PL-08-5Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 07/15/2008
Inspector: Levrock, James
Owner: ARDISSON, PATRICIA
Job Address: 636 101 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: LASSETER PLUMBING CO INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Block:
Phone Number
Parcel Number 1132060172120
Lot:
Phone: 305 - 893 -7180
Building Department Comments
REPLACE SEWER LINE UNDER HOUSE TO NEW
SEPTIC TANK IN THE FRONT OF THE HOUSE
Extended for 1 month only.7/7 /08
130- 1.1 ZQQQ
Passed
Inspecto Comments
-
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Monday, July 14, 2008
Page 1 of 2
i\) \ot T '1-
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATIO
FBC 2004
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) J / C a` tl /1 gip 1S -soil) Phone # 7J" o VW /0 3 -
Owner's Address 4 ,3 o 2). . e . /0
City /491 S'i ,2 L7 State r�o
Permit No. Pi., Vg-5
Master Permit No.
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done)
zip 33 /3J
Phone #
6 36' NC . /6/ 4-7— Srx =�-r
City Miami Shores Village County Miami -Dade Zip 3313)
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name L/9-(JS E-71--72
Contractor's Address 4 ts' Nom_ / 3 0
City A( /27 0q- State Pt. Zip 331'44
Qualifier Name -JO /7 £ d J G rE74 Phone # 37 , 19 3- 7/ J)O
Phone # 3 /93- 7 /Y0
State Certificate or Registration No. C',PC- & 7 /6 6 Certificate of Competency No.
E -MAIL:
A.rchitect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ 23 6
Square / Linear Footage Of Work:
Type of Work: DAddition DAlteration (=New ❑ Repair /Replace ❑ Demolition
Describe Work: R j L A < E „SEcit) f✓ L.,i /V C DIU t� I� 4c90 .4-E 770 /!S 1
7 t j Fadiik.? t— e) F Lei ®tISE .
****** ww*** x**ww** **wwwwww*.wwwwww*FF eesx ***. ac*ae*** wwwwwwxxxxuuxxxxxxxxxzxxxxxxxxxx
Submittal Fee $ Permit Fee $
Notary $
CCF$ 1"g0 CO /CC
Training /Education Fee $ 0'(0O Technology Fee $
$ S Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $
Double Fee $
Structural Review. $ Total Fee Now Due $ 1 �j
See Reverse 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. 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 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 be approved and a inspection fee will be charged.
Signat
The fore
day of
who i
Owner or Agent
i
oing instrument was acknowledged before me this n The foregoin
by 5/4ca)173 Mj'--401JS6h0?
sonall `. to me or who has produced
Signature
Contractor
instrument was acknowledged before me this.jU
day of - , 20 4j7by Taidki ,(17, l Jac =l`Z
who is rsonally known me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: a''
Print: dt S -five po eo
My Commissio
w xxxx xxxx *x
CHRISTINA PORRAS
um MY COMMISSION # DD 391268
Rf „t; Bonded Thw Noteay Pubuo
APPLICATION APPROVED BY:
(Revised 02/08/06)
Sign:
Print:
atA-0Z-Tvz-e
My Commission Expire
*7*. x *xx xxxxxxxxxgf* * * * * * * * * * * * * ***
4`:ry MY COMMISSION DD 391268
EXPIRES May 30,2009
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Plans Examiner
Engineer
Zoning
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