PL-09-1033 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL L\000
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP 117348 Permit Number: PL -6 -09 -1033
Scheduled Inspection Date: March 05, 2010 Permit Type: Plumbing Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: HOLSTON, MERCEDES Work Classification: Gas
Job Address: 1266 NE 101 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 113205008001
Project,
roject: . -... <NONE>
Contractor: TECO PEOPLES GAS SYSTEM � ` Phone: (305)957 -3857
Building Department Comments
PROPOSED 60' OF 3/4 NAT. GAS SERVICE FROM i
ISTING 2" GAS MAIN IN GRASS SWALE BORE SIDE
LK TO GET RISER RELOCATION
Inspector Comment
Passed �u
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 04, 2010 For Inspections please call: (305)762 -4949 Page 1 of 9
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END EAD
ROAD WORK
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A B e Toper Length ° L F 777/7 ork Aretl END
* See Table II ROAD WORK
Table IC
Devioe Spaoing -Toper
Devine SpaoJng- Torment gOp Taper Length Shoulder
ROAD oi'ffi See Table I See Table I 3 L (ft)
Dcumm WORK WHEN faoam Speed 8' l0' 12'
AHEAD PPoESBNT (mph) Shldr.Shldr.Shldr. Notes
25 28 35 42
Table I 30 40 50 GO L >WS
Devine Spacing 35 55 68 82
04etm7w Between Darns (f. J 40 72 90 107
TY
ype n er pe_ D
Cow T 45 /20 150 /80
(ershl 7sEVnerYmtem PoolsvDnm 50 133 _ 167 200
DISTANCE BETWEEN SIGNS -
Speed Swing (ft. )
7oper Tanamrr Toper Tmgera 55 I47 183 220 L =WS
A B 25 25 50 25 50 60 160 200 290
40 or less 200 200 30 to 45 25 50 30 50 65 173 2f/ 26D
45 50 M 70 25 50 50 !� 70 187 233 280 h or r r 500
8' m/niman shoo /der width
500'boyond the ROAD WORK
AHEAD sign or midway between 4L> Length of shoulder taper In feet
signs whldrover to less
W= Width of total shoulder in feet
(oombJned pavo and unpaVed wkffh)
GENERAL NOTES DURATION NOTES S• Posted speed limes (mph)
I. When four or mare work veh/oles enter the thrauph traffic I. Signs and dammeltz)AI devices may be omitted if all of the
kmes In a one /our period or less (exohding estab/lsh/hg following oordlttons are met.
and terminating the work area), the advanced FLAGGER sign a) Work operotkns drd 60 minutes or less.
SYYMBO S shall be substituted for the WORKERS sign. For location of b) Veh1o/es in the work area have high- Intenshy rotating,
flogger$ and FLAGGER signs, we Index No. 63. fleshing, osdlietlhg, or strobe lights operatlhg.
Work Area I— WORKERS sign to be removed or fully covered when no
Sign With /8 x 18' (min.) Orange work to bolhg performed.
Flag And Type B Light J. St101/LDER WORK sign may be used as an atiamate to
the WORKER �1 slgn only on the side where the CONDITIONS
■ CllonneliZI Devine (See Index No. 600) .1xw/der NB1F ca)ng performed WHERE ANY VEHICLE, EQUIPMENT,
4. When a side road Intersects the hlghmV within the TTC WORKERS OR THEIR ACTIVITIES
D Work Zone sigh zone, oddltionol TTC devices anal/ be placed In aownkwee ENCROACH THE AREA CLOSER
with other applhmble TCZ Indexes.
�a Lane Identification + Direction of Trofflo 5. For general TCZ r and additional Information, THAN l5' BUT NOT CLOSER THAN
e4u 2' TO THE EDGE OF TRAVEL WAY.
refer to index No. 60D.
2008 FOOT Design Standards wean sneer No.
07101_/07 1 of 1
TWO -LANE TWO -WAY, WORK ON SHOULDER 602.
0310312010 15:26 (FAX) P.0021009 ITUTawn
Mia mi .or Village �p M ARI a 4 0 �U►
.Building Department � �°
10050 N.E.2nd Aveatto, Miami Shores, F10rida 33138 .3 -- ------ --- --- -
Tel: (305) 795=4 Fax: (303) 756.8972
IiUMDINGi' Permit No. 4 R 0 33
PER1V T APPLICATION - Master permit No.
1BC 2004
Perron TYP (circls)t Building Electrlcz l Plumbing Mechanical Kooning
Owaees Name (Fee STimpla'Tit aboider) A /1 _e'G'a Als dy Phone # 363 87(p 7o S/O
Owner's Addraas 2 taro *-& /v/ sr Y7*zer
city A/ Zia - d
Tenmt/Lessee Name Phone 0
Job Address (wharo the work is being done) /2 t • /l3 .S�-rr -
city trF(mni Shores Vwmme - Z►p s
L #
POLIO / PARCIC / I --$2 vd p S County 00 to
��i- a .�3/ �
Is Ballding,Historleally Deaigaated YES__�_ NO
Contmetorls Company Nam* - =--v P� /ems �� Phone # 3oS F S7 3S 7 '!rxr 77z
Contractor's Address /T"'? '7t 0sa - ,Ga,► ; - - —
City A-- A-7-10 State
Qualifier Name 6 0
Phone # 34T' 7*57 WS s~7 �a'r � •��tr
State Certificate or Registration No. Cwtifleate of competent y
Archlte`04OM's Name (if applleablo) 66- CS C Phone 0 3dS F57 3Jr7 E�tr7Fry�
Vnlvs of Work For dils Permll 5 V �Ues Square / >L 1aeA r r- eatage 0rwurL- '
Typo Of *Orlc []Addition QAltaraaott iew . Re /R lacy Demlition
i eP ❑
Describe Works b a� +� 17t, ia:.l..' Q i 2 ..
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3tructuatl l +lsw. S Total Fee Ki?w Due 5
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Tuesday, May 05, 2009 01:05 PM
F,p av rv`am if so �,x �J�,A,a,"" l 3r1= X511 r
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
$s Phone: (305)795- 2204�,u��
LORD a
Expiration:) 0
Project Address Parcel Number Applicant
1266 101 Street 1132050080010
MERCEDES HOLSTON
Miami Shores, FL 33138 Block: Lot
S;
Owner Information Address Phone Cell
MERCEDES HOLSTON 1266 NE 101 ST
MIAMI SHORES FL 33138 -2609
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
TECO PEOPLES GAS SYSTEM (305)957 -3857 (305)970 -1783
__. Total Sq Feet: 0
4:
Type of Work: PLUMBING For Inspections please call:
Type of Piping: GAS LINE (305)762 -4949
Additional Info: Available Inspections:
Bond Return : Inspection Type:
Classification: Residential Final
Press Test
ROW
Fees Due Amount Invoice # Total Amt Paid Amt Due
CCF $ 80 PL -6-09 -35146 $ 188.30 $ 50.00
Education Surcharge $0.20"_
Permit Fee - Additions/Alterations $180.00 PL -6-09 -35146 $ 188.30 $ 188.30 $ 0.00
Scanning Fee $3.00 Check #: 2326
Submittal Fee $50.00
Submittal Reversal Fee ($50.00)
Technology Fee $4.50
Total: $188.30
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 lams regulating
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
June 26, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 26. 2009 1
Miami Shores Village MO
Building Department ,^ •
10050 N.E.2nd Avenue, Miami Shores, Florida 33I39 BY
Tel: (305) 7952204 Fax: (305) 756.8972
BU. U 1LDING Permit No. je e I V
PERMIT APPLICATION Master permit N o.
F'.BC 2004
a
Permit Type (circle): Building Electrical Plumbing Mechanical R00fing
Owner's Name (Fee Simple Titleholder) ME:-eff01M 11018 01V Phone 0
Owner's Address l d:10 N. t` 1 l . sr ST2eerr
Ci State ' �/
zi 33 /fig
Tenant/Lessee Name ^; /a
Phone S $7 fo 7 0 O
Jot, Address (where the work is being done) 1210% N.L 1 Ol sr 5T2
City M.rrami Shores Villas, a — County ami °l>ad Zip SL aS
FOLIO /PARCEL 1 l — 32 b5 - UnQ�
Is Buil ding Historically D esi g nated YES � NO X `� n� w
/UO 079(061
Contractor's Company Name ? 1Gy S Phone# 30T 9
Contractor's Address /S779 N/ESr �srl�
City A1'02 r;V State 0/ zip 33 /do io
Qualifier Name JO Sus 7, Phone #
State Certificate or RegisMttion No. Certificate of Competency No. 1< l 6 o b
ArebitecMgineer's Name (if applicable) _k Sao !tom Phone 970 - / 3 73
Value of Work For this Permit S �goa Square d Lla=r Footage Of W
Type of Woa'lc: []Addition ®Alteration �tew [j Repair/Replace ® Demolition
7Deserlbe Work: !00 ` 3 /y PE NAT aDas St5LU ` 'Po+rn _ �PCjCTjAJq Z41
g Swa-Q E�&� StaCe L'ho'l V__ -W tae *- rr� �2 i sctti -1 a iv
Submittal Fee $ Perentit Fee S ,�i _ CCF $ CG/CC
Notaryr 5 Trainin ducation Fec!L Technology Fee $
Scanning S Radon $ -- . DPHR $ Zoning $
Bond S Code Enforcement $ Double Fee $
Structural Review, S Total Fee Now Due S
See Reverse sick -4
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 penjit 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 wIH be performed to mod 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 consbuction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT WA RESULT IN YOUR
PAYMG * TWXCE FOR IM.PROVEMi;NT$ TO YOUR PROPERTY. IF YOU INTEND TO 013TAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE - RECORDING YOUR NOTICE OF
COhMI ENCEM E NT."
Notice to Applicant.• As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise In good faith that a copy of rho notice of commencement and construction lien law brodwe win be delivered to the person
whose property is subject to attachment Also, a certified copy of the recorded notice of commencement must be posted at the job silo
for. the fast inspection wldch oeours seven (7) days gfler the building permit is issued • In the absence of such posted noticg the
inspection will riot be approved and a reinspecdon fee will be charged
Signature ' C,194)A.
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of . 20 by
day of . 20 � by
who is personally known to me or who has produced who is personally known to me or who has produced
d Y take oan ath. an oad.
NOTARY P7`T$� MY COMMISSION # DD83OW91 CIIELL
a
N--bcr 29, 2012 )\jQT SSION # DD830091
I soon NOrnxY Notffi t of I rn '-bgr 29, 2012
Y Aasoo. Co.
Sign: SI
Prim print
My Commission Expires:
My Commission Expires;
f #WN # # # #fp #AMr #Je # ##AtYNkdr # ## Wr ### #4AtF #RANDY ## ##'# #MAWAIk! ## #HARD MANkNdt####* k7► Mt9WMMN # # # ## # #'WnYWYi # * #! # #�i/1kWY
APPLICATION APPRO By; Plans Cxuuuincl
Engineer
Zoning
Otwbcd 02i081W)
4