PL-12-1722Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-178529 Permit Number: PL-9-12-1722
Scheduled Inspection Date: October 31, 2012 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: CORTES, MARIA Work Classification: Addition/Alteration
Job Address: 1562 NE 105 Street
Miami Shores, FL 33138-0000 Phone Number (305)458-9935
Parcel Number 1122300530130
Project: <NONE>
Contractor: NELMAR PLUMBING INC Phone: (305) 261-3942
tiunamn uepartment comments
PLUMBING WORK FOR INTERIOR REMODEL ' """""
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
October 30, 2012 For Inspections please call: (305)762-4949 Page 16 of 44
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
I-�ECEIVE.i�
j SEP 13,2012
Permit No.
Master Permit No.-, 1ZJ
PermitType: -PLUMBING
OWNER: Name (Fee Simple Titleholder): M o -k Q tnn4r
f j no- COa-' Phone#: �{.
Address:
City: MA 0jal I VIO flt b State: G�A1�L0(A Zip: _ '-IS � 151
C * .
Tenant/Lessee Name: Phone#:
Email
JOB ADDRESS: 15 6`
NC-- 10 S S A4-,j-Q,-t7
City: Miami Shores
County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name:
v�,
&L ko—,61'65 Phone#: 3 �! 1 -
Address:
City: 1, Am 1,
State: F C - Zip: 3 j � �Etw
Qualifier Name:
d Phone#: u,
State Certification or Registration #:
r
Z"6l1 3$ 2� E Certificate of Competency* O c-)000 4 6 w Q
Contact Phone#: 01n%
f- 7iq W- Email Address: CV
DESIGNER: Architect/En ineer:
g
Phone#: c' a
y
it j r
Value of -Work for this Permit: $
10 Square/Linear Footage of Workr/%�- .�+,���•-,,
Type of Work: ❑Address
❑Alteration ❑New ❑Repair/Replace ❑Demolition,?-
Description of Work:
E Z , IFFF
Isd
S'
Submittal Fee $
Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $ DBPR $ Bond $
Notary $
Training/Education Fee $ Technology Fee $
Double Fee $
Structural Review $
TOTAL FEE'NOW DUE $ fj La l
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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." '
r
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 pen iitJs issued.^ In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. i
i� n re SignatureAl"
L
N / I
^, 0; TO Owner or Agent Con acto--
s S N -
it H 1s f regoing instrument was acknowledged before me this t�i
go 1 ,20,byi1�C LU1'1�5
Y! iat
Auho i personally known to me or who has produced ly Gi
E
e Q flC�,vl As identification and who did take an oath.
o
My Commission Expires: 3 - ZS - ZO Cy
The foregoing instrument was acknowledged before me this
day of (/G , 20 L, by V I 12, L i S6fl-
who is personally known to me or, who has produced
as identification and who did take an oath.
NOTARY LIG
Sign: -
Print:
RENE
My Com in # EE 061A83
EXPIRES: April 25, 20.
B=W Thu Nctery PW* UndenMMe»s
APPROVED BY W4�17--- Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)