PL-09-1246 �� ✓x xx�w� � a 1 rz
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s�! °Rte r Miami Shores Village x {
10050 N.E. 2nd Avenue
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Miami Shores, FL 33138 -0000 _ ShA
Phone: (305)795 -2204
F tORtt�
Expiration: 01130/201
Project A ddre ss Parcel Number Applicant
409 111 Terrace 1121360010450
Miami Shores FL Block: Lot: JEAN TRACH
Owner I Address Phone Cell
` JEAN TRACH 402 111 Terrace (305)754 -2415
MIAMI SHORES FL 33138 -
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
DALEY ROOFING INC (305)754 -9892
Total Sq Feet: 0
Type of Work: PLUMBING For Inspections please call:
Type of Piping: GAS VENTS
(305)762 -4949
Additional Info: Availa Inspections:
Bond Return : 71nspecli Type:
Classification: Residential
Fees Due Amount Invoice # Total Amt Paid Amt Due
CCF $0.60 PL -8 -09 -35533 $ 162.55 $ 162.55
Education Surcharge $0.20 $ �•��
Notary Fee $5.00
Permit Fee - Additions /Alterations $150.00
Permit Technology Fee $3.75
Scanning Fee $3.00
Total: $162.55
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.
November 30, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 30, 2009 1
Miami Shores Village
Building Department JUL 2 4 2009
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 '' __ ,
Tel: (305) 795.2204 Fax: (305) 756.8972 BY; _ .- •.. -....
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING � �"
Owner's Name (Fee Simple Titleholder) �/ �r'/ N mac' IG f{ phone # J O. ��1
Owner's Address 'NA-)
City - lyt, 1HI / State
Zip
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO t/ Flood Zone
Contractor's Company Name OX/ �® IV L 61 /y /T/ /w (.y'" Phone #
Contractor's Address - _t3S'� �� �°° .. 1''1 ' 7 7SY
City , AI/ 7M I State PZ. - ,
Qualifier Name eA � Phone# �3
State Certificate or Registration No .a Fe- �a 7.' Certificate of Competency No. �...-
Contact Phone �g� ` /V_ 77 � E -mail
Architect/Engineer's Name (if applicable) phone #
71
Value of Work For this Permit $ � `"'�� Square /Linear Footage Of Work:
Type of Work: FlAdditi n ❑Alteration E]New
�. ❑ Repair/Replace ❑ De
Describe Work:
Submittal Fee $ ` Permit Fee $ �"J �✓ CCF $ � CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning
Bond $ Code Enforcement $ Doable Fee $
Structural Review. $ Total Fee Now Due $ - A 'S
Sec Revere side
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'RLCOkD 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
COMMENCEMENT." BEFORE RECORDING YOUR NOTICE OF
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 certif
or the copy of the recorded notice of commencement must be posted at the Job site
f first inspection which occurs seven (7) days after the building permit is issued. In the absence. of such posted n e. the
inspection will not be approved and a reinspection fee will be charged.
Signature
Si AA
Owner or Agent on tractor
The fo going instrument was a Howled before me this
0"1" The for of g instrument was ack edged be re m thiswWU
day , 20�9b
day of , 20 , b '�
/ who is person !ly JJ known to me or who has produced who is rso a y known to me or who has produced
s identification and who did take an oath. '{•
' ification and who did take an oath:
NOT Y PUBLIC: �
oa ��ti N TAR PUBLIC:
Sign::
Sign:
Print:
Print: o ^r p
My Commission Expires: % My Commission Expires:���,�d
APPLICATION APPROVED BY Plans Examiner Zoning
Engineer Clerk checked
(Revised 07/10/07)
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
I nspection Number: INSP - 120239 Permit Number: PL -7 -09 -1246
Inspection Date: December 01, 2009 Permit Type: Plumbing - Residential
Inspector: Levrock, James Inspection Type: Final
Owner: TRACH, JEAN Work Classification: Addition /Alteration
Job Address: 409 NW 111 Terrace
Miami Shores, FL Phone Number (305)754 -2415
Project: <NONE> Parcel Number 112136001045
Contractor: DALEY ROOFING INC Phone: (305)754 -9892
Building Department Comments
Inspector Com e
Passed GAS VENT FOP, R
3
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
November 30, 2009 Page 1 of 1