PL-8-16-2178, 141 NW 96th Sta`SNonEs L�� Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
F�ORIDp'
Permit NO. PL-8-16-2178
Permit Type: Plumbing - Residential
ermit Work Classification: Pool - Private
Permit Status: APPROVED
Contractor(s) Phone Cell Phone
FLORIDA POOL PATIO CORP (305)815-0181
Type of Work: PLUMBING FOR NEW POOL
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
AAn
Permit Fee
Scanning Fee
Technology Fee
Total:
Issue Date:10/11/2016 1 Expiration: 04109/201 `'7
Valuation: $ 1,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-8-16-60849
08/03/2016 Check #: 7464 $ 50.00 $ 186.36
10/11/2016 Credit Card S 186.36 $ 0.00
HvanaDie inspections:
Inspection Type:
Main Drain
Final
Rough
Review Plumbing
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 foregoin
construction and zoning. Futhermore, I authorize tie
Ir
tion is accurate and that all work will be done in compliance with all applicable laws regulating
med contractor to do the work stated.
October 11, 2016
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
October 11, 2016 1
Miami Shores Village GENE
Building Department uG 03 2016
_ g p
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 4
BUILDING Master Permit NO.Da) 6 - 219
PERMIT APPLICATION Sub Permit No. T�_ 16
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL
®PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /,141 tlGl %6 -!5,-1
City: Miami Shores County: Miami Dade Zia:3%S�
Folio/Parcel#:(
_ / 3� 6 Da �Q/�d Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee Simple Titleholder): �Q✓
Address: l Kf A)(t) 5
Flood Zone: BFE: __ __ ____ FFE:
City: 41- 'ezm/ -5 "�e/QS State: 14�e_ Zip: �3f
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: �T
City: /•
/j ��-�l/j /
Qualifier Name: CSC CC PJ4�/� C 2
State Certification or Registration #: G%5��� Z' Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Zip:
Address: City: State: Zip:
Value of Work for this Permit: $ IP'47V - Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:,
Submittal Fee $ci Permit Fee $ �CCF $ e W O CO/CC $ "e"
Scanning Fee $ �_ Radon Fee $ () DBPR $ Notary $
Technology Fee $ • Training/Education Fee $ o ZO Double Fee $
Structural Reviews $ Bond
TOTAL FEE NOW DUE $ • 3 VJ
(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 $1500 e a plicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will b eliver to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement st be sted at the job site
for the first inspection which occurs seven days after the building permit is issued. In the ab ce of ch posted notice, the
inspection will not be approved re spection fee i be charged.
Signature Signature
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
�<9 4 day of 20 / by /day of / 20 l by
/
who is personally known to �N� d �/Q l 1 ,who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUB : NOTARY PUBLIC:
Sign: ZOE SALGUEIRO ZOE SALGUEIRO
Sign:
`� n .:.Notary Public a e o on a
Print: vv� Commission # FF 245464 0 Print:Commission # FF 245464
=N o; M omm. x
Seal: % „,`, °a Bonded through National Notai v My Comm. Expires Jun .' 2 z'
Seal: °I. BondedthrouahNationalNotaryAssn.
sssssasesesasssstssstssssssassesssssseeesssesssssssssessasttsssssseseasessesssssasssseessstsstsssssssessess$
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 2/24/2014)