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PL-11-792Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 161037 Permit Number: PL -5 -11 -792 Scheduled Inspection Date: June 17, 2011 Inspector: Hernandez, Rafael Owner: LATOJA, AMELITA Job Address: 1110 NE 101 Street Miami Shores, FL Project: <NONE> Contractor: A AARON SUPER ROOTER Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132050340010 Phone: 305 - 944 -8886 Building Department Comments SEPTIC Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTI N FOR INSP- 159283. FINAL HRS IN FILE missing sod June 16, 2011 For Inspections please call: (305)762 -4949 Page 12 of 12 • Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 159282 Permit Number: PL -5 -11 -792 Scheduled Inspection Date: May 27, 2011 Inspector: Hernandez, Rafael Owner: LATOJA, AMELITA Job Address: 1110 NE 101 Street Miami Shores, FL Project: <NONE> Contractor: A AARON SUPER ROOTER Permit Type: Plumbing - Residential Inspection Type: HRS Approval Work Classification: Septic Phone Number Parcel Number 1132050340010 Phone: 305- 944 -8886 Building Department Comments SEPTIC Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments May 26, 2011 For Inspections please call: (305)762 -4949 Page 5 of 6 arizuoN OF Holds Department of Health Miami -Dade Canty Ham OSTDS/Wef Division IISZ SW 26 St. • Mind, It 33175 ITEzTolvimp, Miami Shores Village M PRAY 0 4 011 Building Department BY:... 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. f "' t —9 'tL- Master Permit No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): f f L4 1 c j CL Phone #: Address: A City: PA 6,11'fi Skr:2,rej State: FL' Zip: 5i 38 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: Q 10 !. 101 City: Miami Shores County: Dade, Miami Dade Zip: 3 3 P3, Folio/Parcel #: d 4 b i ®tea m ®4- -00 V 0 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: A /" ' f)rO /) (c/Fair R.oO+er Phone#: 33,5 ct-144-- 4 ekc Address: GO 22 s,,,.. -2G CA- City: J "` 4 rnP p✓' State: f Zip: z -N aii' Qualifier Name: JOh e ,1 Phone #: I State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ C4W30 Square/Linear Footage of Work: 15 Type of Work: UAddress , ❑Alteration UNew epair/Replace ❑Demolition Description of Work: ! 16, D cam ;r4,, **** ************** *********** ********** Fees*+ x**** *+ a****= x**+ x**************+x=K*x:****x:***** Submittal Fee $ Permit Fee $ / 5 —6 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In j absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. kiNki* Owner or Agent The foregoing instrument was acknowledged before me this 4!" day of w , 20 \ , by W1 ek l+ct► who is person y known to me or who has produced )Lt . 3r ► ., A tification and who ..'d take an oath. NOTAR Signature Contractor The foregoing instrument was acknowledged before me this t{° day of M co,/ , 20 M_, by Jo tun who is personally known to me or who has produced D._ 33 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Co rttrT pp ires:© p mrn� D DuI0l M 7 33.3.�4 �({�_ ' Saa. xnx* axxm x x xaxxx x xx xxxx xmxxx x xxxumxx x xx axx kx xxxaxx a x x � o ms . A ► dmiAly 1:8::„.x � bN *a w * 1 *x K mxx*** Print• My Commission arz n'$s i ° nt' ®06613366 coin° J ria 24, 2011 APPROVED BY (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Plans Examiner Structural Review Zoning Clerk L at** CA I, *t AM*. • g f aux' art um *tilt 3.= 1 1=1 X 0 1 it tu t Pt $ t m. wI t At 1 XX 40116„- *009 . , #1 tee an net be noel tett 14-I Ara, fA0 i v it.tot tift4titft q;:ittltimr-4it'fitmFFtN1'"711,1r!1 1'crIrm rye telt' " 411 ,T11,'"1" )2,1"1,11,,,Pr• • STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMF Permit Application Number • PART II s- SITE PLAN- Scale: Each block represents 5 feet and 1 inch = 50 feet. I I ; . ; , • ; • i ' • 11 ! • ' • i • 1 1 • , ; I • ... . . . „ ...„. _ . • I ; • . ! ; ; • ! ; ; , t - . . „ •. , • •. •• -• • • . y, - • i • • •••• ■ • . t f • -Y-*•-**';''1"H 1- ". - I 11 • , ; t t ' ; , ; • ; - ''' . '1. ' ' - ! , , , t 1 ■ i . . I ; • I ' , 1 : 1 - , , , .. • . 1 . - - 1- z-•: i.-:-;:j- . 4 Ito t-• -,--1-, t__, _t_i__1_ :._1:.!_..1_LA.J._ C , tle-, 4 , - 1- •., -:- - -;-!.--; -1'-;* r-: .-7-!-I-i-'-i. >-'.'"i'-','-'-' i''!--..: !"-i • ! 1 1 • I I , • - r" "1-1 -; t , ; t , _ r-11-71- ! : -41-T•-4 r "•',-"'„"•—c--",—■''' c . IH11" .1/1; , .' ' —.'" -- "" ' —'-'''— i•—• —1 *01 - !--. •i---1 - 1 ' • 1-C—i i ' ' i •; ; ' • ; , , • .. , : , . 1 i • 1.1. !1 ; ' • i ' g.,,,..,09 : Ott', , 0,--1:-..et—i-' :* • i -: 1 • ' 'r. . i . 1 , " t ' i ' • '. ' , . ,:-• ! ! ,••••••!' •" ; 771717 F:" T r1 Notes: 0•40‘ Site Plan submitted by: Signature Plan Approved V Not Approved By ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Title Date County Health Department • DH 4015, 10196 (Replaces HRS-H Form 4015 whIch may be used) (Stock Number: 5744-002-40154 Page 2 of 3