PL-16-2741 r
G Ib -14 l°1
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number:�INSP=281055 `I Permit Number: PL-10-16-2741
Scheduled Inspection Date: April 18,2017 Permit Type: Plumbing - Residential
Inspector: M;�ve1 CQbee►-a
Inspection Type: Final
Owner: LERA, LUZ ELENA Work Classification: Gas
Job Address 190 NW 100 Terrace.,
Miami Shores, FL 33150- Phone Number
Parcel Number 1131010230250
Project: <NONE>
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Contractor: CONWELL&ASSOCIATES CONSULTING COMPANY (GC) Phone: (305)962-5673
Building Department Comments
GAS LINE. Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed Ed CREATED AS REINSPECTION FOR INSP-268603. missing gas final
Failed
Correction 1
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
April 17,2017 For Inspections please call: (305)762-4949 Page 34 of 36
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PRESTIGE GAS SERVICES CORP.
1511 SW 71 CT MIAMI FL 33144
pp; PHONE: 305-300-0608
GAS BVIS FAX: 305-356-4332
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DATE: APRT. 7, 2017
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TO: WHOM IT MAY CONCERN:
THIS LETTER IS TO CERTIFY THAT PRESTIGE GAS SERVICES CORP HAS PERFORMED A DROP TEST AT
THE FOLLOWING SITE AND TESTED ALL THE APPLIANCE CONNECTIONS. THE GAS LINE HAS BEEN
cHEcKED TO THE STANDARDS OF THE 2014 FLORIDA BUH.DING CODE AND PROPERLY TESTED TO MEET
THE STANDARDS OF NMA 54 AND NFPA S8. THE WORK WAS PERFORMED FOR Luz LERA 190 NW
100 TERR MIAm FL, 33150
TEST PRESSURE: Mr
LOCK UP PRESSURE: IUD
OPERATING PRESSURE: 1L0"'
TEST Tom 30 MINUTES
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STATE LICENSE No: LPG 32634
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TYPE AND CLASS: 0803
IF YOU SHOULD HAVE ANY QUESTIONS REGARDING THE MATTER PLEASE DO NOT HESITATE TO CALL US. i
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SINCERELY,
YESENIA AGUliAR
'q rAY COf� MISSION# 51322
N^`,f ec l E- 4,2017
W07)39p-o 53 Florld- bfar�Servioexom
I LAZARO
CEO y
PRESTIGE GAS SERVICE CORP.
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' Permit-A/c. PL-10-16-2741
`sNOREsMiami Shores Village permit Type:Plumbing-Residential
s� 10050 N.E.2nd Avenue NW Work.Classification:Gas
-P1Aildrik
ii "�" Miami Shores,FL 33138-0000 ur
pBri7tif Status:APPROVED Phone: (305)795-2204
f<ORiDA
lssue'Date: 10119/2016 Expiration: 04/17/2017
Project Address Parcel Number Applicant
190 NW 100 Terrace 1131010230250
Miami Shores, FL 33150- , Block: Lot: LUZ ELENA LERA
Owner Information Address Phone Cell'
LLU"
Z ELENA LERA 638 NE 97 Street
MIAMI SHORES FL 33138-2471
Contractor(s) Phone Cell Phone Valuation: $ 600.00 ,
CONWELL&ASSOCIATES CONSULT (305)962-5673 (305)926-5673
Total Sq Feet: 0
Type of Work:GAS LINE. Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Final
Bond Return: Press Test
Classification:Residential Scanning:3 Review Plumbing
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Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# PL-10-16-61595
$2.25 10/11/2016 Credit Card $50.00
DCA Fee $2 25 $115.10
Education Surcharge $0.20 10/19/2016 Credit Card $ 115.10 $0.00 I
Permit Fee $150.00
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Scanning Fee $9.00 r
Technology Fee $0.80
Total:,7',:'.,' $165.10
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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.
OWNERSAFFIDAVIT: I wfify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and ing ut rmore,I authorize the above-named contractor to do the work stated.
October 19, 2616
Authorized Signature:Owner / Applicant / Contractor / Agent Date
psi•
Building Department Copy
October'19,2016 1
F � .
�x �?
a �\ Miami Shores Village
r Building Department 0 11 2016
\ XJ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 � S
BUILDING Master Permit No. 12r— /v1
PERMIT APPLICATION Sub Permit No.j--(
F—]BUILDING ❑ ELECTRIC ❑ ROOFING dREVISION ❑ EXTENSION ❑RENEWAL
.[PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 190 NW 100th Terrace
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3101-023-0250 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):Luz Elena Lera Phone#:305-528-5552
Address: 190 NW 100th Terrace
City: Miami Shores State: Florida Zip: 33150
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:CGS WAI 014 h 33
Addres}: t (A)
ci MCA n State':
uaii€ier-Na e: KGinn ' CWWA.
Sta fic-atiorrory egistratioFl#: �„ Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
ul a of Work-font miss Permit:'_$ (Ooo Square/Linear Footage of Work:
Type of Work: ❑ AdAddition [:1Alteration IN New EDRepair/Replace ❑ Demolition
Description of Work: Ciao Mfr&
J
Specify color of color thru tile: /�,,/�
C J
Submittal Fee$ ' Permit Fee$ CCF$ +y0 CO/CC� /CC$ .�
Scanning Fee$ Q Radon Fee$ 7-- �,.�_ DBPR$ 2- Z 5' Notary$
Technology Fee$ '80 Training/Education Fee$ '' 7—0 Double Fee$ --ey Reviews$ Bond$ ——Jp
TOTAL FEE NOW DUE$ t 1 f D
(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
OMMENCEMENT."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 t be ap roved and a r inspection fee will be charged.
Signature Signatur
OWNER or AGENT CONTRACTOR
The for oing instrumen a acknowledged before me this The foregoing instrument was acknowledged before me this
T" day of 20 /16 by day of
(� cv— ,20 / by
T1- YA ho is personally known to -Q.hwZ'�"`'� L", 67hwQ�,�ivrta sonaily known
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
dot"1O•q 0,.� GLADYS C.PAI ` ..
Notary Public•Sta Sign:
y onan.ExPbes Feb 18,2017COMMISSION#5F a Print:
BMW1l►roupb National Notary Assn.
Seal: �os',".:�°e�% VERONICA PHILLPt
MY COMMISSION it FF 06M
* * EXPIRES:February 22,2018
4,eoF °! Bonded ihruBWgdNotary SMices
***************************** *****************************************************************************
APPROVED BY �a-1 Z- Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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