PL-17-646 .;. t .
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone:(305)795.2204 Fax:(305)756-8972
Inspection Number: INSP-278438 Permit Number: PL-3-17-646
Scheduled Inspection Date: March 13,2018 Permit Type: Plumbing -Residential
Inspector: Hernandez,Rafael Inspection Type: Final
Owner: WOLLOWICK,.JOSH Work Classification: Addition/Alteration !
Job Address:1255 NE 99 Street
Miami Shores,FL 33138-2642 Phone Number 305)531-0970
Parcel Number 1132050090100
Project: <NONE>
Contractor: DEL RIO&SON PLUMBING CORP Phone:(786)2954098
Building Department Comments
NEW 3 BATHROOMS KITCHEN SINK,WASHING Infractio _ Passed Comments
MACHINE,WATER HEATER NEW SEWER LINE TO TANK INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
March 12,2018 For Inspections please call: (305)762.4949 Page 1 of 44
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JOSH WOLLOWICK103650497- 1
1256 NE 99 STIMIAMI •' s • . • !
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111170028 APP&S Service •• / 11 1 11
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Signature7n��6
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_I .. Work Order Summary 4006063186
Siegel Gas-Medley
Scheduled Daterrime 03/06/2018 08:00:00 Notificetion:3007002865 Sales Order:829475388
- Planner Group:001 Planner Group-5575
NEkV OWhI€_R_,CQI41!ERF2 AP-PUANCES't 6Ak C}C Plant:5575 Customer:203437259
Assigned to:5575 9%MEDL_T1_DEFAULT
JOSH WOLLOWICK 103650497 Grid#:STMIA2 Zone:
i
1255 NE 99 ST MIAMI SHORES FL 33138-2642 Material: Owner. Subtanks: N
Equipment ID: Company ID: _ Manufacturer Serial#:
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"03/07/2018 09:50:31 EST Kathleen.Gonzalez(GONZALEZK)-NEW OWNER CHECK LINES AND CONNECT TAW GAt L 3d5= ( 12681(2,
HQUR�:Ij '' SCH 3/9-SALES REP:JESUS SOSA""AUTOPAY/FXD 5 MONTHS.SVC 150 3.25PPG INTITAL FILL'03/08/2018
11:59:57 EST Eugenia Valdivia(VALi?IVlAE)'alsagsed t cQmerCsyand ctryerti cusr?i�r blas tisconvertion_kil for.,: . ..
_.
both app112lnsW_ ana madac.ustomeraware of Nrges depending':of tFie:eiitra h 8 to convertrt can belrru`i 5999'
to:144 00`addltional of
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OP# Description Status Work Center Completed Duration jActual
0010 CONVERT STOVE AND DRYER,LEAK CHECK CNF. 5575_999 MEDL T1 DEFAULT 03/06/2018 1.0 0.5
0020 CONVERT STOVE AND DRYER,LEAK CHECK REL 5575_999 MEDL T1_DEFAULT 1.0 0.0
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11,14Now Tank and Regulator Information
Tank Size Manufacturer Serial#: Manufacturer MFR Y r/MO RecerL Date/Type PFI Performed and Documented
DOT/ASME _AOL At .. (if applicable)
Ywrys utt
—
Yes0'0 No
Regulator MFG pate CorViqon Manufacturer Model
First-Stage
Second StageXX i
Integral Twin
Appliance Info ation
Appliance Type ex.Heat e ,
Quantity Per Type 3
Total BTU of Type 54,000
Customer Care Una Information(shoWd be eMercd ror new uwtiiis w new cusromwai
New Customer S If New Exterior Line Is Installed or Replaced If New Interior Line is Installed or
Safety Assurances Y!N Perform Test for Leakage Replaced Perform.Pressure Test
Tank shutoff showed to customer?. Line;terial Line Depth(in inches) Line Material
Customer knows smell of propane?
New piping prior Test for Leakage(Propane) Comments:
to the 2nd stage Start Pressure End Pressure I •Time Held System OK
reg. PSIGI PSIGI MINI'
Pressure Testing(Air/Inert Gas Only)
New piping after Start Pressure End Pressure . Time Held System•OK.
the 2nd stage reg. .
PSIGI PSIGI MIN
Leak Check(Propane Only) Regulator System Performance Test
Single or Integral Start PressureEnd Pressure Time Held System OK Flow Pressure, Lock-up Pressure
twin stage system PSIG PSIG MIN
IN WC IN WC MINI IN WC IN WC
Two Stage - Leak Check(Propane Onlyys Regulator System Performance Test
1st Stage Start Pressure End re Time Held System)OK Flow Pressure Lock-up Pressure
PSIG 3 VZ_PSR; MIN PSIG PSIG
2nd Stage Sta Pressure Ej4 assure Time Held Sys OK Flow Pressure Lock-up Pressure
I WC IN WC MININ WC IN WC
Cuslorner:Signature . Service Tech s
ignature
Permit NO. PL- -17-G4G
�sKO1s LMiami Shores Village Permit Type:Plumbing-Residential
r� 90 10050 N.E.2nd Avenue NE ' Work Classification:Addition/Alteration
Miami Shores,FL 33138-0000 Pen
m�
PeitStaf+as:APPROVED
�� Phone: (305)795-2204
�ORtD4'
Issue date: 3/31/2017 Expiration: 09/27/2017
Project Address Parcel Number Applicant
1255 NE 99 Street 1132050090100
Miami Shores, FL 33138-2642 Block: Lot: JOSH WOLLOWICK
Owner Information Address Phone Cell
JOSH WOLLOWICK 1255 NE 99 Street (305)531-0970
FL 33142-
1255 NE 99 Street
FL 33142-
Contractor(s) Phone Cell Phone
Valuation: $ 16,850.00
DEL RIO&SON PLUMBING CORP (786)295-0098
... �,.. .......,_. �w.M Total Scl Feet: 0
Type of Work:NEW 3 BATHROOMS KITCHEN SINK,WASHI Available Inspections:
Type of Piping:
Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning: 1 Review Plumbing
Underground EJE
k
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $10.20
DBPR Fee Invoice# PL-3-17-63258
$8.85 03/09/2017 Credit Card $50.00 $ 587.65
DCA Fee $8.85
Education Surcharge $3.40 03/31/2017 Credit Card $587.65 $0.00
Permit Fee $589.75
Scanning Fee $3.00
Technology Fee $13.60
Total: $637.65
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 the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Fut erm , I authorize the above-named contractor to do the work stated.
March 31, 2017
Authorized Si .Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 31, 2017 1
Miami Shores Village '�FcF�
*g1fo �'Fo
Building Department ?o -
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 �--�
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4%9
FBC 2014 S�
BUILDING Master Permit No. a<,16--101 1
gS^Z
PERMIT APPLICATION Sub Permit No. 7: -7 —~
OBUILDING ❑ ELECTRIC ❑ ROOFING REVISION EXTENSION Ej RENEWAL
6P(U"MBING [:] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR ( � t�� DRAWINGS
pGS ,t�
JOB ADDRESS: 12 S G�✓ q �5 N�o_l ll' , S�`�0 w-'a i F t ',33 ` .9 Z!
City: Miami Shores County: Miami Dade Zip:
E
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: l FFE:
WNER:Name(Fee Simple Titleholder):_ ,��5''1 �° �cw1C�� Phone#:
Address: 12- S� �� er 9
City: ! A� State: Fes- i Zip: _M :3 7
t
Tenant/Lessee Name: / Phone#:
Email: a S � ���i ra u `lyw&A - "-I
CONTRACTOR:Company Name: 'M PL"..' Phone#: ' � ZqS OU ci b
Address: bcAq,n 2.4 !Eft 2 1.
City: State: Zip: 3 l �+
Qualifier Name: Phone#: !o q
State Certification or Registration#: L F-G 1 2-Lib( IQ Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ - ao Square/Linear Footage of Work:
Type of Work: ❑ Addition \ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: `v SMS �c ��sw� 3 L I i
Specify color of color thru tile: S S q - 45
Submittal Fee$�• O Permit Fee$ CCF$ 1¢� 'ter C CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ u Double Fee$
Structural Reviews$ Bond$ Q+
TOTAL FEE NOW DUE$ f5 CD .
(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 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
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument eras a�n�owledged beforemethis
day of rG� 20 �7 ,by 03 day of Q rC�(!1 20 ( 1 by
who is personally known to � ,whois personally known to
--------------------
me or who has produced as me or who has produced l" as
identification and who did take an oath. identification and w o did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: /Jl� Sign:
Print: Print: .L
Seal: Seal: ;.. .... SARAH MARTINEZ
l�:�Y!��cd'' Ana Maria panto =.: :. MY COMMISSION# Ftss7os
.� EXPIRES:February3,2019
r -
�;pF Bonded Thru Notary Public Underwriters
CC's MISSION I FF129133
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WWW. R N !OTARY.COM
APPROVED BY 3-V �� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)