PL-07-1345//giorfp
—* • •
f;1‘
• X
Ytt
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
' • '
. „ .
Inspection Date: 08/16/2007
Inspector: Levrock, James
Owner: CHURCH, MIAMI SHORES PRESBYTER!,
Job Address: 602 96 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: TECO PEOPLES GAS SYSTEM
Block:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Gas
Phone Number (305)754-9541
Parcel Number 1132060141410
Lot:
Phone: (305)957-3857
Building Department Comments
TRENCH FOR GAS LINE
AUK 1 7 2TO
Passed
or Comments
Failed
Correction
Needed
Re-Inspection
Fee
($75)
No Additional Inspections can be scheduled
re-inspection fee is paid .
until
Wednesday, August 15, 2007
Page 1 of 2
imizmnvn
Miami Shores Village BY, "" 24
Public Works Departmen1""
t
Public Works
Permit Application
FBC 2004
10050 N.E. 2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit Type: Public Works WATER ,, / E ,
Owners Name (Fee Sim Titleholder) (�r L t, 1 �, S 1 �-V CV 1 r V Phones: 3 U J 15 l C 5 G
owners Address t O 2 iv - 9, 6
city ! r L` sgA,' Y ✓ State P(/' Zip
Phones: 5c7 7' 7 " ! �/ ^ ? 5 'r )
Tenant/Lessee Name —�
Job Address (where the work is being done) ®2- /v-E? ` (
City Miami Shores Village
1s Buiiding Historically Designated:
Contractors Company Name
Contractors Address Z .CE
City f\) \ (5A
YES
County Miami Dade
NO
Architect/Engineers Name (if applicable
$ Value of Work For this Permit
hP
Phones: q7 7 083
zip 33162-
60o
Type of Work: 0 Addition
Describe Work: K, V Ni`e_ (4,
vd:c' :r kr6ir'.
' $ubitfiit I Fee j
El minnow
VL
Phone #:
Lineal Footage Of VY rk: , / ,
❑ RepahlReplace 0 Demolition
_ A
�,� +a r4' ; ,
i1 fwi�F.(. r' e'a;
-ly;�e ye:7,.t,30
Permit Fee $ 100 "r OCF $
Training/Education Fee $ 0 -50 Technology Fee $
Notary $
Scanning $
3.00
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
1000-50
CWCC
2 -5O
Radon $ Zoning Bast $
Structwal Plan Review $
Bonding Company's Name (if applicable)
Bonding Cairpany/'s Address
City
N/A
State
Mortgage Lenders Name (if applicable)
Mortgage Lender's Address
City State
WA
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 CONDmONERS, 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 b Applicant As a condition to this issuance of a Public Works permit with'an estimated value exceeding $2500, the applicant must
prornise 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 be
approved and a reinspection fee will be charged.
Signature ,4,j) , . AA- >,aw�
Owner or Agent
Signature
S US VIA Contractor
The foregoing Instrument was acknowledged before me this-249 The foregoing instrument was acknowledged beforya me this 2 0
day of fftMAK. 20 by ''/A 6 -11/4 Q''
day of
-1e met, by Sus 6T`i
e or who has produced o Is personally know to r
as identification and who did take an oath.
NOTARY ; i UG:
Sign: ...Ai
'n ,V
Print: y/
(1
My Commission
LUIS MONTERO
PAY
Commission Expires Feb 2, 2010
Bonded
National Note Assn.
or has produced
as identification and who did take an oath.
Y PUBUC:
,,at, "' No,, LUIS MONTERO
a -� 6. Nam,/ Public - 8t918 of Florida = i Common Expires Feb 2.2010
'��.�"�::°' ,,� Commission # DD 513850
Bonded By National Notary Assn.
My Commission
APPLICATION APPROVED BY:
11/17/2005
-7/Ve?
iA jIc'i
Public Works DIrector or
his designee.
NEI
2ND
A
V
E
N
U
E
N
NE J &7tH•sT��;ET •
•
• •0S
•. •
.S• •
• • •
• * •
•.
•• • • • •• ••• 0.
•
•• • • • • •
EXHAUST FAN
•• DOOR
/W
L
PAVERS 5'
PEER
BLDG DEP
AL.KWAY 5'
IG TREE
DM! .E'WAY
PARK
DRIVE
SUBJECT TO COMPLIANCE WITH ALL FEDERAL MOME%
STATE AND COUNTY RULES AND REGNM1 i, +, JUN 2 7 MI
it")SIDEWALK ,
\ SWALE GRASS
GAS MAIN 4 ''PL(INSIDE 6" CI)
80' -- -- -- -- - -CD 80'
R/W R/W
NE 95TH STREET
SIDEWALK
S. R/W
CONSRUCTION NOTES:
I. ALL GAS PIPELINE CONSTRUCTION TO FOLLOW TECO PEOPLES CAS STANDARDS.
2. TRAFFIC CONTROL SHOULD BR MAINTAINED AND COORDINATED WITH THE
APPRORIATE GOVERNMENTAL AGENCY.
S. ALL DISTRUBED ASPHALT /CONCRETE /SOD ARRAS TO BE RESTORED TO PRIOR
CONDITION, UNLESS OTHERWISE SPECIFIED.
BY: � ZIf
48 HOURS BEFORE DIGGING
CALL SUNSHINE 1- 800 -432 -4770
ATLAS
M 13
SCALE:
NTS
DRAWN BY:
LM
NEW 3/4" PLASTIC GAS SERVICE
602 NE 96 ST. MIAMI SHORES, FL
DATE:
6/22/07
SHEET:
1/1
JO:
19044