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PL-05-209Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 7/11/2005 Plumbing Permit Permit Number: PL2005 -209 Applicant: WILLIAM /MARLENE ROACH Owner: ROACH WILLIAM /MARLENE JOB ADDRESS: 2 NW 109 ST Contractor Local Phone: Parcel # 1121360110170 Contractor's Address: Legal Description: DUNNINGS MIAMI SHORES EXT NO 7 Permit Status: APPROVED Permit Expiration: 12/28/2005 Construction Value: $300.00 Work: TOILET AND TILE WORK Page 1 of 1 PB 52 -33 LOT 1 BLK Fees: Description Amount FEE2005 -9393 Building Fee $100.00 FEE2005 -9394 CCF $0.60 FEE2005 - 9395 Notary Fee $5.00 FEE2005 - 9396 Training and Education Fee $0.20 FEE2005 -9397 Technology Fee $2.50 FEE2005 -9398 Scanning Fee $3.00 Total Fees: $111.30 Total Fees: $111.30 Total Receipts: $0.00 'JUL 13 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 1 assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: TOILET AND TILE WORK L n Passed In= = ctor f , Comm - ��- �. 1 a Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Date: 04/26/2006 Inspector: Levrack, James Owner: ROACH, WILLIAM /MARLENE Job Address: 2 109 Street NW Project: <NONE> Contractor: Building Department Comments Tuesday, April 25, 2006 Miami Shores Village, FL 33138- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Block: Permit Type: Imported Permit Inspection Type: Final Work Classification: Plumbing Phone Number Parcel Number 1121360110170 Lot: Page 2 of 2 , BUILDING PERMIT APPLICATION s - FBC 2001 Permit Type (circle): Building Electrical Total Fee Now Due $ (Continued on opposite side) 11L30 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 e195) 79S:Z2O4 axe d 5) 756.8972 Contractor's Company Name Contractor's Address City State Owner's Name (Fee Simple Titleholder))( M r! elle, 4$ � r Phone # ,6)3- 2 13.-S3 33 Owner's Address 4 9, f V vV to C, s-I - City State Zip Tenant/Lessee Name Phone # Job Address (where the work is being done) 2 I v (..A.J 1 Oct S City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Structural Plan Review. $ Permit No. 10C 2 Master Permit No. Phone # Mechanical Roofing Zip Zip Qualifier State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit X C ©O ' Square Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New wo ❑ Repair/Replace ❑ Demolition ,/1 Describe Work: kV) I I ( ' 11 i e wort_ � ****************************p ** *** * *** * *********** * ** **** ** Submittal Fee Permit Fee $ © CCF $ 0. CO /CC CO W Notary $ 5- Training/Education Fee $ ©• 20 Technology Fee $ Z - 50 Scanning $ 3. CO Radon $ Zoning Bond $ Code Enforcement $ 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 afier 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. NOTARY Sign: Print: *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: chc 05/13/03 Owner or Agent The foregoing i trument w acknowledge • before me this day of u 20 by Signature Contractor The foregoing instrument was acknowledged before me this (lay of , 20 _, by who is personally known to me or who has produced identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: ero ��'li% Print: sion e s:y My p �� Expires: Ju 3 �' �� My Commission Expires: M Commissio � Expires. ., . � - m: oF o� , .� 9�'�11 Y P =coded ******************** . ,�* * * ,r **4:* ** * * votwep t f ,* ** * ** *** ** tit************ x * * ** * * * * * *** *** * * * **** *** ** * * ** r who is • -rsonally me or who has produced C l„A). 0 ti . Plans Examiner Engineer Zoning ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL - SERVICE TEMPORARY A/C (COAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHARGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY • OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 If STEAM BOILERS SHOWER MOTORS AVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 If MECHANICAL VENTILATION SINK, RESIDENCE _ MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 If FIRE SPRINKLER SYSTEMS URINAL - MOTORS OVER 25-100 If COOLING TOWERS WATER CLOSET ( MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS 'HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECT I ONS SIGN TRANSFORMERS UTILITY -SEWER _ SIGN TIME CLOCK UTILITY -WATER FIXTURES _ SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS 4' TILE/RES. VIOLATION PU DRAINFIELD, MP & ABANDON SEPTIC TANK REINSPECTION _ SOAKAGE PIT CU. FT. _ CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING 4 TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER' S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL