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RC-09-1808Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 128417 Permit Number: RC -11 -09 -1808 Scheduled Inspection Date: July 27, 2011 Inspector: Bruhn, Norman Owner: PHILISTIN, ESTHER Job Address: 174 NW 102 Street Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Kitchen Cabinets Phone Number Parcel Number 1131010230100 Building Department Comments KITCHEN AND BATHROOM REMODEL passeW 2)J2-7-41 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 26, 2011 For Inspections please call: (305)762 -4949 Page 1 of 30 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 02010 BUILDING Permit No. RO� PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING r _ OWNER: Name (Fee Simple gqTitleholder): �5 p � h C \ kq C t/) Phone #: ? Y� - S2( �— -) % 0�-,6 Address: 2 k J t C� � r5 4-6°Q d City: 1..9,. j 3. U-U State: Zip: 33 / 5-73 Tenant/Lessee Name: Phone #: Email: yJOB ADDRESS: () (Cr it 1 c_-e_) ( 2 Si a City: o2a Miami Shores (s County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 5 b,ICZ. f h t\ S i Phone #: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: Address /❑�Alt�erationn New p ❑Repair/Replace ❑Demolitio`n� Description of Work: _UJ� 61 { (ZY44 / �� �`° (C COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees********* ** * * * * * * * * * * * * * * * * * * * *** * * * * * ** *** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ -30 6 C�� ��1�°I 0 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 reinspection fee will be charged. Signature -&441-r1L,9t. Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 5 The foregoing instrument was acknowledged before me this day of , 20 1 l , by 3-It—ICS PH ILO ay of , 20 _, by who is personally known to me or who has produced I� who is personally known to me or who has produced As identification and who did take take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: i Now intim 6. Sign: _ �� .�'., Sign: Print: ,• a e ti� � . 4. Print: et.. a" S�' My Commission Expires: •' Q • ',,'tt / /I,II11I11 \ \ \ \ \\ Plans Examiner Zoning My Commission Expires: APPROVED BY Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Project Address 174 102 Street Miami Shores, FL Parcel Number Applicant 1131010230100 Block: Lot: ESTHER PHILISTIN Owner Information Address MCMONMEgitg Phone Cell ESTHER PHILISTIN 12650 INGENUTIY Drive ORLANDO FL 32826- Contractor(s) HOME OWNER Phone Cell Phone Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: KITCHEN & BATHROOM REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : Occupalcy: Single Family Exterior. Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $6.00 $0.60 $2.00 $5.00 $300.00 $0.60 $3.00 $50.00 ($50.00) $8.00 $325.20 Invoice # Total Amt Paid Amt Due RC -11 -09 -36289 $ 32520 $ 50.00 . . . ... . ... . .. . . . . . . ... . . RC -11 -09 -36289 $ 325.20 $ 325.20 2i $ 0.00 For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Drywall Final Framing Insulation In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 01, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 01, 2009 1 o q _ ;Iv- Miami Shores Village romomrwmT Building Department Nov 0 2 219 J 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 F,gx: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING. Owner's Name (Fee Simple Titleholder) ' y Phone # 7E 5 ^7? 5)7 g-6 Owner's Address l 7 C iaa City / Pkoz,5 State -F/ Tenant/Lessee Name Email Permit No. BY :.00mo.m xffdac Master Permit No. Zip Phone # Job Address (where the work is being done) 1.14 rquO 102.t E- City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone OWW2/ Contractor's Company Name Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E-mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ � _ Square / Linear Footage Of Work: Type of Work: DAddition I Alteration ONew L} taRepair/Replace ❑ Demolition Describe Work: •001,)99 * *^ * 5 **t*****************icx * * *** ** Fees************* * ** * * * * * * * ** * * *** * * * * * * ** * ***** CCF $ (1 • as CO /CC .$ Submittal Fee $ Permit Fee $� Notary $ 5.00 (� Radon $ / Training/Edu�ntion Fee $ Technology Fee $ g . Scanning � . DPBR $ Bond $ Double Fee $ / Violatio date: Structural Review. $ i / Total Fee Now Due $ 215. 2 0 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 The fore oin instrument was acknowl ged be day of ,20U1by who is pers nally known to me or who has produced 20 L.. NOTAR PUBLIC: Sign: cation and who did take an oath. Print: My Commission Expires: 1 A401" * * * * * ********************** * ** **** APPROVED BY �pl'� ***************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Signature Contractor The foregoing instrument was acknowledged before me this day of ,20 ^,by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: 4/011 Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Zoning Clerk checked VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: h , . 7 09 • DATE: ( O ADDRESS: (7( 61) (. ©2 5 L 33/37J Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to.be done by a licensed contractor. You have applied for a permit under an exoeption, to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for salenr lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sate or lease, which is a violation Of this exemption. You stay not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you hav ®licenses required by state law.and by county or municipal licensing ordinances. Any person working on your building who is not licensed tfigst work uncler your supervision and must be employed by you, which means that you must deduct F.LC.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction . • must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please red and initial each paragraph. 1. I hold. title to the above property and I am planning on doing this construction Myself. 2. I understand that as an owner- builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application. •Inactive permits for a period of over 180 days- will become null and void (expired) and a new permit will be required. to be issued for reinstatement of the permit., Initial 3. I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There'is a copy of the code in this office for review. Initial 'a*? 4. I. understand that the building official and iinspectors' are not there to design, alter or give advice on how to meet code — only if the structure meets the minimum code. Initial 5. I understand that as an owner - builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate any contract disputes. Initial 6. I understand that if I compensate any person or company for work performed they are requited to have a business License in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company or person. %itial 7. I underi3tand'that if any person gets injured on my construction project—they are entitled to workmen's compensation:. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include kiss of wages during recovery from injury. Initial �. 8. I understand that under state and local laws I can not do . any Electrical, Plumbing, Heating, Air & Roof work on my 'property with out first obtaining the proper permits by licensed contractors. Was acknowledged before me this oday of el, L. lYl Initial who was personally known to me or who has Produced there License or b 1 1r) oc9 -0 os' Z1. 20lntification. NOTARY PUBLIC vr' OF FLORIDA Cloodia NOTARY . V �;ubil'loosryq -, Co+� Tv 13 2011 ��a:,noTFeuAi TI:,tio:`OVCCO.,u+iC. BO�TtiR '4 Ciame XiitAt ,� 6-4 Ais # » /e~I oaf, 759 #.-�r ea/Pa ,Tjs/alla,4ri^ 'tiC CY4 4,& /AlaJ.eF/ie' - 1~a' jot i4 e.ss 5Aee /$ rk 1?Dk 13 / Miles 45 t y • 660 ,ey/fivy'(ofoese - 4,pae) .11a6- .t/ I9 y 7/Y. Q5 r cC''�S tidy bilorotee 44e, Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. Top Kitchen + Granite Kitchen Creations 4200 S. University Dr. Davie, FL 33328 (954)370 -5553 Designed: 8/29/2009 Printed: 8/31/2009 Esther Philistin Esther Philistin Drawing #: 1 detewre/2- Pc, To' ,geree7-pe 7 Si/Low- 1- 4o 6n- 7J 1`d- A-7,4 ®rte Pei/ L-62-nitteRofir FY76- 491`" ""e42 3 MC M nriTC trr 6;-. "r e%k°ci It Nov 0 6 2009 /9-641 Cireow e,4,fr A 3°',"' BY: re e SUBJECT TO COMPLIANCE WITH ALL FEDERAL. STATE AND COUNTY RULES AND REGUiLAT!C`1S Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 141761 Permit Number: EL -11 -09 -1810 Inspection Date: April 28, 2010 Inspector: Devaney, Michael Owner: PHILISTIN, ESTHER Job Address: 174 NW 102 Street Miami Shores, FL Project: <NONE> Contractor: MICHAUD ELECTRICAL SERVICES INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1131010230100 Phone: (786)273 -1270 Building Department Comments ELECTRICAL WORK FOR KITCHEN AND BATHROOM REMODEL Passed Inspector Comments , 4 - (,/,°C7A----- Or Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 April 28, 2010 Page 1 of 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 141615 Permit Number: EL -11 -09 -1810 Scheduled Inspection Date: April 27, 2010 Inspector: Devaney, Michael Owner: PHILISTIN, ESTHER Job Address: 174 NW 102 Street Miami Shores, FL Project: <NONE> Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1131010230100 Contractor: MICHAUD ELECTRICAL SERVICES INC Phone: (786)273 -1270 Building Department Comments ELECTRICAL WORK FOR KITCHEN AND BATHROOM REMODEL Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. P/(7.- April 26, 2010 For Inspections please call: (305)762 -4949 Page 22 of 29 1 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 05/23/2010 Applicant Owner Information Address Phone CeII ESTHER PHILISTIN 12650 INGENUTIY Drive ORLANDO FL 32826- Contractor(s) Phone CeII Phone MICHAUD ELECTRICAL SERVICES IN (786)273 -1270 Valuation: Total Sq Feet: $ 1,000.00 120 Type of Work: ELECTRICAL Additional Info: KITCHEN & BATHROOM REMODEL Classification: Residential Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $0.60 $0.20 $5.00 3180.00 $3.00 $50.00 ($50.00) $0.80 $189.60 Invoice # Total Amt Paid Amt Due EL -11 -09 -36291 $ 189.60 $ 139.60 $ 0 EL -11 -09 -36291 $ 189.60 $ 189.60 $ 0.00 For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 01, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 01, 2009 1 NP? p C 540Miami Shores Village Building Department 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. Master Permit No. N , •02 200q Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) �64- (' he 1 cs ,9 Phone # 7 r6 54-7 " S7 a Owner's Address City �.QCQ v. _ � t t C� State Zip 3 3) 5-0 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) l 14 au) City Miami Shores Village County Miami -Dade Zip 53 % 50 FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name `�V 1 i �Vt c , L, La e [eel S r V Phone # 7a-2-73-l2 7D Contractor's Address ii2/141) 207 5$'— City Vll`Gti.eitc i.el.44.(2.1.t State FL, Zip$30CST Qualifier Name CA-15—v- c°• UV ` Z coo\ Phone # t - 73°12 A) State Certificate or Registration No. E-12 `3® / Q. 793 Certificate of Competency No. 03E0009 04 Contact Phone /Sit 273- 1'2 7 Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ❑Addition ❑Alteration Describe Work: too 0 E -mail Phone # oO Square / Linear Foota Of Work: IZ 0 ['New Repair/Replace Gooitz_ ❑ Demolition rUl * * * * ** * * * * *0 * * * * *** * * * * * * * * * * * ** *** Fees************* * * * * * * * * ** * * * * * * * * * * * * * *** * * * ** Submittal Fee $ Permit Fee $ /867, 4,e CCF $ . (Q(J CO /CC $ Notary $ 5 4 0 v Training/Education Fee $ 1 D Technology Fee $ • 8 0 Scanning $ 3 .00 Radon $ $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 139 690 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 installatidn 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 re- inspection fee will be charged. Owner or Agent Signature /i -, Contractor The fore ring ins G. , t was acknow - . ged before . e s The foregoing instrument was acknowledged before me this 2 F day of %'.,O by' _. 1Y,1 day of/1/0ipinoe.; , 2009 , by i ' '�►e� //i � ; . who is . - rsonally known to me or who has produced ,MMI, who is personally known to me or who has produced t,/ acation and who did take an oath. 43O- ?- 4I)— .jJ'12 entification and who did take an oath. NOTARY PUBLIC• NOT Sign: Print: My Commission Expires: a $1,- , o Print: C ,et% My Co $1 P APPROVED B � %�j, ,,P* Plans Examiner 2 11 JEAN 0. ACHILLt :,�•,. .pQMMISSION # DD 653671 Fr, EXPIRES: April 7, 2011 1 hrt,q;•' Bonded Thru Notary Public Underwriters Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 174 102 Street Miami Shores, FL Owner Information ESTHER PHILISTIN Expiration: 05/12/2010 1131010230100 Block: Lot: 12650 INGENUTIY Drive ORLANDO FL 32826- ESTHER PHILISTIN Phone CeII Contractor(s) Dale Plumbing Phone CeII Phone (786)663 -1804 Valuation: Total Sq Feet: Type of Work: PLUMBING Type of Piping: KITCHEN & BATHROOM REMODEL Additional Info: Bond Return : Classification: Residential Fees Due CCF Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $0.60 $0.20 $5.00 $100.00 $3.00 $50.00 ($50.00) $0.80 $109.60 Invoice # Total Amt Paid Amt Due PL -11 -09 -36290 $ 109.60 $ 59.60 PL -11 -09 -36290 $ 109.60 $ 109.60 $ 0.00 $ 1,000.00 120 For Inspections please call: (305)762.4949 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Underground Rough Heater Water Service Final Water Main Lavatory , In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all Work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 01, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 01, 2009 1 l.� @ Iii/3 Miami Shores Village Building Department 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 No. PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) e/ ? d( Phone Phone # Z r 47— 3 2j2 Owner's Address 174 Ow t®? Q - State Tenant/Lessee Name Email NOV 0 2 2009 BY: ®o ® - ®d ®e_® Zip 33 )SD Phone # Job Address (where the work is being done) 114 , V V V t O 4 City Miami Shores Village County Miami -Dade Zip 5515D FOLIO / PARCEL # Is Building Historically Designated YES NO " \ Flood Zone Contractor's Company Name 'D i k) . J- 0 (I 8 i'AJ G.. 1,4 C 54 ,J .4•7 Contractor's Address City M a I ti + SHorZL S State f'/ © Qi b A Zip 33 /50 Phone # 7g (o ‘6 /EC'G Qualifier Name M .. d av v IQ ) D,q G+lK o NS Phone # S /g04 Certificate of Competency No. C F C 4- Z O State Certificate or Registration No. Contact Phone ? 6' 6c2 E -mail Architect/Engineer's Name (if applicable) Phone # I , OM Value of Work For this Permit $ ' DO Square / Linear Footage Of Work: 12d Type of Work: ❑Addition EAlteration, New ❑ Repair/Replace 1S1 Demolition Describe Work: R EC 7-1 ( F 1 C/ /0 Al O F K i 7 C//L IZ = .4 C G A : / c kv fry;11._ �1 A ` '' ��;_ ie a Zc CALL C. ** * ** * * * * ** * * * * * * * * * ** * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * *** * * * * * * * * * * * *:** Submittal Fee $ s Permit Fee $ / r'c Notary $ . TiO Training/Education Fee $ w Scanning $� . 0 0 Radon $ Double Fee $ CCF $ 7O CO /CC $ Technology Fee $ 4475 DPBR $ Bond $ Violation date: Structural Review. $ 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 MR 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 rrinspection fee will be charged. r The for day of Owner or Agent e :. ' i trum- ft was ac • o edged before e l / #11 : 20Q9 , by ,vho is personally known to me or who has produced V (Q "0 As identification and who did take an oath NOTARY PUBLIC: 05 4PG� Is Sign: C<i �o� °o Print: ti' �o AlCwo My Commission Expires: - 1 Jr Signature a,e,..‘414;v0 Contractor The fore • . i g ' i stru nt was ackno //wled ed beefore e this I1 day of I.' i :�1 , 2009, by L. vi l �' , Vag 1105 who is personally known to me or who has produced i as identification and who did take an oath. NOTARY PUBLIC: * * ** AP it _ % o- iv' *P \'b Sign: L �. u y /1 1 Print: C' • ��tl9"tC G' o` `3c My Commission Expires: : ©��c�o. r e * * * * * * * * * * * * * *., ****** i**** 9tiC4ek *** *** * *kk****9e4ede**** *****kk * *** ***,Y*9C*****9t*** Plans Examiner Zoning Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked RC-II- 09.110: Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 CL Inspection Number: INSP- 128426 Permit Number: PL -11 -09 -1809 Scheduled Inspection Date: April 28, 2010 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: PHILISTIN, ESTHER Work Classification: Addition /Alteration Job Address: 174 NW 102 Street Miami Shores, FL Project: <NONE> Contractor: Dale Plumbing Phone Number Parcel Number 1131010230100 Phone: (786)663 -1804 Building Department Comments RECTIFICATION OF PLUMBING FOR KITCHEN AND BATHROOM REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 27, 2010 For Inspections please call: (305)762 -4949 Page 3 of 22