PL-11-1375Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
nspection Number: INSP- 162629
Permit Number: PL -7 -11 -1375 I
Inspection Date: August 01, 2011
Inspector: Hernandez, Rafael
Owner: LANG, ROSLIND
Job Address: 889 NE 97 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: CASTELLON PLUMBING CORP
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060142650
Phone: 305 -553 -1490
Building Deaartment Comments
CAP ABANDONED GASLINE CAPT HOT & COLD WATER
TO LAUNDRY SINK
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
August 01, 2011
Page 1 of 1
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 APPLICATION
FBC 20
RECEIVED
JUL 2.9 2011
13t:
Permit No. RI
Master Permit No.
Permit Type: PLUMBING
OWNER: Name p Titleholder): 1�
(Fee Simple Titleholder : ' � J �� ®� ,, S I,N q., Phone #:
Address: CI 7 ,5-7
City: i"--k (kr■1 State: Zip: 33 ( & '
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: o GI
City: Miami Shores
Folio/Parcel #:
County: Miami Dade
Is the Building Historically Designated: Yes
Zip:
CONTRACTOR: Company Name: d _C 74, // P/j
Address: q ' `cir, / /..3t) /..3t) <' °
/ Zip: r2 2j
City: % i � /�� � �� ;, � -�� � State: ��// f ®�
,4/A.��� .'A'' �f 1'V Phone #-fere')2 f(9
State Certification or Registration #: CA— 0 JrA 'e9 Certificate of Competency #:
Contact Phone #: /mss ;, A 4, Email Address:
DESIGNER: Architect/Engineer: Phone #:
Flood Zone:
Phone #: ((7.Pk ) 2 °- / 9"S"
Qualifier Name:
®4,
Value of Work for this Permit: $ r�
Type of Work: ❑Address ❑Alteration
Square/Linear Footage of Work:
❑New ❑Repair/Replace
Description of Work: ..a p`� 010
Irll /emolition
**** *****s:+ x**** a:* *+ x********************Fees ** ********* *** ****** **************w ** * ****
X
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ k DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ \ C
Bonding Company's Name (if applicable) i■
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 Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of , 20 _, by day of y ,
who is personally known to me or who has produced who is personally known to me or who has produced r`° t ID
NOTARY PUBLIC: As identification and who did take an oath. as identification and wh o did take an oath.
(xi lenis s4
....--4 Exp',••.�i�-
Sign. Sign: � . _ ��'
Print: Print: --f r" Cnl l`,0 1�
My Commission Expires: My Commission Expires: '�... ,A, f/0 ' '4'./y
F ,\-
'�n,,, , O RID�R�0\
Contractor
The fore oing instrument was acknowledged before me this"
201 b (00) jZA2
NOTARY PUBLIC:
a�+ x* �xa��x�xa��x�xa��xx��x *a�+�+xa:a��x+u�uw�xx�x� *** six *�xx�x+�xx�m�x�x�xa *** * *** ** pus= *+x+u�x�a�x�xx��x+x�aa�+ +��n********�xa��: *a�� *** *�x�u�x**4WWa4*******
APPROVED BY _ — a ?- 2-5 -I/ Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)