 6 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:���°'�"�
hta`_
Specify colorofcolor thru tile:
Submittal Fee $o ` PC4 I'd Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews S
CCF $
DBPR $
CO/CC $ _
Notary $,
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $ j I I , is, �::
(Revised02/24/2014)
Bonding Company's Name (if applicable) N/A
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.
vGSignature_'
OWNER or AGENT
The foregoing instrument was acknowledged before me this
- -3 day of Kka'UlA-, 20 L� by
Matthew & Elizabeth Allen who is personally known to
me or who has produced b(tiy&.Q/x Ll Uas
identification and who did take an oath.
NOTARY PUBLIC:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
��/ ` day of Q-K, - 2 by
• VAn kAY , wh is personally known
me or who has produ as
identification a who ake an oath.
NOTARY PUBLIC:
3
Sign:1— p -- Sign:
Print: C� V ar, int: 7 ��
Seal: ; ? RU S.gV�AN KIRK III
MY CQMMISSIUN # GG 070833
+9V`
EXPIRES: June 7 2021
B00nc.Md ' hru Notary Public Undertivriters
APPROVED BY ; ^" _._. "'Lr� Plans Examiner
Structural Review
Qlizabeth Sandoval
^ ,�,�. � hti�-State of Florida
N, c Commission #GG 30615
�'�F.,,.^•OHO Expires3/27/2020
***************************
Zoning
Clerk
(Revi sed02/24/2014)