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PL-07-135Issue Date: 1/25/2007 Owner's Name: MAYDA PEREZ Permit Type: Plumbing - Residential Work Classification: Gas Job Address: 620 101 Street NE Additional Information Miami Shores, FL 33138- Contractor(s) Phone AMERIGAS PROPANE AND SUBSID 305 - 883 - 8600 Primary Contractor Yes Type of Work: GAS Additional Info: Classification: Residential Type of Piping: Bond Retum : 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. Fees Due CCF Education Surcharge Permit Fee - New Construction Scanning Fee Technology Fee Total: Building Department File Copy Applicant- nature Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Amount $0.60 $0.20 $219.99 $3.00 $5.50 $229.29 Permit Expires: 07/24/2007 Invoice Number PL - 1 - 07 - 27305 Total: Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PL -1 -07 -135 Phone: (305)754 -0700 1132060172130 Lot PB: Total Square Feet 0 Total Valuation: $ 1,000.00 Required Inspections Press Test ROW Final Amt Due $229.29 �K 64'/1 JAN 2 6 PAID Amt Paid NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Date Monday, January 29, 2007 01/26/2007 Check Receipt Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Number: PL -1 -07 -135 Invoice Number: PL -1 -07 -27305 Applicant: MAYDA PEREZ Company Name: Owner Address: 301 NE 101 ST MIAMI SHORES, FL 33138 Job Address: 620 101 Street NE Miami Shores, FL 33138- Payment Type Check Number 6494 Amount $229.29 Change $0.00 Total Payment: $229.29 Page 1 of 1 BUILDING AN 2 4 2007i PERMIT APPLICATION FBC 2004 B Y° City Miami Shores Villae FOLIO / PARCEL # Is Building Historically Designated Miami Shores Village g u ),. Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 L i YES Permit Type (circle): Building Electrical Plumbing Mechanical Owner's Name (Fee Simple Titleholder) VA/at-le 1 e11' / ,r/ Phone Owner's Address 6)-0 /en d� < Cit F 1 * [ 1 SHOLeS State I Zip 6 Tenant/Lessee Name /VA Phone # Job Address (where the work is being done) Architect/Engineer's Name (if applicable) i.. f Value of Work For this Permit $ 6P4a. Submittal Fee $ Scanning $ Radon $ Permit Fee $ Notary $ Training/Education ee $ 0-W Bond $ Code Enforcement $ Structural Review. $ Permit No. p 107 -135 , Master Permit No. Re-04, 2 $ 8'Z Roofing County Miami -Dade Zip Contractor's Company Name Phone # 666 Contracto ' Address / ® 6 eQ-X-12 City State Zip Qualifier Name ' . (' Phone # ®0 --RI J "% C� State Certificate or Registration No. Certificate of Competency No. Phone # Square / Linear Footage Of Work: Type of Work: ['Addition 13A<eration ` Describe Work: ******************************** * *F ** * ** *** *** * ** *, ** * **** * ** *** * ** *** ** * ***** CCF $ 0 CO /CC ❑New ❑ Re . air/�tep LSO 7- t` ' DPBR $ olition aze Technology Fee $ Zoning $ Double Fee $ Total Fee Now Due $ p d ,C� C See Reverse side -+ Bonding 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 Owner or Agent The foregoing instrument was acknowledged before me this /y day of rA'L./ , 20 04' by 11 M- whrsonally known to me o ho has produced Sign: Print 7 i; r �� DANIEL P. DOWER Q MY COMMISSION # DD463852 liorag* EXPIRES: Aug.21,2009 (407) 388.0183 Plc Ida Notary 8wloaoan e an oath. NOTARY PUBLIC: (Revised 02108/06) As iden ' • , • who did 1vf P My Commission Expires: APPLICATION APPROVED B f..2-1, oq Signature r"""' i ,s—.. Contractor The foregoing instrument was acknowledged before me this day of who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ,20�by Sign: Print My Commission Expires: * *** .******************************** * * * * ** * * * * * * * * * * * * * * * * * * * * ** * ** Plans Examiner Engineer Zoning • v • • • • • ... ••• • • • . • • • s•• • • .! • • • • • • : •.. • . ...• •. • • . • ••••• • ••• • • • • • ' , • .• - • • • ..• ♦ • •••. • • — • • , • •• •• ..• • • •• • • • •• ••• • •• • • • • • • • • •• ••• • • ••• •• •• • Infto top Trie44.9 • Ant e tH1- • 8 9 e 0 e n • g • V' • � , ��, ° a Sgnature dQu i 3 ; d0 3 r DETERMINE. NORTH - • av 11E101: PR1N N_41!F 1 QLCT I-! I1LC IP3 Sworn m and odor¢ me this � ' p+- d ,� a bt4e", � \ \1111 l4 °. • 42;0 M\55 10ly _��r.�t,.,�� 1 1 t, �� A9 i or r ' :ucc! tde:fo,4 $ 2 #DD 414281 : o tit 1