PL-15-905 Permit NO. PL-4-15-905
s•± Miami Shores Village Permit Type:Plumbing-Residential
10050 N.E.2nd Avenue NW ' Work Classification:Sprinkler System
Miami Shores,FL 3313&0000 Perm ' Permit Status:APPROVED
Phone: (305)795-2204
`OR10D� Issue Date:7/9/2015 Expiration: OV05/2016
Project Address Parcel Number Applicant
123 NW 102 Street 1131010220070
Miami Shores, FL 33150- Block: Lot: OCTAVIO GODOY
Owner Information Address Phone Cell
OCTAVIO GODOY 123 NW 102 Street (786)493-7296
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 1,700.00
ARMANDO PENA (786)255-5474
Total Sq Feet: 0
Type of Work:IRRIGATION SYSTEM Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Final
Bond Return: Underground Sprinkler
Classification:Residential Scanning:3 Review Plumbing
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# PL-4-15-55233
DBPR Fee $2.25 04/17/2015 Credit Card $50.00 $116.70
DCA Fee $2.25
Education Surcharge $0.40 07/09/2015 Credit Card $ 116.70 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $166.70
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. in
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFID T: tha all the o ' g information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a Futhe or ,I author' above-named contractor to do the work stated.
July 09,2015
Authorized Signatur . ner / Applicant / Contractor / Agent Date
Building Department Copy
July 09,2015 1
7BY
CEI1�
G Miami Shores VillagePR 2015
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 (0 _
BUILDING Master Permit No.? LJ" �C)b
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
dp�� CONTRACTOR DRAWINGS
JOB ADDRESS: 1G.J l/ /lez
City: Miami Shores Coun : Miami Dade Zip:
Folio/Parcel#: / ® T® Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFEE: FFE:
OWNER:Name(Fee Sim le T'tleholder): Phone#:
Address:
City: / State: zip:.2 /_60
Tenant/Lessee Name: i� Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address: 6 Siti 7/A- S74
r /
City: e`t S te: Zip:
Qualifier Name: e 4 Phone#: S6 -ZSS_SY� Sr
State Certification or Registration#: � C O S (�3 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: zV City: State: Zip:
Value of Work for this Permit:$ , Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New WRepair/Replace ❑ Demolition
Description of Work:
r
Specify color of�1coll orr thru tile:
Submittal Fee$.GU `W Permit Fee$ 015V- ;Z'/ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ .'�'O
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 approved and a reinspection fee will be charged.
Signature Signature
nature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of Q- `� ,20 k5 ,by /1day of
q 1�1 � 20 �� ,by
who is personally known to r7 ���(. } �!'1�� ,who is personally known to
1.
me or who has produced LbCL�WZ ao% me or who has produced f-lol&®A belya LI L as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PU C:
Qzk
Sign Sign
Print: Print:
Notary Pub fc
Seal: aH:*] Seal: �' StMeo/FioWetate 4f aianea Ileana GonzalezZoi ao` My Commission EE080300 Ei3 1 58750 Expi►es 07/12/201801 e
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APPROVED BY K�6-/.f•/S Plans Examiner Zoning
Structural Review Clerk
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