PL-04-169&in °A6
MIAMI SHORES VILLAGE
°
BUILDING DEPARTMENT
305- 795 -2204
Bui i ng Inspection Request
Date 17 1
Type Insp'n ffx 9 n
Permit No. P I VS- 1
Name TCer t_tol 1 NW Address 10320 NW 2 A u42.-
Company i� l, x 1Q2 rG 21 •
Phone # 7,03' . 9 L IJ ° 537.5
Inspection Date 0
Approved
Correction
Re- Insp'n Fee
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical luibing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) �v Ce [ O tea) Phone #
Owner's Address (c ( VY4Q)
City State Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done) I 2S0 E G 4 Sr
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES
Contractor's Company Name
v
$ Value of Work For this Permit
Describe Work:
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
5Ob,OO •
NO )C
PECE VED
1, iv fi 2004
Permit No. 1' oaq 1 1
Master Permit No. Pi Z ' - 1 {OK
zip '3'61'68
Phone # ( 63 J- 5QO2
Nt1 f o Se-pit
Contractor's Address 2.1 c N J 21 dkv -Q.,
City J X Y�o State CZ- Zip 331 L t
Qualifier e3Ck - Te.)C P
Architect/Engineer's Name (if applicable) Phone #
Submittal Fee $ Permit Fee $ 1 15 .O0
Notary $
Scanning $ Radon $
Square Footage Of Work:
v• X Type of Work: ❑Addition ❑Alteration ['New Repair/Replace ❑ Demolition
'Pump wel dor, 161.0 fzen v
Training/Education Fee $ 0 20
CCF $ o O d CO /CC
Technology Fee $ 4.3 ?-
Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Bonding Company's Name (if applicable) ' V 1)'
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) 1�
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be a oved an reinspection f e will be charged.
Signature
Cho 12/15/03
NOTARY : LIC:
er or Agent ,
The foregoing instrument was acknowledged before me this 7
day of -� G�`"� , 20 ® 41 by /
who is personally known to me or who has produced
As identifl ation and who did take an oath.
Sign: \ ��n_,�t y�
Print: V �x r ck Il l0..V; 'u" ' "NEW O 8. RIGS
MY COMMISION 9 DD 281326
94-P-119
j
Contractor
The foregoing instrument was acknowledged before me this 7
day of --101. , 206 by
b_trurTe))telm
who is personally known to me or who has produced
as identification and who did take an oath.
•
NOTARY PUBLIC.
Sign:
Print:
•
My Commission Expires:,, "! 11 1 4 ` ' EXPIRES: January 14, 2008 My Commission E l -- -
44c. w e - Beaded Thru Budget Notary Services y �`3 ' * MY COMMISSION A DD 281326
* * * ** * * * * * * * * * * *, ** ** * *** * * * * * * *** * ** ****** * * * * * ** * * *, * * * * ** * * * * ** * * * * * * * * *** **4, iii; c ot * K&IAn$r11R lit * **
(Certificate of Competency Holder) Bud � kes
State Certificate or Registration No.
APPLICATION APPROVED BY
* * * * * * * * * * * * * * * * ** * * * * * * * * * * ** :. * * **
Certificate of Competency No.
****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 6/15/2004
Applicant: MARCELO LEAL
Owner: LEAL MARCELO
JOB ADDRESS: 1250 NE 94 ST
Plumbing Permit
Permit Number: PL2004 -169
Contractor ALL PRO SEPTIC & SEWER INC Contractor's Address: 1531 NW 26 AVE
Local Phone: (305)635 -3002
Parcel # 1132050100200
Legal Description: MIAMI SHORES BAY VIEW PB 40 - 16 W35FT OF LOT 21 & E65FT OF LOT 22 LOT
Fees: Description Amount
FEE2004 -6121 Building Fee $175.00
FEE2004 -6122 CCF $0.60
FEE2004 -6123 Training and Education Fee $0.20
FEE2004 -6124 Technology Fee $4.37
Total Fees: $180.17
Total Fees: $180.17
Total Receipts: $180.17
Permit Status: APPROVED Permit Expiration: 12/7/2004 Construction Value: $500.00
Work: ABANDON TANK
Signed: (INSPECTOR)
Page 1 of 1
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY: