415 NE 102 St (7)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request ctY
Date
.A\O5
TypeInsp'n 5144 PA/t4/rik
Permit No. ®5 j
1
Name [�
Address —! / 5
Company - .•e1// "e
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
❑
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date5 'T 1 (
`O
Type Insp'n hA'*) / G 6
Permit No. / 0 5- L G
Name lam/ /02
Address t "! 5 Are $7
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax(3.05)- 756.8972
BUILDING _� Permit No. eL-.P,� -/'
1 /
PERMIT APPLICATION
FBC 2001
Tenant/Lessee Name
$ Value of Work For this Permit
Total Fee Now Due $ /.7 o •
(Continued on opposite side)
Miami Shores Village
Building Department
aster Permit No.
Permit Type (circle): Building Electrical ' lumbin Mechanical ��^p Roofing
LL # ' JZ # /
_S',6 d!,6L - ,L7 Phone O
Owner's Name (Fee Simple Titleholder) Y
Owner's Address 0/ 6-/en vt CO&cc o4cc-
City /j1 / //n/ sf �S State FL . Zip 3 '
Phone #
Job Address (where the work is being done) 7 /S- /0as7.
City Miami Shores Village County Miami -Dade Zip 33/3Y
Is Building Historically Designated YES NO
Contractor's Company Name L J FT } U ,3 /W G Phone # ,34 - 3 ' //e
Contractor's Address P J /1/6 , ./3 4 f'
City / m /4/0/ State / Zip 33/ (
Qualifier JU /i m L 4 6 /
State Certificate or Registration No.e /C 0 Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
Type of Work: ['Addition ❑Alteration ❑New Er Repair/Replace ❑ Demolition
Describe Work: RFpIPE (,llfi rE ' S /O /,vP / X TtJ.e4�SS
«474? ,(lge c. c 4 ppF.' L,JJE -S' _ £EpMe / ✓✓ /T ed#r e ,Vz 4 7
4 ti (9_, E f'`iocv R..4N.
* * *n * * * * * * * * * * * * * * * * * * * * *F * * * * * * * * * * * * * * * * * * * * * * * * * * ** /l
Submittal Fe U C I d Permit Fee $ `CD c- CCF $ /t. d CO/CC
Notary $ ' Training/Education Fee $ ® Technology Fee $ J , 7d
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
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."
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 ti ' not be approved and a reinspection fee will be charged.
i• W
Signature
The foregoing instrument was acknowledged before me this
20 D b 54&Lk.. 606Ct?T
to me or who has produced
As identification and who did take an oath.
Chc 05/13/03
day of
who is p
NOTARY P :LIC:
Sign:
Print:
My Commission Expires:
Own
r or Agent
*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *
APPLICATION APPROVED BY:
is h. •S ;:
Jrt
QR
S
MY COMMISSION # CC 997648
.II
Bonaea Thru Notary Public Underwriters
Signature,.;
The foregoing instrument was acknowledged before me this /
day of "c,.2 , 20 O by J 014 At LA.L.0 =7`3C -
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Cr cliSTINA PORRAS
'97648
May 30,2005
e ry un c Undetwtlten
Sign:
5 Print: e / ra(,.(f7 /A // -
My Commission Expires:
Contractor
** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 4/11/2005
Parcel # 1132060170780
Plumbing Permit
Permit Number: PL2005 -111
Applicant: RITA MCCARTHY
Owner: MCCARTHY RITA
JOB ADDRESS: 415 NE 102 ST
Contractor LASSETER PLUMBING CO INC Contractor's Address: 865 NE 130 ST
Local Phone: 305 - 893 -7180
Legal Description: AMD PL OF MIAMI SHORES SEC 4
Page 1 of 1
PB 15 -14 E1/2 OF LOT 14 & LOT 15
Fees: Description Amount
FEE2005 -4711 Building Fee $150.00
FEE2005 -4712 CCF $1.80
FEE2005 -4713 Training and Education Fee $0.60
FEE2005 -4715 Technology Fee $3.75
Total Fees: $156.15
Total Fees: $156.15
Total Receipts: $0.00
a (09
Permit Status: APPROVED Permit Expiration: 10/2/2005 Construction Value: $2,400.00
Work: REPIPE WATER LINES TO EXISTING FIXTURES WITH NEW COPPER LINES. REPLACE WATER HEATER AND ONE SHOWER
APR 11 PAID
Signed: (INSPECTOR)
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
REQUEST FOR INSPECTION
Job
Address
Inspection
Date Ready
Time Ready A.M. P.M.
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
contractor
or Builder
Legal
Description
Address of
Building
Lot
,
MIAMI SHORES VILLAG F LORIDA- -
DATE
_PERMIT N° 9892
CONTRACTOR OR BUILDER
Work to be performed under this Permit
Bl.
Subdi-
vision
Value of
Project $
Contractor's
License No
Amt. of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees. / • /
Signed • BY
INSPECTOR
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_ bf Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
195 ( „
Permit No._
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances �f Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address es 6 "� No Street
Registered Architect and /or Er(gineer t j
Employing Plumber's Name .Vi i� C tf d
Location and Legal Description Lot
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Street and Number where work is to be performed —No
Lie
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he // u : erstands and accepts his o . ions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled G &neral Laws of Florida Perm. -nt Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public hotice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
\r
Block
( Signed )
(Signed)
No Street ,
Subdivision___ ) `� 41 -1
Street / 4
Date F " /P-
My Commission Expires ' Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TOSS
U RINALS
CATCH
BASIN
FLOOR
/ DRAIN
!
DRINKING
FOUNT' NS
.-t
.44
TOTAL
FIXTURES
C ONT R .
/
/
2.--
_L
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
0
Permit No._
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances �f Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address es 6 "� No Street
Registered Architect and /or Er(gineer t j
Employing Plumber's Name .Vi i� C tf d
Location and Legal Description Lot
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Street and Number where work is to be performed —No
Lie
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he // u : erstands and accepts his o . ions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled G &neral Laws of Florida Perm. -nt Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public hotice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
\r
Block
( Signed )
(Signed)
No Street ,
Subdivision___ ) `� 41 -1
Street / 4
Date F " /P-
My Commission Expires ' Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.