PL-08-1164Project Address
9650 N BAYSHORE Drive
Miami Shores Village, FL
Owner Information
VERONICA DUMAS
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Address
Parcel Number
1132060143750
Block: Lot:
9650 N BAYSHORE Drive
MIAMI SHORES FL 33138 -3515
Contractor(s) Phone
AMERIGAS PROPANE AND SUBSIDIA 305 -883 -8600
Cell Phone
Fees Due
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$0.40
$180.00
$3.00
$4.50
$189.10
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
APPROVE
Expiration: 1 2
Phone
Type of Work: PLUMBING
Type of Piping: GAS LINE
Additional Info:
Bond Retum :
Classification: Residential
Applicant
VERONICA DUMAS
Valuation: $ 2,000.00
Total Sq Feet: 0
Available Inspections :
June 25, 2008
Date
Cell
Inspection Type:
Press Test
ROW
Final
1
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 above -named contractor to do the work stated.
Wednesday, June 25, 2008 1
11 CAUAK
BUILDING
PERMIT. APPLICATION Master Permit No.
FBC 2004
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) g Yi./AW — DttlA� Phone # ( ?I (qci
q %4 t2
State Zip
Owner's Address
City
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Budding Historically Designated YES
Contractor's Company Name
Contract. is Addre s
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
City
Qualifier Name
State Certificate or Registration No. 44P6 ®®° P9
E-MAIL:
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $
NO
State `°C'
Phone #
Phone #
Zip
Phone #
Permit No. PI O' 1 (0+
s;ENME W
JUAN 2 3 21108 a
BY:= ---- - - - - --
County Miami -Dade . Zip
Certificate of Competency No.
Square / Linear Footage Of Work:
Type of Work: ■ Addition ['Alteration , Q Repair /Replace ❑ Demolition
Describe Work:
x*xxx* xxx x x dcxxxxxx xxx x**w www ww w*www* Fees** xxx**** xx*,c ww x xxx x x*x xx x* x w x r xxxx xxx xrx
Submittal Fee $ Permit Fee $ // ' CCF $ CO /CC
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ 1 �
See Reverse side -+
4
Bonding Company's Name (if applicable)
Bonding Company's Address
City
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: [ 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 ' 'o e., y+ reinspection fee will be charged
8 Signature
Owner or Agent
The fore oing instrument was acknowledged before me this 1 The foregoing instrument was acknowledged before me this
day of 20 ab , by Ife4 J`� IJ ifd , day of , 20 , by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
State
Zip
Signature C
NOTARY PUBLIC:
Contractor
Sign:
Print:
My Commission Expires:
,Fw xxxxxxx*xxxxxxx*xxxxxxx xxx . ,Yxxx xx xxxxxxx******uxxzxxxxxx xxxxx ,Yxxxxa'- xxxxx xxxr xxxxxxxx xxx,4
al70 Flans Examiner
Engineer
Zoning
DETERMINE NORTH •
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DRAWN BY: • • •
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AFFIDAVIT:
This Instelation shall comply with NFPA 54, NFPA 58,
as well as al state & bcal codes and regulations.
GENERAL SITE PLAN.
I Page
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Signature of Qualifier
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PRINT NAME- v ;etc._ ( g"
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Qualifier # LP C31 W. 2 - 5
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ORLANDO DDAZ
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(RAO RECORDS
CERTIFY TO: YIANN1S AND VERONICA DUMAS
ADDRESS: 96931401013BAYSIIOREDRIVE
MIAMI SHORES, FLORJDA.33138
81.25 SW 120 STREET
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BOOK 10, PAGE 37, PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA
FLOOD 7.04E: 'FE
X MS IS A FLOOD HAZARD ZONE MIS IS NOT A FLOOD HAZARD ZONE
COMMUNITY PANFLNO. 120652
PANEL NO. 91 SUFFIX J DATE °FM& 07/17PIS
BASE FLOCE7 ELEV. 11.00 FINISH FLOOR ELEV: EIEV LOWEST ADI. GRAM CERT
NOTE: UNDERGROUND ENCROACHMENTS, IF ANY, NOT LOCATED. NPBCHONCEBEENIS NOWak O NE
I HEREBY CERMET THAT THIS SKETCH CIF 'DAS PROPERTY IS TRUE AND COTTEEcr ThE BEST MY loRMRDGE AND
BELIEF AS SURVEYED AND PLATTED UNDER MY DMECIION. I !CERMET . .1 : TMS - .SUIRVEY RATET:THE IMMO&
REQUIREATEMIS ADOPTED TAT THE HOARD OF PROFESSIONAL LAND SURVEYORS,
AND ALSO CH-61017EA.. CODE. THERE AREND ENCROACHMENTS, TATT::EWASIETSTYPT: '
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