PL-18-2455Miami Shores Village
10050 NE 2 Ave
Miami Shores Village FL 33138
305-795-2204
Location Address
Permit NO.: PL-9-18-2455
('} - -• r� Permit Type: Plumbing - Residential
Work Classification: Gas
Permit Status: Approved
Issue Date: 09/24/2018 1 Expiration: 03/18/2019
Parcel Number
Project
9400 N BAYSHORE DR, Miami Shores, FL 33138 1132050100110 <NONE> LL
Contacts
AMINE DOUKKALI MARIELA B ROVITO Owner AMINE DOUKKALI MARIELA B ROVITO Applicant
JTRS JTRS
801 N VENETIAN DR 907, MIAMI BEACH, FL 33139 801 N VENETIAN DR 907, MIAMI BEACH, FL 33139
(305)992-6776 (305)992-6776
ORIGINAL PLUMBING INC Contractor
(954)274-3041
Description: NEW GAS LINE Valuation: $ 800.00 1305-762-4949 Inspection Requests:
Total Sq Feet: 0.00
Fees
Amount
CCF
$0.60
DBPR Fee
$3.75
DCA Fee
$2.50
Education Surcharge
$0.20
Permit Fee
$250.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$260.85
Permit Received By
Payments Amt Paid
Inspections:
Total Fees $260.85
Inspection Type
Credit Card $260.85
1
Plumbing Final
Amount Due: $0.00
Review Plumbing
Date
Building Department Copy
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
regul�jng construction and z9ning. Futhermore, kauthorize the above named contractor to do the work stated.
Signature: Ownbr / Applicant / CoWactor / Agent Date
September 24, 2018 Page 2 of 4
�4 . Miami Shores Village,. 018
�� BuildingDepartment S 1 2
x BY'
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972`
INSPECTION LINE PHONE NUMBER: (305) 762-4949 l
FBC 201 0�n
BUILDING Master Permit No. 12C\
PERMIT APPLICATION Sub Permit
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[ETPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS: !7 y O D A). b /L
City: Miami Shores County: Miami Dade Zip: I ��
Folio/Parcel#:I/ ` 3 2 0 5-, D 1 fl Is three Building Historically Designated: Yes NO V
Occupancy Type: >- rif✓ Load: Construction Type: c IJ Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): A M(&_ Phone#:
Add
City: M w _� it r le rj S State: %" c= Zip: 3 � ( �?A
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:
Address:
City: '
Qualifier Name:
Name: 6 At e rvA (_ (✓��-L fJi/1 �/='� C Phone#: gSU- ' _—Iy r 1
State Certification or Registration##: '
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: _
Address: City: State
Value of Work for this Permit: $ Z) 0 c11 Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition ❑ Alteration u New ElRepair/Replace ❑ Demolition
�_(4- Description of Work: / G -r5 L r
., 1. I,
t f
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $ SG ` CCF $_
Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 2�C%
(Revised02/24/2014)
7
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 Jksq::�,�
OWNER or AGENT
The foregoing instr ent was acknowledged before me this
day of 201i2kJ by
Who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:l
Print:
W
CONTRACTOR
The foregoing instrumen s ac nowledged before me this
4_7 day of 20 by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: — 0� ----------- —
Print:
MY COMMISSION # GG 041376
Seal: s. 2020 Seal:
EXPIRES: December 30
3:xij.adThruNArYPOW Underwriters ; o�;ayP,;RICHARD
AGUIRRE
* , _ Notary Public - State of Florida
D MY Comm. Expires Sep 28. 2019
APPROVED BY—���--= ti / Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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