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PL-10-663 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Nu INSP- 140981 Permit Numbe PL -4 -10 -663 Scheduled Inspection Date: May 19, 2010 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: BUTLER, JOHN Work Classification: Gas Job Address: 500 NE 102 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060171070 Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Phone: (305)957 -3857 Building Department Comments PROP 3/4" PE SERVICE LINE FROM THE ALLEY Inspector Comments Passed Failed t Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 18, 2010 For Inspections please call: (305)762 -4949 Page 12 of 29 LA ' �!ORs Miami Shores Village iIt1j) � 10050 N.E. 2nd Avenue 0 � Per i • "• ""' `" Miami Shores, FL 33138 -000 Phone: (305)795 -2204' ORiDp' .ISOM D Expiration: 10 /18/2010 Project Address Parcel Number Applicant 500 NE 102 Street 1132060171070 Miami Shores, FL 33138 Block: Lot: JOHN BUTLER Owner Information Address Phone Cell JOHN BUTLER 500 NE 102 Street MIAMI SHORES FL 33138 -2455 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 TECO PEOPLES GAS SYSTEM (305)957 -3857 (305)970 -1783 Total Sq Feet: 60 Type of Work: PLUMBING Available Inspecti Type of Piping: GAS LINE Inspection Type: Additional Info: Final Bond Return : Press Test Classification: Residential ROW Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice # PL -4-10 -37632 Education Surcharge $0.20 04/20/2010 Check #: 4982 $ 50.00 $ 54.60 Permit Fee - Additions /Alterations $100.00 Scanning Fee $3.00 04/21/2010 Check #: 4984 $ 54.60 $ 0.00 Submittal Fee $50.00 Submittal Reversal Fee ($50.00) Technology Fee $0.80 Total: $104.60 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 laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. April 21, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy April 21, 2010 1 APR Z 0 AN Miami Shores Village ............ Public Works Dep artment 10050 N.E. 2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 11� Public Works Permit No 1 V ��( J Permit Application FBC 2004 Permit Type: Public Works Owners Name (Fee Simple Titleholder) Ph.. #: i U5' a�� Owners Address '5 0 0 lyl"5 /p2 p cl 5Z" city IN alx; / Aj state ,C zip 3,3 Tenant/Lessee Name /� /� Phone r. Job Address (where the work is being done) city Miami Shores Vigage County Miami Dade zip Is Building Historically Designated: YES NO 1- 2( Contractor's Company Name '�'�CD ©�� 5 1 Phone #7 � ®> . y " 3 Contractor's Address MES -s tD /,;rJt- W&)Y city x -M9 d/5 ./ s tate �_ zip 331�x Architect/Engineer's Name (d applicable) .1?eo O L E5 0AS Pion td $ Value of Work For this Permit Too p Q Lineal Footage Of Work: ,C y Type of Work: ❑ Addition QAlteration New E] Repair/Replace Q Demolition Describe Work: �-7 y ..........+++....... Fees .................... Submittal Fee $ �' Permit Fee $ Z( S � COICC Notary $ Iy[ a TrainingdEducadon Fee $ 7- 0 Technology Fee $ 0 ` _J Scanning $ Radon $ zoning Bond; Code Enforcement $ Structural Plan Review $ Total Fee Now Dull ; (Continued on opposite side) Bonding Company's Name (if applicable) Bonding Cc4tparry's Address WA City State Zip Mortgage Lender's Name (if applicable) WA Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 this issuance of a Public Works 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 adachment Also, a certified copy of the recorded notice of commencement must be posted at the job s►1e 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 � 7� The f ro9 g 9 � ongoing instrument was acknedged before ) m I e this 16 day of , 20LUb 7 U s V� c,A ,ie. day of i f 20 /vby Al J� Sus 1/ &7A . is personalty known to me or who has produced W ho is personally know to me or has produced as identification and who did take an oath. ias identill o did take an oath. NOTA UBLIC• R Si cQ Sign: Print: �J>?A 2/`A S a � f r � Print 2e �r S rS # V P Notary Public State of Florida My Commission Expires: ro .�►RY� n Notary Public State of Florida My Commission Nora Arias Loftin Nora Arias Loftin p f ` My Commission DD610653 e` My Commission DD610653 of F��~ Expires 11!21 /2010 APPLICATION APPROVED BY. ` °� ! ®` Public Works Director or his designee. 11/17/2005 i � � l � r{ f r , s r MVg ' • -0 • .T. .<. +,. 000400 : 00000 j • • • • • 4 MR , k p6LOr,l I ONA g i • • • •••••• t` P e: F F t " F Fx ,E w o- v' r e r • •{•a •ffwf• • • f all Aso A ••s! �� »may � � � � � \ \� � \ �� / � � ) \ .� �'� � _� � \ � \� � � � v�� \�� i N R/W SURFACE RESTORATION , - <> ' °` •'' IN RAW ABOVE THE PIPE ZONE -N EAC 5 I rxi+Z . EtR31S C , w i PR 2 2010 «x BY-. ,_.. ,... ....................... RIGHT Of WAY LLI TRENCH REPAIR. MILUNG, AND OVERLAY I 4 i " .... I ...... ... • TYPICAL TRENCH AND PAVEMENT 100 • • •••� • . .• • • •• RESTORATION FOR TRANSVERSE O I `• : •• ( •, "•• " " " "` . "`•` CROSSING •• ••• • • • ••i••• I� • • • • • GINDOW • • •• I •i•••• OBNWRS BEFOREYW DN3NFLOWDA • •• •�� • • • • i••• • SUO NE 108 * r *• • STREET • • • r•• • • •• ••�••r / n I� •• ••� ••• BL 94 11 • • • • • / _ !/ �� •• •• •• • ! • • •r•i • •�•• ii •• /�/ NB THE LAWI 9 1- 800 -431r -4770 BUNENINE STATEp1E CALL OFFLORmA, ING I • • .�� i ��lOP..75 PE GAS SERVy • • • • • • • • • I I PROP..E /M, TRAN /FIT, TAP /TEE R /� I ` , ^ LEGEND �x =N //A�� yE iL Y vb � — — — R/W RIGHT OF WAY ' — ExIFiG GAS MAIN P/L PROPERTY LINE S R/W T/T TAPPING TEE EFV EXCESS FLOW VALVE SVC SERVICE LINE SP STEEL PLASTIC COAT PE POLYETHELENE NO LANE OF TRAFFIC TO BE BLOCKED OR DISTURBED FOR THE WHOLE DURATION Off' WORK ALL WORK TO BE DONE IN ALLEY TECO / PEOPLES GAS - N. MIAMI OPERATIONS 500 NE 102ND STREET: E MIAMI SHORES PEOPLES GAS PROPOSED 3/4" P.E. GAS SERVICE M 1C SCALE: 1" = 50' DATE: 04/15110, SHEET 1 of 1 mj� Y.