PL-12-1494 Miami Shores Village
Buildin g Department artment I ZO
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. RC 12°-SW9
Permit Type: PLUMBING
JOB ADDRESS: P 0 0 A1, /04 S v
City: Miami Shores County. Miami Dade Zip: 33135
Folio/Parcel#: (l°22 32®2,10 W
Is the Building Historically Designated:Yes —0—Flood Zone:
OWNER:Name(Fee Simple Titleholder): wj�2 ) )ety Phone#:
Address:_
City: / .� /yl/ State: -A�:I— Zip: 15 1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:-3QS-,1-99° �'lSV
Address: 2 67 a c.°����.c.�
City: c State:T L- Zip: 'r33/.�-7
Qualifier NaMe: �! �/ v. Phone#: .3®$"5 q` - ef 9J 1
State Certification or Registration#: �1���' ' �� Certificate of Competency#:
Contact Phone#:308° 981°-Z9-6t 4 .Email Address: MeASSOc-t�tTW& 01 oo S e K. Ke-l
DESIGNER:Architect/Engineer: E-44ctr MrAno,-Z' f EF Phone#: 30.5-2 i q-q 7q(
Value of Work for this Permit:$ Square/Linear Footage of Work: -®c 60me
Type of Work: ❑Address DAlteration New ORepair/Replace ODemolition
Description of Work: 9►eQOv Acme
k .
Submittal Fee$ Permit Fee$ _ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ A d
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 w charged.
Signature SignaeifinistUrumment
O fwasacknowledged Agent Contractor
The foregoing instrum nt before me this The fo was acknow ged be ore e this
day of TN rQ ,201.3 by �ycg�tdt� aoleor day of 0 3 b ,
who is personally known to me or who has produced who is p rsonally known to me or who has produced
As identification and who did take an oath. �' ratification and who did take an oath.
NOTARY PUBLIC: N)TARY PUBLIC:
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My Commission Expires: My Co sio oneed
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised3/12`2012XRevised 0y 7/10/07XRevised 06/10/2009)(Revised 3/15/09)
S 5uR
Miami d Village
Building Department
10050 N.E.2nd Avenue
� Rxpp► Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE 0 ONTRACT /,ARCWTEer
Permit N. RC 12-,58'9
Owner's Name(Fee Simple Title Holder): A l ndk Rode i--t- Phone#: " '54- x'92-ZTM
Owner's Address: IW5 M99no lau Dr.
City: Mort-h i UMI State : FL Zip Code: 33191
Job Address(of where work is being done): t001? 10jF t104 S-t,
City: Miami Shores State:—Florida Zip Code: 5313
Contractor's Company Name: Mr Assocrafed C,ortkae`iou Phone#: :305 -577- clgS q
Address: 7 52 SW 17? Tern
City: Pai l m eel Bey State: Zip Code: �3 31 ,67
Qualifier's Name : M P"no Lic. Number: C FCC 04,41119
Architect/Engineer of Record Name:mar M unqZ P& Phone#:
Address: 6623 NW 1-7.3 4n,
City: Maw►o State: FL Zip Code: 33015
Describe Work: Meuj 0me
I hereby certify that the work has been abandoned and/or th contractor architect is
unable or unwilling to complete the contract. I hold the Building Official and the
Mia ' Shores harmless for all legal involy e
Signature Signature
owner or Agent Contractor or Architect
The foregoing instrument was aknowledged before me The foregoing' stru nt was aknowledged fore AVU3 this.#day of Tixne,2g3,by l . �r this�day of �20Lby
Who is personally known to me or who has produced who is ersonally kk1nso� to me or who has produced
as indentification. 1 v ' 1 as indentification.
Notary li Notary u i
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Sign: Sign: h Florida
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RONN07ARY.com Bonded Ttary Assn.
aim,.
ATTN:Marlin Plumbing of Miami Inc
CHANGE Of PLUMBING CONTRACTOR
Date June 7,2013
General Contractor Buildina Department
RCI Design&Construction,Inc. Miami Shores Village
2355 Magnolia Drive 10050 NE 2"d Avenue
North Miami,FL 33181 Miami Shores,FL 33138
Re:Letter of responsibility for new home construction plumbing
This serves to inform that MP Associated Contractors Inc has been the sole plumbing contractor under master
permit#RC12-588 located at 1009 NE 104 St,Miami Shores,FL 3313&The plumbing contractor Marlin Plumbing of
Miami Inc was mistakenly registered as the plumbing contractor and has not performed and does not have any
responsibility for any work at the project located at 1009 NE 104 St,Miami Shores,FL 33138. We agree to hold the
Building Official and Miami Shores Village harmless and relieve them from any responsibility or liability for any legal
action or damage resulting from the errors,omissions,or construction Irregularities resulting from this error.We
have submitted all licensing Information,application form(s),and all other forms necessary to complete the change
of contractor process.
Should you need any further information,please contact Matt Raiszadeh at 954892-8289
Sincerely,
1'/7- 1 8
Print Name(qualifier for RCI Design&Construction Inc) Print Name(qualifier for MP Associated Cont.Inc)
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la-to-re Si afore
STATE OFF IDA STATE OF FLORIDA
CO F MIAMI-DADE COUNTY OF MIAMI-DADS
SWO AND SUBS ED BEFORE E THIS O DAY SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY
F OF 201
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2�15 NOTARY PUBLIC ATE OF O D
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�r y a Y pGeG Ma Elizabeth liaivadeh
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Print Narr>e Agent) .. IF EXPIRES: SEP.22,2013
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Signatu
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
SWORN TO AND SUBSCRIBED BEFORE ME THIS 7DAY
OF MuWW 2
.a wn,
�.� PG,�Ana Elizabeth Ralszadeh
NOTARY UBUCSTATE ORIDA .�: :'-COMMIS�oN#DD895323
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EXPIRES: SEP.22,2013
'••non;.`•?°. www.AARONNOTARtGcam
COMPLETE •MPLETETHIS SECTION ON
• Complete Items 1,2,and 3.Also complete A Sign re
Item 4 If Restricted Delivery is desired. ❑Agent
• Print your name and address on the reverse
so that we can return the card to you. B. Received y(prftited Marne) C.D of slivery
• Attach this card to the back of the mailplece,
or on the front If space permits.
1. Article Addressed to: D. Is deliveryaddress different from Item 17 0 Y
4)
3.s I If YES,enter delivery address below E3 No
IAJ 3. Se
ft CerBfled Mail 0 Express Mail
❑Registered 0 Return Receipt for Merchandise
0 insured Mail 0 C:O.D.
4. Restricted Delivery?(Exft ee) 0 Yes
2. Article Number 7 012 2920 0 0 01 1281 1078
(1Fansfer from service fab�y
'S Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1840
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