PL-16-1663 (2) Et
Miami Shores Village felt 7yj?i �tlftin� Iesidf+ntio.
10050 N.E.2nd Avenue NE C7i f � �s � f� �tio
Miami Shores,FL 33138-0000
ha g Phone: (305)795-2204 '�` � �APP'Ra VED
issue Dat+a. Expiration:7�f�k��1� ,�; Ex
Project Address Parcel Number Applicant
1190 NE 92 Street 1132050270460
DAVID MARKUS
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
DAVID MARKUS 1190 NE 92 Street
MIAMI SHORES FL 33138-2935
Contractor(s) Phone Cell Phone Valuation: $ 3,300.00
PCI SOLUTIONS INC (954)567-9354
_- -- Total Sq Feet: 115
Type of Work:REMODEL MASTER BATHROOM RELOCATE LA 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 $2.40
Invoice# PL-6-16-60198
DBPR Fee $3.38 07/28/2016 Check#:4116 $241.16 $0.00
DCA Fee $3.38
Education Surcharge $0.80
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $3.20
Total: $241.16
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.
OWN FFI AVIT: ify at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
cons ruction an�zo ' Fut a ore,I authorize the above-named contractor to do the work stated.
�;. July 28, 2016
A thoriz Signat e:Own ( Contractor / Agent Date
Building Department Copy
July 28, 2016 1
Miami Shores Village
Building Department A
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 JUN
4
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 �� 1
BUILDING Master Permit No.
PERMIT APPLICATION sub Permit No.
❑BUILDING r-1ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 0/0 Alt�- 12� S--r
City: Miami Shores County: Miami Dade Zip: 3 3 `
Folio/Parcel#: 32 d-5-' 02 7 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
2-
OWNER:
OWNER: Name(Fee Simple Titleholder): -� l,+✓ AR eLlt, Phone#: If - d�4.7 Y:2 7�
Address: f z) /V� q s-r
City: /® / b 63 State: Zip: 31 3k
Tenant/Lessee Name: Phone#:
Email: >�2 '�92 74�0L coM
CONTRACTOR:Company Name: — ,Cy L O' 70I`ll Phone#: 2 9
Address: (*oVr
City: /~ �L1_ ! �.,q State: Zip:
Qualifier Name: «( S u la'll�' /�.P� Phone#: �5�-4L1 q-1 9(0
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ --i;-30c) ' Square/Linear Footage of Work:
Type of Work: ❑ Addition ,A Alteration ❑ New
�,r ^ ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ � _ CCF$ ° �(,'0 CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ ° Training/Education Fee$ .� Double Fee$
Structural Reviews$ Bond$ pp p
TOTAL FEE NOW DUE$ �`V J °
(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 occ rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved d a reinspection fee will be charged.
1
Signature Signatur '
OWNER or AGENT l CONTRACTOR
The foregoing instrument
�was
/acknowledged before me this The foregoing instrument was acknowledged before me this
_day of 0`'�/r`7 20�,by Q,! day of Aft 20 & by
who is personally known to C*�,OaF'&L— VAo is personally known to
me or who has prod=:,4,T ta,� L ,•Cpti,��s_ 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: BQ.h►t Z Print: Q a-y
,��•,.,,, ,)pAMLD:EE
Seal: ' ISON 45W Seal:MYK EXPIRES:Novem ,2016 •'V'",,, JOANNE L DEAN
g� rIw Note�q PubAc UnderwrtteB PAY COMMISSION#EE 845044
EXPIRES:November 4,2016
APPROVED BY > Plans Examiner Zoning
Structural Review Clerk
(RevisedO2/24/2014)
„,••� PCiSO-1 OP Iia-BI
C'C?RL� CERTIFICATE OF UA BILITY INSURANCE TEI16
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E0512412016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATM14 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOSIt,THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY T14EPOLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTMITE A CONTRACT BETWEEN THE ISSUING MSUREMIS}, AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLOM
IMPORTANT: it the certificate holder Is an ADDITIONAL INSURED,the policyilesl must be endorsed. It SURROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies malt require an andersement. A statement on this Certificate does not canter dab”to the
Certificate holder lin lieu of such andOMMOLAIS1.
R ' Michael Gorham
Brom S of Florida,Inc. _ r _ .
1201 W ss Crook Rd 0130 .$S4-795.2222 �IAp.954-77'64446
_ ..
P,O.Box 5727
Ft,Lauderdale,FL X8310-5747
Michael Gorham COVERAGE
MaSSaChUS0ft SaCO 22306
rvs I PCI gott�tianap lnC. aHanover n Insurance Co 136084
PCI Storm Water S ons;Inc __. ...._
PCI Storm Dater Solutions Inc
�? c Hanover Insurance Co. 232!2
1007 N Federal Hwy#267 ____..m.Brldgefteld Emp�Is Ins.Cct � �i0701
Fort Lauderdale,F1.33304 VISURER s
COVE ES CERTIFICATE NUMBER, REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELFT 14AVE BEEN ISSUED TO?ISE INSURED NAMED ASOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ITHSTANDING AWREQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TtIIS
CERTIFICATE MAY EEE ISSUED OR tAAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED"EHEIN IS SUBJECT TO ALL THE TERMS
EXCLUSIONS ANO CONPITIO ;S OF SOCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
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f 901,:A a$3'6PI t - -,may tmceaaerx9 sT e+sate gSaxe Im r�Wu,+tesgp _
State plumbing license:CFC14271S8
CE T FfdCATE HOLDER CAN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CA LLED BEFORE
C of Miami Shores THE EXPIRATION DATE THEREOF< NOTICE WILL I ED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
IMO NE and Avenue
Miami Shares,FL 33138 � Av NrATr�
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