PL-10-137 rl
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Miami Shores Pillage ,
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10050 N.E. 2nd Avenue -'
Miami Shores, FL 33138-0000'
Phone: (305)795 - 2204' ' u a x , ; 3 .,,,,.., :>� r •
Expiration:
Project Address Parcel Number Applicant
848 91 Terrace 1132060050350 MOJDEH SHUSHTAR
Miami Shores, FL 33138- Block: Lot:
`s
Owner Information Address Phone Cell
MOJDEH SHUSHTAR 3928 GATEWAY Drive
PHILADELPHIA PA 19145 -
Contractor(s) Phone Cell Phone Valuation: $ 2, 000.00
THE NEW MIAMI SHORES PLUMBING (305)751 2446 (786)553 -5424
__ ... _.... n.x_._. Total Sq Feet: 0
Type of Work: WATER SERVICE REPLACEMENT For Inspections please call:
Type of Piping: PLUMBING (305)762 4949
Additional Info: Available inspections:
Bond Return : Inspection Type:
Classification: Residential Top Out
Re Pipe
Main Drain
Heater
Water Service
Final
Water Main
Lavatory
Underground
Fees Due Amount Invoice # Total Amt Paid Amt Due
CCF $1.20 PL -1 -10 -36919 $ 156.20 $ 50.00
Education Surcharge $0.40
Permit Fee - Additions✓Alterations $100.00 PL -1 -10 -36919 $ 156.20 $ 156.20 $ 0,00
Scanning Fee $3.00
Submittal Fee $50.00
Technology Fee $1.60
Total: $156.20
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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 Preto and in strict conformity with the plans; drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting t1* permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required foMLECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
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OWNERS &'FIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructiopnd zoning. Futhermore, I authorize the above -named contractor to do the work stated.
February 03, 2010
A4tborized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
February 03, 2010 1
Cq
Miami Shores Village SAN $ 2010
Building Department BY : ....................s..
to050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit NoP 1 - 1 �n
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type Plumbing
Owner's Name (Fee Simple Titleholder)
M 4 1
hone # (366 fo L N
Owner's Addres ANTE Ck T A
City m ;aer s�64m, State C! Zip .3313r
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO -
Contractor's Company Name ®"' ��` +ICJ $ T �U�l�� Phone #
Contractor's Address 9co
s"[
City /zm/ State Zip V
Qualifier Name is A 4 10 0 Phone#
State Certificate or RRgistration N �� Certificate of Compgtency No.
E -MAIL:
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑ Re ❑ Demolition
Describe Work: , S'T o z c� t cn_�
SAN ti
Submittal Fee $ Permit Fee $ �� CCF $ • �� CO /CC
Notary $ Training/Education Fee $ (0 Technology Fee $ Q • uc)
Scanning $ ®® Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side -
Bondijig Company's Name (if applicable)
Bonding Company's Address
City State Zip
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 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 approved and a reinspection fee will be charged
Signature Signa
Ow4or ent Contractor
The foregoing instrument was acknowledged before me this�� The foregoing instrument was acknowledged before me this a
day of 20(x, by c�� hgs��o u i°' day of� r 20/D , by M:5
who is personal known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NO Y PUBLIC:
Sign: S R R A
Print: Print: MY COMMISSION # DD753565
My Commission Expires: ' 3"v 6� (1 gz i 0 My Commission
A N T,
1 ModdeNotaryS®rvi --m
APPLICATION APPROVED BY: X ?_7 e Plans Examiner
Engineer
Zoning
(Revised 0
Notaiy Publc State of Flofida
:o Y Pv% Margaret Medtele
• < Montgomery
My Commission DD540351
°F 061211010
=1
Mir
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 134397 Permit Number: PL -1 -10 -137
Scheduled Inspection Date: February 05, 2010 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: SHUSHTAR, MOJDEH Work Classification: Addition /Alteration
Job Address: 848 NE 91 Terrace
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060050350
Project: <NONE>
Contractor: THE NEW MIAMI SHORES PLUMBING Phone: (305)751 -2446
Building Department Comments
REPLACE EXISTING WATER SERVICE
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 04, 2010 For Inspections please call: (305)762 -4949 Page 4 of 8