PL-11-1138Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 161270 Permit Number: PL -6 -11 -1138
Scheduled Inspection Date: July 06, 2011
Inspector: Hernandez, Rafael
Owner: KONCHAK, SUSAN
Job Address: 1250 NE 97 Street
Miami Shores, FL
Project: <NONE>
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Sprinkler System
Phone Number
Parcel Number 1132050090580
Contractor: AFFORDABLE IRRIGATION, INC Phone: 305 -681 -6322
Building Department Comments
REAPAIR REPLACE SPRINKLER SYSTEM IN FRONT
YARD
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comme s
July 05, 2011
For Inspections please call: (305)762 -4949
Page 11 of 21
Miami Shores Village
Building Department JUN 2
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 20
RAArriStiNte
Permit Type (circle): Btriftlttg----Rooring,
Permit No, R-- tl '1 1 51r*
Master Permit No
Owner's Name (Fee Simple Titleholder) 011li4./0 ifeo n cilefic- Phone j 00 5q--0 - 3/ 0 3
Owner's Address /2 S-0 41-• 67
City /77/ 'if sti i 6" 41 0 4 a State .-c--.- Zip 3
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done) /a re) ,/- E • 77 )-
City Miami Shores Village County Miami-Dade Zip
. FOLIO / PARCEL # .
Is Building Historically Designated YES NO Flood Zone
Contractor's Company Name ?dd. .4.4f.,1,7-0v.t Phone #Q elf) 632 4
Contiactor's Address 41 .43:1-4,..e49,7
Zip 33/.6,
City 'tiif /14, State 12---
Qualifier Name d1/t-e-0 ASA'S
Phone c4.3 Pi) 3/0- c6s /2;
State Certificate or Registration No. Certificate of Competency No. 4/6//40 9 0 .:2-
Contact Phone (-3 '47 Cg. 2 2- E-mail a/A- 46). dZe_ oter4e•
Architect/Engineer's Name (if applicable)
Viihne of Work F
Ty
of Work:
escnibe Work:
r this Permit $
ElAlteration
Addition
Soy re / Line
Phone #
r Foo
ge
f Work:
11 epair/Replace LI Demolition
***************************************Feeo******** * ********************************
,,,, , ■
Submittal Fee $ CCF $
Permit Fee $ //eL,"‘-‘ CO/CC
Notary $ • Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ - Code Enforcement $ Double Fee $
StructurafReview. $ Total Fee Now Due $
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 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) d i after the building permit is issued In the absence of such posted notice, the
inspection will not be apprgved and a rei ectio ( fee wi be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this
day of ,20_,by , day of
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PU LW:
The foregoing instrument was acknowledged before me this
20_,by
who is personally known to me or who has produced
Sign:
Print: co mfgf
My Commission Expires:
* * * * * * * * * * * * * * **
.*1 MY COMMISSION # OD 706232
Bondad EXPIRES: August 19,2011
That Notary P a Odom:Rota
APPLICATION APPROVED BY
(Revised '07 /10/07)
as identification and who did take an oath.
NOTARY PUizLAC:
Sign:
Print:
My
7 // Plans Examiner
inmissbl'AllC�STATE OF FLORIDA
"'•�% Jor� a Toledo
commisioe #DDB15435
"glel
> D'rua ATLAN,7WI1lfit;fGZAByoHi&
Zoning
.. Engineer Clerk checked
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Liz .v., A . /kid Z /7/. X7.7•4.
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Miami Shores Village
APPROVED
BY
DATE
ZONING DEPT
BLDG DEPT
III,JI (T TO COMP! _'ANC ITh A� FEDERAL
( "I !M TY RULES AND REGULATIONS
NOTARY PUBLIC - STATE OP FLORIDA
Jorge Tondo
Commission #DD815435
,,a Expires: AUG. 22 . ; 2
term
Ile e.
A EP
1)044P
•
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CC# 96P000219
Affordable Irrigation, Inc.
188 NW 138 Street....
Miami, FL 33168
Tel: (305) 681 -6323