PL-07-10Issue Date: 1/8/2007
Owner's Name: EDWARD FERNANDEZ
Permit Type: Plumbing - Residential
Work Classification: Gas
Job Address: 137 105 Street NW
Miami Shores Village, FL
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 07/07/2007
Contractor(s)
Phone
TECO PEOPLES GAS SYSTEM (305)957 -3857
Primary Contractor
Yes
Additional Information
Type of Work: PLUMBING
Additional Info: GAS
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.
Building Department File Copy
Applicant Signature
Parcel #:
Block:
Section:
Permit Status: APPROVED
Permit Number: PL- 1 -07 -10
Phone:
1121360080130
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 600.00
Reauired Inspections
Press Test
ROW
Final
Fees Due Amount
CCF $0.60
Education Surcharge $0.20
Permit Fee - Additions /Alterations $159.99
Scanning Fee $3.00
Technology Fee $4.00
Total: $167.79
Invoice Number
PL - 1 - 07 - 27183
Total:
Amt Due
$167.79
\S �
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.
Contractor's Company Name t e C C>
Value Iworik'or Permit $
41.+
Type � WOW: 'DAddition
Descr `
* * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Scanning $ Radon $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
0!
BUILDING
PERMIT APPLICATION
FBC 2004
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Address C S - 271
City ° �y
Qualifier Name — 72 S v S V .e GA-
State Certificate or Registration No. (
State
6tt.L \,0-
Permit Type (circle): Building Electrical Plumbing , �� Mechanical
Owner's Name (Fee Simple Titleholder) -� V & D FeZ. ►�o � hone #
Owner's Address
City �' 5 V `'0,State — Zip ' 1 C>
Tenant/Lessee Name Phone #
Job Address (where the work is being done) / 3 7 t7 w f 0 5J
County Miami -Dade
** *Fees * **
Submittal Fee $ Permit Fee $ I � O 0
Notary $ Training/Education Fee $ 0-e;90
DPBR $
Permit No.
Master Permit No.
Phone #
Zip
3OS 9
e Zip ` 3/ ��.
Phone # us 970 ( ?83
Certificate of Competency No. ' / 2 O
Architect/Engineer's Name (if applicable) Phone #
c.; t
Squad / Di3 . Footage'of''$rkz
Item; .tt3
ew v ° =°+
Roofing
H ' Q.91`7
El Demolition
******** * * * * * ** * * * * * * * ** * * * * * * * * * * * * * **
CCF$ 000
COICC
(7
Technology Fee $
Zoning $
Bond $ • Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ /61 - 19
See Reverse side -
1 JAN 0 3 2007 L
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
er or Agent
The foregoing instrument was acknowledged before me this
day of
NOTARY PUBLIC:
LUIS MONTERO
Notary Public - State of Florida
• 1y COmmssion Expires Feb 2, 2010
Sign: • .; f ±, Commissiori. t DD 513850
Print
My Commission Expires:
x**** * * * * * *,* **** * * ****** * ** **** ** **
APPLICATION APPROVED BY:
(Revised 02/08106)
Sign:
Print
Signature ` � � f (
Co tractor
�
^ The foregoing instrument was acknowledged before me this)
<E
by ,, — '< V be —, day of / , 200 , by S us - UQ0 ,
or who has produced ( who is personally known t who has produced
As identification and who did take an oath. . as identification and who did take an oath.
NOTARY P . ►
AS C U 6i
My Commission Expires:
**************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
- 01
LUIS MONTERO
Notary Public - State of Florida
.duly Commission Expires Feb 2, 2010
>•� Cnmmiksi0n �
"aH.A Bonded By National Notary Assn.
Plans Examiner
Engineer
Zoning
ATLAS
M 0'
SCALE:
NTS
RAWN BY:
LM
POOL
1
x
2" BSE GAS MAIN
ALLEY
(137)
CONSRUCTION NOTES:
N, R/W
. R/W
N
NEW RISER
FO
E.O.P
NW 105TH STREET
1. ALL CAS PIPELINE CONSTRUCTION TO FOLLOW TECO PEOPLES CAS STANDARDS.
E. TRAFFIC CONTROL SHOULD BE MAINTAINED AND COORDINATED WITH THE
APPRORIATE GOVERNMENTAL AGENCY.
3. ALL DISTRUBED ASPHALT /CONCRETE /SOD AREAS TO BE RESTORED TO PRIOR
CONDITION, UNLESS OTHERWISE SPECIFIED,
1V, 3 rr Q f -t c �C,U l cE
I Z iv t4) /o S ��' \ *1 v?es
48 HOURS BEFORE DIGGING
CALL SUNSHINE 1- 800 - 432 -4770
DATE:
1)40'3/ bb
SHEET:
1/11
JO: 1715 1
ATLAS
MD5
SCALE:
NTS
DRAWN BY:
LM
8'
LX.
N,R/W
2" BSE GAS MAIN
POOL
(137)
CONSRUCTION NOTES:
ALLEY
S. R/W
NEW RISER
E.O.P
1. ALL GAS PIPELINE CONSTRUCTION TO FOLLOW TECO PEOPLES GAS STANDARDS.
2. TRAFFIC CONTROL SHOULD BE MAINTAINED AND COORDINATED WITH THE
APPRORIATE GOVERNMENTAL AGENCY.
3. ALL DISTRUBED ASPHALT /CONCRETE /SOD AREAS TO BE RESTORED TO PRIOR
CONDITION, UNLESS OTHERWISE SPECIFIED.
FO
NW 105TH STREET
48 HOURS BEFORE DIGGING
CALL SUNSHINE 1- 800 - 432 -4770
At 9 ,7 0 f c � Q ftc fie,vieE
i 3 Z ti w 10 s MAPt\
DATE: I
1)-
SHEET:
1/1
Jo: /715