PL-16-2920Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. PL -10-16-2920
Permit Type: Plumbing - Residential
Work Classification: New
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
CeII
KILUAN, INC
652 NE 105 Street
MIAMI SHORES FL 33138-
150 SE 2 Avenue
MIAMI FL 33131-
Contractor(s) Phone CeII Phone
J & J DAVIS PLUMBING SERVICE INC (954)680-6543
Type of Work: INSTALL 1/2" WATER LINE FROM HOUSE
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 -10-16-61799
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
Water Main
Top Out
Underground
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 information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the ve-named contractor to do the work stated.
r
November 04, 2016
ate
Authorized Signature Applicant / Agent
ent Copy
Building Depa
/ Contractor
November 04, 2016
1
BUILDING
PERMIT APPLICATION
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
RECEIVED'
NOV 0 3 2016
EBC20
Master Permit No. ,. PVS 2? 18
Sub Permit No. -PL L i O _ 16 - Zpe
fl BUILDING ( I ELECTRIC f ROOFING Lj REVISION El EXTENSION RENEWAL
PLUMBING I I MECHANICAL CPUBLIC WORKS j CHANGE OF { 'CANCELLATION 1 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 652 NE 105 St.
City:
Miami Shores County: Miami Dade Zip: 33138
Fol io/Parte!#: 11-2231-012-0140
Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Kiluan, Inc Phone#:
Address: 990 Biscayne Blvd.
City: Miami State: Florida Zip: 33132
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: J & J Davis Plumbing Phone#: (954) 680-6543
Address:
5101 S.W. 111th. Terr.
City: Davie State: Florida Zip: 33328
Qualifier Name: John Davis
State Certification or Registration #: CFC 057602 Certificate of Competency #:
DESIGNER: Architect/Engineer: Victor Bruce Phoney: (305) 310-5030
Address: 370 N.E. 101 St.
Phone#: (954) 680-6543
City: Miami Shores State: FI.
Value of Work for this Permit: $ 300.00 Square/Linear Footage of Work: 50 OF
Type of Work: I Addition 1 1 Alteration
E( New 1 1 Repair/Replace
Description of Work: Install 1/2" water line and back flow preventor for pool auto fill
Zip: 33138
Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee S Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Dnuhie Fee S
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(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
a F
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.
Marco Buu
Signature
0 N R or AGENT
The foregoing instrument was acknowledged before me this
2)\ day of
Marco Bruzzi
0CAD bQi1( , 20 I (D , by
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:`
Print:
Seal:
Lo6cA G- 156'
4�,.4LUCIA G ISASI
mi )*) MY COMMISSION #FF182628
'`f,tosti? EXPIRES December 10, 2018
APPROVED BY
(Revised02/24/2014)
Signature
John Davis
CONTRACTOR
The fpregoing instru jm, nt�was acknowledged before me this
1 — day of (\101(11-101/r , 20 i (o , by
to John Davis
as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
o is personally known to
Sign:
Print:
Seal:
ft' i- Plans Examiner
Structural Review
fin- L. Lel
Zoning
Clerk