PL-07-19-1604, 1361 NE 104th StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
1361 NE 104TH ST, Miami Shores, FL 33138 1122320320020
:ontacts
ERIC ZETKA Owner DESIGNER POOLS INC Contractor
260 NE 99 ST, MIAMI SHORES, FL 33138 JORGE LUIS GARCIA
szetka@hotmail.com
Business: 3059696300
Inspection Requests:
Description: POOL PIPING FOR NEW POOL & DECK Valuation: $ 1,000.00
305-762 4949Ji
99 j Total Sq Feet: 1,450.00 y
s
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
Credit Card
01/13/2020 $111.55
Credit Card
07/11/2019 $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 AFFIDAVVT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constructio oning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: ner / Applicant / Contractor / Agent Date
January 13, 2020 Page 2 of 2
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address Parcel Number
1361 NE 104TH ST, Miami Shores, FL 33138 1122320320020
Contacts
i
ERIC ZETKA Owner DESIGNER POOLS INC Contractor
260 NE 99 ST, MIAMI SHORES, FL 33138 JORGE LUIS GARCIA
szetka@hotmail.com
Business: 3059696300
Description: POOL PIPING FOR NEW POOL &DECK Valuation: $ 1,000.00
Inspection Requests:
Total Sq Feet: 1,450.00 „' "E
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
Applicant Copy
Payments
Date Paid Amt Paid
Total Fees
$161.55
Credit Card
01/13/2020 $111.55
Credit Card
07/11/2019 $50.00
Amount Due:
$0.00
For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/.
Requests must be received by 3pm for following day inspections.
NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
additional restrictions applicable to this property that may be found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS,
public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES.
January 13, 2020 Page 1 of 2
Miami Shores Village JUL 1 201�
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 l
BUILDING Master Permit No.b?'P 01-1 - I
PERMIT AP PL ATION Sub Permit NoU 0�1-1 `�-- l b03
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING [� MECHANICAL ❑PUBLIC WORKS F--j CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I�'2' (I I E I O y' St'
City: Miami Shores County: Miami Dade Zip: S 313 1
Folio/Parcel#: J I - 22. 32 - 032 - 00 2 0 Is the Building Historically Designated: Yes NO _
Occupancy Type: O.3.1— Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): E r 1 C S CID tfi Ze J k Q Phone#:
Address:
City: MiAml sDelfQs State: FL zip: 3 3)
Tenant/Less-lee Name: (n� 1,� �-y� ! n Phone#:
Email: S 1.M A l I l0 1 1' IQ 1 �. mm
CONTRACTOR: Company Name: aC16PEIQG�r IG Phone#: 161n. 4I2. 0001
Address:: 2 (O1 W. 11 St
City: ffi 0 W—(, h State: r- L Zip: 33 010
Qualifier Name: E_I q l o i g ue r 00 Q Phone#: l lbb- 4 I2. OO (D 1
State Certification or Registration #: ,CC 13 60 5 _Iu U g Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Ad
State: Zip:
Value of Work for this Permit: $ L Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration E'New ❑ Repair/Replace ❑ Demolition
Description of Work: � I eC-Al I -611 f 01 pool
Specify color of color s +V th u tile:
� /l � 5
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ li I I
(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/AGENT
Thee foregoing instrum t was acknowledged before me this
41 day of E U rU 20 4 by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Signature
NTRACTOR
The foregoing instrument was acknowledged before me this
I day of b1 ry 20 Gj by
),U 11d, rho is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign:
P Print:
Y'P ANYELIZA 11RA00 r" Po ANYELIZA TIR
Seal: t.'.a Seal: '� MY COMMISSION #GG076093
a: b MY COMMISSION #GG076093 EXPIRES: FEB 22, 2021
EXPIRES: FEB 22, 2021 Bonded through 1st State Insurance
Bonded through 1st State Insurance
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)