PL-07-22-1680Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: PL-07-22-1680
Permit Type: Plumbing - Residential
Work Classification: Gas
Permit Status: Approved
Issue Date: 10/12/2022 Expiration: 04/12/2023
Location Address
Parcel Number
1030 NE 99TH ST Miami Shores, FL 33138
1132050320010
Contacts
CAROLYN MCKERLY
Owner FOREVER GAS CORP
ROBERTO GONZALEZ
LContractor1030
18111 NW 68 AVE 1105, HIALEAH, FL 330153989
Business: 3052980193 foreverga
Inspection Requests:
Description: 3/4" GAS LINE (LPG) TO SUPPORT A NEW 22 KW
Valuation: $ 1,350.00
305-762-4949
WHOLE HOUSE GENERATOR
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
education Surcharge
$0.60
Permit Fee
$50.00
Scanning Fee
$9.00
Technology Fee
$10.00
Total:
$124.80
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$124.80
Credit Card
10/12/2022 $124.80
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS A FIDA I certify that all the foregoing informal: on is accurate and that all work will be done in compliance with all applicable laws
r gul ing c n tr io and zoning. Futbertr+gre,,Iauthonze Nis ove gammedd contractor to do the work stated.
,, ``jjc� ,e� lL�i`-4 .� 1��I2/2z
Authorized Signature: Owner / Applicant / Contractor / Agent
Date
October 12, 2022 Page 2 of 2
Miami Shores Village p,UFMCEIVED
Building Department LCI&`> -JUL 01202z
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 13y.
nip
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBc zoa b
BUILDING Master Permit No — f
PERMIT APPLICATION Sub Permit No. "V�
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWALVPLV
UMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
® CONTRACTOR DRAWINGS
JOB ADDRESS: % ® 3 U / c f � J
City: Miami Shores P' County: Miami Dade Zio: 33 /,? 0
Folio/Parcel#: /Z_ 3 -� 6 S " O J ? )- - 00 /O Is the Building Historically Designated: Yes NO
Occupancy Type: SF Load: Construction Type: C��iiI�V Flood Zone: _� BFE::: d �Q� FFFE:
OWNER: Name (Fee Simple Titleholder): G. Q<yy/ 1ICC/C.- elev Phnnafk-dOL93d 7779
City: 14f/ Lvdi
Tenant/Lessee Name:
Email:
r'eS State:
CONTRACTOR: Company Name: Phone#:.305 Z %PO I9
Address:
City: k Cr- y'1 J /$tate: L Zip:
Qualifier Name:Z,,//G''�///� Phone#: ✓70S��g�� �g
State Certification or Registration #: A 7" O Certificate of Competency #:
DESIGNER: Architect/Engineer: Al 14 Phoneth
Value of Work for this Permit: $ S
Type of Work: ❑ Addition ❑ Alteration New
of Work: 2141
Specify color of color thru tile: iV #
is S v
Footage of Work:
❑ Repair/Replace
I- a- h-ozi
❑ Demolition
�a
Submittal Fee $ �j Permit Fee $ r2T7+1 CCF $ �I 1p 1/ CO/CC $
Scanning Fee $ ' U�(V/j Radon Fee $ 15 J / DBPR $ Notary $___
Technology Fee $ 13,dy Training/Education Fee $ 31 (t./ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014) 1
Bonding Company's Name (if applicable)
Bonding Company's Address �T —
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.
SigaurZ� Signature / ,
OWNE rAG T O RACTOR
The foregoing
foorregoing instrument was acknowledged before me this
1— day of 20 ri . by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: J42,6,4
� p
Print: &LAL,V,4nenlelt"
Seal: Notary Public
State of Maine
My Commission Expires
August 5, 2022
a
The foregoing instrument was acknowledged before me this
2(0th day o4ff, MQy ,20 as .by
IabR.r is UW 2G 1'eJx_ , who is personally known to
me or who has produced
as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
STATE OF FLORIDA
Comm# GG340030
Expires 5/30/2023
ssas as»s�a.srtasaess»+:�ssss��s
117171 ZZZoning
(Revised02/24/2014)
Structural Review
Clerk