PL-04-130 r Miami Shores Village
Building Department
11 11011 M E2ntLA, ami Shores,Florida 33138
R 1ZOf\/! aa: (305)756.8972
BUILDING APR 2 , 004 Permit No. P 1260 4
PERMIT APPLICA Master Permit No. 1, J z:Qw
FBC 2001
Permit Type (circle): Building Electrical Iumbing Mechanical Roofing
Owner's Name(Fee Simple Titlehold Xdo0hone 3'1, 41(o
Owner's A ess
City State )C�L_ Zip
Tenant/Lessee Name Phone#
Job Address(where the work is being done) S'p4 -
City Miami Shores Village County Miami-Dade Zip
Is Building Historically Designated YES NO7- C co,
O J
Contractor's Company Name C�il� . Phone# '
Contractor's Address a '
City State Zip t �
Qualifier
Architect/Engineer's Name(if applicable) Phone#
$Value of Work For this Permit Q Square Footage Of Work:
Type of Work: ❑Addition ❑Alteration JR14ew ❑ Repair/Replace ❑Demolition
Describe Work:
Submittal Fee$ r)'()0 Permit Fee
S �;�A'0__CCF S R CO/CC
Notary$ Training/Education Fee$ , Technology Fee
Scanning$ Radon$ Zoning Bond$
Code Enforcement$ Structural Plan Review. $
Total Fee Now Due$ !Q qr
(Continued on opposite 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
Arnmenced 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 gWd faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose prope'ty is sub' of-t attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first nspecti whie occurs seven (7) days after the building permit is issued. the absen of such posted notice, the
inspection wql not b p rov d and a reinspection fee will be charged.
A;_
Signature x Signature
wne r Agent Contractor
The foregoing ins ent acknowledged before me this r( e foreg 'ng instrument was acknowledged before me this
day of �(� 20 day of T� L ,2(l� by
who rsonaily wn t me or who has produced who is personally known to me or who has produced
A e tion and who did take an oath. oidenatio who did take an oath.
NOT PUBLIC ►^ NOTARY UBLSign: SiPrint: Print: d l
My Commission Expires: v My Commission Expires: M' Chav�w
YAAary ChaWan� ' MY Commission OM7628
-*4 Expires 24�te of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
Chc 12/15/03
OR
Miami Shores Village Plumbing Permit
10050 NE 2nd Avenue
Permit Number: PL2004-130 , °'`
Phone: 305-795-2204
Printed:5/25/2004 Page 1 of 1
Applicant: URQUTA HERNANDEZ
Owner: HERNANDEZ URQUTA
JOB ADDRESS: 1213 NE 94 ST
Contractor LLERADI QUALITY POOLS INC Contractor's Address: 7875 S. W. 40 ST. SUITE 223
Local Phone: 305-266-8997
Parcel # 1132050100020 Legal Description: MIAMI SHORES BAY VIEW PB 40-16 LOTS 2 &3 LOT SIZE 150.00 X 125.00 OR
Fees: Description Amount
FEE2004-5238 Building Fee $150.00 Total Fees:$1-54.5,15,
FEE2004-5239 CCF $0.60
FEE2004-5240 Training and Education Fee $0.20 Total Receipts: VtO
FEE2004-5241 Technology Fee $3.75
Total Fees: $154.55
Permit Status: APPROVED Permit Expiration: 10/23/2004 Construction Value: $700.00
Work: POOL PIPING ay
Signed: (INSPECTOR)
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 responisibility for all work
done by either myself,my agent,servants or employes.
Signed: (Contractor or Builder) BY:
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305-795-2204
Building Inspection Request ,
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MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305-795-2204
Building Inspection Request
Date u
Type Insp'n 6r i�
Permit No. '-�--
Name
Address l
Company ' 1k
Phone#
Inspection Date
Approved
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BUILDING DEPA4
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Name v V� t 1Z /n� Q
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Company ' I d 1
Phone# %
InspectionDate
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Correction ❑
Re-Insp'n Fee ❑