PL-09-19-2288, 9425 N Miami AveAlkwevi\.,
7L- 0r -(45�- 22-S8
Assured Development Group Inc.
Engineering and Inspection
PIERRE M. VALLES P.E.
5470 E. BUSH BLVD. SUITE 202
TAMPA, FL., 33617
(813)506-1431
Miami Shores Village Building Department
10050 NE 2nd Ave,
Miami Shores, FL 33138
Re: Affidavit Inspection Report
9425 North Miami Ave
Miami Shores, Florida 33150
Permit # PL-09-19-2288
Dear Applicable Building Official:
In accordance with Florida Building Code 20176`h Edition; Administrative Section 105.14
Permit Issued on Basis of An Affidavit; I herewith provide you with disposition on the Building
components inspected.
To the best of my knowledge and belief, the building components outlined herein and inspected
under my authority have been completed in conformance with the Florida Building Code 2017
eth Edition:
- Final Plumbing including:
- Concealed plumbing
- Shower liner
- Shower faucet pressure balance
- Ground rough
Should you require any additional information, do not hesitate to call me.
Sincerely,
Pierre M. Valles, P.E. #66356 Digitally signed
Q1P-;111` < bW- d - P-RE by Pierre M
N0. $6456 using a Wghal Seta and dam
-tetftdoWand VaIIes
gTaT; OF are not considered signed and
9 '.. FY ? sealed and Me signature must 6e
verMad on a" electronic copies
Date: 2019.10.31
21:36:03-04'00'
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
9425 N MIAMI AVE, Miami Shores, FL 33150 1132060130510
:ontacts
RAMON TOLEDO Owner WESTLAND PLUMBING CORP Contractor
9425 N MIAMI AVE, MIAMI SHORES, FL 33150 CARLOS COBOS
Home: 3054691290 floridainsurancequote@gmail.com 675 W 63 DR ****
Business: 3058636223
Other:7862360198
L600.00
Ins ectron Recu�estsDescription: REPLACE KITCHEN SINK, DISH WASHER, AND Valuation: ICEMAKERTotal Sq Feet: �:
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.30
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
09/30/2019 $50.00
Credit Card
10/04/2019 $60.30
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.
OWNERSIDAVIT: ertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating/�nstructio d zoning. Futhermore, I authorize the above named contractor to do the work stated.
Signature: Owner
/ Applicant / Contractor / Agent
Date
October 04, 2019 Page 2 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
'PLUMBING ❑ MECHANICAL ❑PUBLICWORKS
JOB ADDRESS: Lf IeA Z
SEq 3 0 ZW3
FBC 20 a 2
Master Permit No.�
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
ONTRACTOR DRAWINGS
,)
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NC -
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): �(� Phon
Address:` /yc��T� f/✓lt`i�t+^'1c i/�
City: lMidi*�'^� 5�� State:)
Tenant/Lessee Name:
Email
ne#:
p:
CONTRACTOR: Company Name: V eAjl�MV_..4D �Cti'YY) �O L 1A JCS Phone#:Wb V ,� (OZ23
Address: i�to `\�- � 5-t I � ^
City: �� 0 1�(Q_V 1 Stater r t G Zip: �C 1 to
Qualifier Name: CA'( n C, r L 4 b e),�, Phone#:7� Z�
State Certification or Registration #: C—C, a_!:� 7 I)0 Certificate of Competency #:
DESIGNER: Arthitect/Engineer: Phone#: _
`'Address: City;: , State:
ZX77�.•
Value of Work for this'Permit: $ SquaiQl.inear Footage'of Work:
Type of Work: ❑ Addition ❑ Alteration New Repair/Re'ace
Description of Work:
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
Notary $.
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 00 .
(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
Zi
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
:Z�- �—
OWNER or AGENT
The foregoing instrument was acknowledged before me this
dda`y of ��� 20 by
iC(mc�h 1`�� TO��C who is personally known to
me or who has produced as
CONTRACTOR
The foregoing instrument was acknowledged before me this
fh day of ,20 19 by
— who is personally known to
me or who has produced_ p .\\\\`` 1ADY P 2
identif cats and id take an oat;\\\\\i"'Y PRE � ���i/ ident
NOTA PUB IC: �s ����\y:�"`•tON•�� ���i NOTE
•VOA"GM25,16�•�
Sign.
i
Print: AYK�'� o • •. Print:
Seal: ��ii,9'i•p&bec und! 0jc
&'40 Seal:
tion a d wh did tak an oath.cPv
PUBLIC:
Z y ..y #EGG 28726800
;
� n ten., r /��/.A1'in�' tG••�. '_cC�'�\��`
APPROVED BY � /a/114 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)