PL-15-2092 Q
s O ft
y, Miami Shores Village r, � � R"shienthi
t��fln/Alte
Miami Shores,FL 33138-0000
Phone: (305)795 2204 �?
�7?i €tftlS PROVEOF
k 11 � Expiration: 03/29/2016
Project Address Parcel Number Applicant
1148 NE 105 Street 1122320280140
STEPHANE FERNANDEZ
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
STEPHANE FERNANDEZ 1148 NE 105 Street
MIAMI SHORES FL 33138-
1148 NE 105 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,800.00
MG PLUMBING&SPRINKLER SERVI( (305)525-9236 Total Sq Feet: 0
Type of Work:INSTALL BATHROOM FIXTURES,BUILD SH Available Inspections:
Type of Piping:
Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning:1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee Invoice# PL-8-15-56755
$2.25 10/01/2015 Credit Card $260.70 $50.00
DCA Fee $2.25
Education Surcharge $0.40 08/18/2015 Credit Card $50.00 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $1.60
Work without Permit Fee $150.00
Total: $310.70
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 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 Irhd zonin Futhermor uthorize the above-named contractor to do the work stated.
October 01,2015
ArDepaftment
e a ure: ner / `Applicant / Contractor / Agent Date
Build Copy
October 01,2015 1
Miami Shores Village
Building Department artment AUG 18 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
FBC 201
BUILDING Master Permit No. 1�-�15 1 ��
PERMIT APPLICATION Sub Permit No.��j! - 2-09
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: AL e-F - /yS '
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): 5-I`PN&Air:5; Phone#:
Address: ll k4 F m E los r" 3f- _
City: !Awk g e---, State: F- Zip:
Tenant/Lessee Name: Phone#:
Email:
M SE2i✓iGF.1ReG
CONTRACTOR:Company Name: C PbuM 6 1A) 4AD SA'Alkft Phone#: � _���_• q,q.3,(v
Address: /9(
S V&) -203
City: /Klpf ) 64,O&LS, State: Zip:
Qualifier Name: on,7e�g W. NY6t IM Phone#:
State Certification or Registration#: GFGD_5_6! v20 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 0a�®® Square/Linear Footage of Work:
Type of Work: ❑ Addition ,® Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: W§'r/t U_ .t04;7jgKTVAe-s _EVdLa
PWO I&r,VA 0- C2%MP 60,,r- FOR, Refe-
Specify color of color thru tile:
Submittal Fee$ 3 Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ 260
TOTAL FEE NOW DUE$
(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 fist inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the
inspection wi-'l net be approved and a reinspection fee will be charged.
Signature Signature
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this T/
.. he foregoing instrument was acknowledged before me this
_day of : 1 20 +� by l day offC!/� u,671 1 ,20 by
ersonally knownm�� W I�� s per nally kn to
me or who has produced as me or who has produced as
identification and who did take an oath. identificatio and ho did take an oath.
NOTARY PUBLIC: NOTARY PU I
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Sign: lotfdl:fKy���
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Print: SIGN Print: 10112*016
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Seal: \,.Seal:
o2ism SO
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)