PL-09-1558Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONF. N B, & (305) 762.4949 qr /
BUILDING ECE6VED
Permit f I-' -�
t No.
PERMIT APPLICATION X09
�� r Master Permit No.
FBC 20
'Owner's Type: PLUMBING
Owner's Name (Fee Simple Titleholder) r_ 't Phone #
'✓Owne 's Address C
/Cityss
aJ I 7 I ! i LJ.5 State
Tenant/Lessee Name # d) 749 Phone # j) S -2s (f 5 z
Email <i"a-OL✓Cc/ /27//4,11°7/ " 41. cc/71A
571,r_e_rj
/
4Address (where the work is being done) r7 6 , /t . E, l l /
City Miami Shores Village County
FOLIO / PARCEL #
Is Building Historically Designated YES NO X.
Contractor's Company Name /% /{C£ ?Soy» c7RE /i a.) Phone # C 05J9G - ,
Contractor's Address e ,2o 2 W . 2 g C' T.
Miami -Dade
Zip
Flood Zone
City )/ A /' j?h / State
Zip 3 30 /G
Qualifier Name 4j t i e/ e_ a/man d, S Phone # (30 .5) 96:12 - 6 ?"6"
State Certificate or Registration No. Certificate of Competency No. 125Pao° 3d.:17
Contact Phone
Architect /Engineer's Name (if applicable)
E -mail
Value of Work For this Permit $ a' -166
Type of Work: ['Addition ['Alteration New ❑ Repair/Replace ❑ Demolition
Describe Work:
Phone #
Square / Linear, Footage Of Work:
******** : * ** * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * ** Ar****** * * * * * * ** * * *** * * * * * * * * * ** * * * **
Submittal Fee $ c90 .00 Permit Fee $ P 7O
Notary $ S Ab
Scanning $
Double Fee $
CCF $
Training /Education Fee $ .
Radon $
Structural Review. $
0
DPBR $
Violation date:
CO /CC $
Technology Fee $
Bond $
Total Fee Now Due $
.ts ISp.15
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. 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 be approved and a reinspection fee will be charged.
Signature
Owner or Agent
Signature
f/ Contractor y� ,�
The foregoing, ' nstrument was acknowledged before me this w The foregoing instrument was acknowledged before me thisTh 1/
day of
, by tlZ'CL At Ark -fa '1 , day ofS`P , 2001 , b 3Lf-e< Al (Y)PildaitS
or who has produced who is personally known to me or who has produced ft//9 -
s identification and who did take an oath. Pc 3(-1610 as identification and who i'a Ce an oath.
o is personally known to m
X/OTARY PUB
Sign:
Print:
My Commission
"."P' YP4 THOMAS H. ROBERTSON
MY COMMISSION # DD 516422
EXPIRES: April 3, 2010
+rFoF Foe' Bonded Thru Budget Notary Services
APPROVED BY Plans Exa
NOTARY PUBLIC:
;.a
Sign:
Print:
My Commiss
M her
* * * * * * * * * * * * * * ** * * * ** - ** * * * * * * **
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
Zoning
Clerk checked.
ON
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 125068 Permit Number: PL -9 -09 -1558
Scheduled Inspection Date: December 08, 2009
Inspector: Levrock, James
Owner: HOLSTON, MERCEDES
Job Address: 1266 NE 101 Street
Miami Shores, FL 33138-
Project: <NONE>
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Sprinkler System
Phone Number
Parcel Number 1132050080010
Contractor: Mike & Son Irrigation Inc. Phone: (305)968 -5975
Building Department Comments
Install sprinkler irrigation system to irigate entire yard
(back,front, both sides and swale area including pump
heads, puc pipes, timer and sensors -All Materials and labor
to irrigate yard.
Passed
Failed
Ins ; e omments
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
December 07, 2009
For Inspections please call: (305)762 -4949
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