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PLC-10-626Project Address 370 GRAND CONCOURSE Miami Shores, FL 1132060136040 Block: Lot: MIAMI SHORES BAPTIST CHURL Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Contractor(s) LASSETER PLUMBING CO INC Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $0.60 $0.20 $100.00 $3.00 $50.00 ($50.00) $0.60 $104.60 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy April 14, 2010 Address Parcel Number Phone Type of Work: NEW GAS TANKLESS Type of Piping: GAS Additional Info: PLUMBING Classification: Commercial Pay Date Pay Type Invoice P. PLC-4-10 -37582 04/14/2010 Credit Card 04/14/2016 Credit Card Amt Paid Amt Due $ 54.60 $ 50.00 $ 50.00 $ 0.00 Expiration: 10 /11/2010 Applicant Cell MIAMI SHORES BAPTIST CHURCH 401 NE 95 ST Miami Shores FL 33138 (305)758 -0559 Valuation: Total Sq Feet: $ 1,000.00 0 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Underground 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 spedifications 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 14, 2010 Date 1 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Plumbing Miami Shores Village Buildin g Department artment 10050 N.El2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Owner's Name (Fee Simple Titleholder) s ,, t/ 'So `j �jphone # 361' a Owner's Address 370 �--L�" /,)L C O/ L City Alm-m/ JII6X 6SState Zip 33/3P Tenant/Lessee Name fY/ /`9 -i79 / J#/g b f / ffr/S . Phone # 36 E -MAIL: 3 6 AND COniCOok ig Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip 3343 d' FOLIO / PARCEL # Is Building Historically Designated YES NO X Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Off/ , 1�`1 a APR 1!4 2.o1u BY: Permit No. ?Lct — 694, Master Permit No. Contractor's Company Name 2 EL PLt1m /� G Phone # 3 O 5 � O 3 - V d p[P Contractor's Address O ' jV , /3q J' I City X / L13-N/ State FL. Zip 3 3/6 �� . 2- & � �t r Qualifier Name � � �� S /� Phone # c�VU /93- 7116 State Certificate or Registration No. ei�' 0 ( ✓ Certificate of Competency No. E -MAIL: -,S , i'm / G Z *TT /tier • Phone # Type of Work: ❑ ddition DAlteration on DNew [Repair /Replace ❑ Demoliti � n Describe Work: rl Jj , 4,4 V /L_. :,_ /d A.t. I t r l / Square / Linear Footage Of Work: **********W W W W * ** ****eY ******4f****** ** FeesX*Xx dr******** ************************** ***** Submittal Fees .0 Permit fee $ /60 — /jt j �- e-e_CCF $0 e`: CO /CC Notary $ 41:::) Training /Education Fee $ 0 . Technology Fee $ 0 . Scanning $3 CO Radon $ DPBR $ Bond $ Code Enforcement $ Double Fee $ Zoning $ Structural Review. $ Total Fee Now Due $ rte y • 60 See Reverse side -> Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) rt Mortgage Lender's Address City 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 will not II a. proved and a fee will be charged. Signature Sign: Print: My Commission Expires: (Revised 02/08/06) State Owner or Agent ,� The foregoing instrument was acknowledged before me this /o2s��l� day of >/ = / 20/6 , by z19-1(67 A6 67f. who '. aersonally know )to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: APPLICATION APPROVED BY: Zip Sta • Contractor The foregoing instrument was acknowledged before me this� day of , 20 ja, by c_TOEVO 44Z , who is rsonally known me or who has produced as identification and who did take an oath. NOTARY PUBLIC: &/4/46e Plans Examiner • Engineer Zoning ITEM BAT1I MB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE 1 BIDET• LIGIir OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES NM A/C (WARD) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR CRAIN SERVICE REPAIR/METER CIW10E REFRIGERATION GREASE TRAP APPLIANCE OUTLETS � PROCESS AIU PRESS PIPING INTERCEPTOR RANGE TL UtRi)ERGROUIU TANKS LAVATORY OVEN ABOVE CROWD TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 IP STEAM BOILERS SHOWER MOTORS OVER 1- 3 IP HOT WATER BOILERS SINK, POT /3 COM1'. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 IP • TRANSPORTING ASSEMBLIES 1 SINK, SLOP MOTORS OVER 8- 10 IP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 IP 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 HEALER- REPLACE VAhabla GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL ~� WATER SERVICE SIGN TUBES SIGN TRANSFORMERS SIGN TIME CLOCK SEWER CONNECTIONS UTILITY -SEWER UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS GRAINFIELD, 4" TILE/RES. VIOLATION FUM' & ABANDON SEPTIC TANK REINSPECT ION -i 1 SOAKAGE PIT CU. FT. CATCH BASIN 01SGWRGE WELL DOMESTIC WELL AREA. DRAIN --- ROOF INLET • SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING • - LAWN SPRINKLER SYSTEM 3AS RANGE ETER SET (GAS) 3AS PIPING fis ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEr OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS,) PLUMBING ELECTRICAL MECHANICAL Inspection Number: INSP - 140573 Scheduled Inspection Date: April 16, 2010 Inspector: Hernandez, Rafael Owner: CHURCH, MIAMI SHORES BAPTIST Job Address: 370 GRAND CONCOURSE Project: <NONE> Miami Shores, FL Contractor: LASSETER PLUMBING CO INC Building Department Comments April 15, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Number: PLC -4 -10 -626 Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)758 -0559 Parcel Number 1132060136040 Phone: 305 -893 -7180 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 18 of 23