PL-05-21-1311Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
41 NW 106TH ST, Miami Shores, FL 33150 1121360060210
Contacts
Jesus Jimenez Owner NATIONAL POOL DESIGN LLC Contractor
41 106 ALFREDO RODRIGUEZ
2423 SW 147 AVE SUITE 212, MIAMI, FL 33185
Business: 3055591020 freddy@nationalpooldesign.com
Mobile: 7862675595
National Pool Design Agent
Ernesto Don
2423 SW 147 Ave 212, Miami, FL 33185
ernie@nationalpooldesign.com
P ; Ins ection Requests
Description: swimming pool plumbing �I Valuation: $2,400.00 N I Total Sg Feet: 500.00 ,
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.80
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.60
Plumbing - Pool - Residential
$100.00
Scanning Fee
$12.00
Technology Fee
$3.75
Total:
$172.15
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$172.15
Credit Card
05/21/2021 $172.15
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 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.
Signature: Owner
/ Applicant / Contractor / Agent
Date
May 21, 2021 Page 2 of 2
Miami Shores Village RECEIVED
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 202-0
Master Permit No. 6 PF- 10 - 2517S'
Sub Permit No�L-
❑ REVISION ❑ EXTENSION ❑RENEWAL
5?fPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: W W4 /O
(D 7 r"
City: Miami Shores
County:
Miami Dade
Zip:
Folio/Parcel#: 3 G , L�)O (0— C ;L 10
Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type: PM I_Flood Zone:
BFE: FFE:
01-umb
OWNER: Name (Fee Simple Titleholder):
J�GrjUj
f me rlGZ
Phone#: s Ob ^ cw�— 14 3 9
Address: w ty&j 1o6
ST
City: 411 NAJ /Lj
State:
Zip:
Tenant/Lessee Name:
Phone#: 30,s^
Email: 26tpq SeVS &
Adj. Corn
CONTRACTOR: Company Name: �/(,t�'7 V M 1 �(J Q )
Address: 74y1' sw /y % AVC cj" 't-
City: /�' � ��►VY) i,,/ State: _
Qualifier Name: /9)Jre dO �d rJ'jV-e.Z_
State Certification or Registration #: CPC %
DESIGNER: Architect/Engineer:
ne#: 3 0J--5:974 40 26
Phone#: 30,r �?70 -TW3
% & y S Certificate of Competency #:
Phone#:
Address: City:
Value of Work for this Permit: $ S/dG • Od Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration dNew ❑ Repair/Replace
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
r
CCF $_
DBPR $
te: Zip:
❑ Demolition
CO/CC $
Notary $
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $ _
(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
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
OWNS or AGENT
The foregoing instrument -was acknowledged before me this
day of AAar 20 by
i (8C-X C22 who is personally known to
me or who has producedfrpi_ h as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Signature
CONTRACTO
The foregoing instrument was acknowledged before me this
�+ day of 120 by
who ersonally knoo
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
as
Print: Print:
t►o-You" CRISTINA RODRIGUE2 �J4 poi•. CRISTiNA RODRIGUEZ
Seal. °` Notary Public State of Florida Seal: ;'a� Notary Public • State of Florida
Commission # HH 083889 Commission HH 083889
or fl?• My Comm. Expires May 16, 2025oF �9 My Comm. Expires May 16, 2025
Bonded through National Notary Assn. Bonded through National Notary Assn.
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)