PL-16-2918Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. PL -10-16-2918
Permit Type: Plumbing - Residential
Work Classification: Gas
Permit Status: APPROVED
Issue Date: 11/4/2016
Expiration: 05/03/2017
Parcel Number
Applicant
652 NE 105 Street
Miami Shores, FL
1122310120140
Block: Lot:
KILUAN, INC
Owner Information
Address
Phone
Cell
KILUAN, INC
652 NE 105 Street
MIAMI SHORES FL 33138-
150 SE 2 Avenue
MIAMI FL 33131-
Contractor(s) Phone
J & J DAVIS PLUMBING SERVICE INC (954)680-6543
CeII Phone
Valuation:
Total Sq Feet:
$ 1,000.00
50
Type of Work: INSTALL POLYETHYLENE GAS LINE WITH
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.25
$2.25
$0.20
$150.00
$3.00
$0.80
$159.10
Pay Date Pay Type
Invoice # PL -10-16-61797
11/04/2016 Credit Card
10/27/2016 Credit Card
Amt Paid Amt Due
$ 109.10 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Press Test
Review Plumbing
Review Plumbing
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 informa'n is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the abo�i led contractor to do the work stated.
November 04, 2016
Authorized Signature: Owner / • - -n / Contractor / Agent
Building Departm-dopy
e
November 04, 2016 1
BUILDING
PERMIT APPLICATION
(BUILDING Ell ELECTRIC
1 X
PLUMBING MECHANICAL
JOB ADDRESS:
652 NE 105 St.
Miami Shores Village
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
Master Permit No.
Sub Permit No.
ROOFING n REVISION
(PUBLIC WORKS
RECEIVED
NOV 0 3 2016
BY:
FBC 20
Q)c c- Is- -398
n EXTENSION
CHANGE OF E] CANCELLATION
CONTRACTOR
RENEWAL
SHOP
DRAWINGS
City: Miami Shores
County:
Miami Dade
Zip: 33138
Folio/Parcel#: 11-2231-012-0140
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Address: 990 Biscayne Blvd.
City: Miami
Construction Type:
Kiluan, Inc
Is the Building Historically Designated: Yes NO X
Flood Zone:
BFE: FFE:
Phone#:
State: Florida
Zip: 33132
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: J & J Davis Plumbing
Address: 5101 S.W. 111th. Terr.
Phone#: (954) 680-6543
City: Davie
Qualifier Name: John Davis Phone#: (954) 680-6543
State Certification or Registration #: CFC 057602 Certificate of Competency #:
State: Florida
zip: 33328
DESIGNER: Architect/Engineer: Victor Bruce
Address: 370 N.E. 101 St.
Value of Work for this Permit: $ 1,000.00
Type of Work: n Addition n Alteration
Description of Work:
!xi
Phone#: (305) 310-5030
City: Miami Shores State: FI. zip: 33138
Square/Linear Footage of Work: 5_0 L/F
New 1 1 Repair/Replace
n Demolition
Install polyethelene gas line for future generator ( covered with PVC pipe fnr protection)
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 1 °CI) • 13
(Revised02/24/2014)
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) N/A
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: 1 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.
Marco Buu
Signature Signature
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this The fgoing instrument was acknowledged before me this
.3l day of QC,iibM
2Y , 20 lCO , by 1 day of (WM kVA 0 , by
Marco Bruzzi John Davis , . �t
,who is •ersonally kno • n to , u< o is personally know to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
s►
two
rte•.
LUCIA G ISASI
)'1 MY COMMISSION #FF182628
* EXPIRES December 10:k 2018
(407) 398-0153 Florldallotary rvice.com
APPROVED BY
(Revised02/24/2014)
C «i!
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
scE E3
qd10010c
*************************
G' Plans Examiner
9"'''• BRENDA L LYBRAND
i►1't` riV
�7�'+; MY COMMISSION i FF 084252
��.: EXPIRES: January 24, 2018
**WOO 41XVIPKYAttc* el"
Zoning
Structural Review Clerk