PL-15-2316 \ \ \ \\
Miami Shores Village
,." 10050 N.E.2nd Avenue NEt
Miami Shores,FL 33138-0000
,�s� •,, � Phone: (305)795-2204
,
Expiration: 03/23/2016
Project Address Parcel Number Applicant
551 NE 105 Street 1122310140280 BENIGNO MENDEZ
Miami Shores, FL 33138-2044 Block: Lot:
Owner Information Address Phone Cell
BENIGNO MENDEZ 551 NE 105 Street
MIAMI SHORES FL 33138-2044
551 NE 105 Street
MIAMI SHORES FL 33138-2044
Contractor(s) Phone Cell Phone Valuation: $ 800.00
G.E POOLS CONSTRUCTION INC (786)355-3382 I Total Sq Feet: 0
Type of Work:SPA PIPING&POOL EQUIPMENT INSTALL Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Main Drain
Bond Return
Final
Classification:Residential Scanning: 1 Rough
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Invoice# PL-9-15-57051
DBPR Fee $3.38
DCA Fee $3.38 09/25/2015 Credit Card $236.36 $0.00
Education Surcharge $0.20
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $236.36
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 urate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-name ractor to do the work stated.
September 25, 2015
Authorized Signature:Owner / Applicant / for / Agent Date
Building Department Copy
September 25,2015 1
Miami Shores Village
Building Department SES L 1 2015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795-2204 Fax: (305)756-8972
INSPECTION LINE PHONE NUMBER: (305)762-4949 Vp 15— IS-o 1
FBC 20(p
BUILDING Master Permit N;'.�j 'p
PERMIT APPLICATION Sub Permit No.T[ I � J ?-:D
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
XPLUMBING F-1MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF CANCELLATION Ej SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: S� I I VI G5-�-
City: Miami Shores County: Miami Dade Zip: 3 3) 3 Y
Folio/Parcel#: Is the Building Historically Designated:Yes NO .�
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
,X OWNER: Name(Fee Simple Titleholder): B G Nl Wjb K0\jDt-2-- Phone#: 3 oS V l 52--7G G
Address: (V&
City: !1 J 5 State:_ C_ Zip:
Tenant/Lessee Name: u w) (0lgo "CN 1)1::x_ Phone#: :305 &15 2_3 SS
Email: c-rrfr�
CONTRACTOR:Company Name:G L f>dy L S cc)"X C (on .!�ki C Phone#: —19&
Address: 4 ZZ 0 3(_t PL_
City: H `f�.�/','� 1r# State: Zip:
V U
Qualifier Name: '�Ae _to CS�J c V *I ,,�// " ,`i/ Phone#: ^ -0 3-55 3392
State Certification or Registration Mc kpc. I'�� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Foo ge of Work:
Type of Work: ❑ Addition EJ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:_ ' gyp i V,),!:) a% pooL e +
OO
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ M, CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 2_S(; -3r,,2
(Revised02/24/2014)
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS,TANKS,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 approve and a reinspection fee will be charged.
�( Signature Signature
f OW R or AGENT /0,NTR/CTOR
The foregoing instrument w acknowledged before me this The foregoing instrument was acknowledged before me this
3 day of PAJQ >_➢ ' 20 15 by `3 day of(� C� V�'4 ,20 l- by
� 0 �.c��'� who is pesrsonally knn+acn to - :�l�' n I r CQ�t �V who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: a°` �P�e��o AIDA UERO Print: pu
my COMINS90 I FF 165583 ° AILA PEGUERO
Sea I: r EXPIRES:October 5,2018 Seal: * * My COMMISSION#FF 165583
r"rFOF Fti°a`O Bonded Thro Budget Notary Services iy of't&`O' BEXPIRES!October 5 2018
Bonded EXPIRES!
Budget Notary,Services
************************************************************************************************************
APPROVED BY 9 _ $ /S Plans Examiner Zoning
Structural Review Clerk
(RevisedO2/24/2014)