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PL-11-1531Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 163586 Permit Number: PL -8 -11 -1531 Scheduled Inspection Date: August 24, 2011 Inspector: Hernandez, Rafael Owner: GREEN, GIL & DEANNA Job Address: 113 NE 101 Street Miami Shores, FL 33138- Project: <NONE> Contractor: THE NEW MIAMI SHORES PLUMBING Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1132060131910 Phone: (305)751 -2446 Building Department Comments REPAIR SANITARY LINE UNDER HOUSE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 23, 2011 For Inspections please call: (305)762 -4949 Page 17 of 23 g1931 I T —A 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 RECEIV AUG 19 2011 BY: Permit No. R-4 (-- � 1 Master Permit No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): a��G (�� '1 _ Phone #: Address: 115 we o l Q City: t`Ale%rri\ SInores State: 1 Zip: 33(38 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 113 rte-- 10 I 54.• City: Miami Shores Folio/Parcel #: County: 11 -3206- .013- t9llo. Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name 2 ?'Jett) M torn Sli OJZ°S ?tom U 1 Plabne #: 14u) 144 Sf Address: co O -601--7 5 I 214 City: Mkam 1 State: 17--' k Zip: 3`1 6 8 Qualifier Name: D 2 n r1 l S M el a v 1/l i 1 1'1 Phone #: State Certification or Registration #: C P C 07 a 2- 0s Certificate of Competency #: Contact Phone #: Email Address: 111 Sp/26716 l'15 e Q© 1-c4; wl DESIGNER: Architect Engineer: Phone #: Value of Work for this Permit: $ �taD Square/Linear Footagee of Work: Type of Work: ❑Address ❑Alteration ❑Newepair/Replace ❑Demolition Description o ork: ice► ITPt -Q: **** *ek+k.k A:rk **************************Fees************* . ..:Fgc .R>k *� *** �_�° %6 a<:�. = $x:kxxx:$x>;e:e- r,.�r,.:;:�>;e 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 $ / L Bonding Company's Name (if applicable ) Bonding Company's Address City 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 t,l.0 .ail the foregoing information is accurate and that all work will DC dune 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 10 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. :1 Lsn. 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. Si nature Owner or , ent The foregoing instrument was acknowledged before me this 12} i day of , 20 I( , by `�/- -a rieloi 6 kr..en • , who is ersonall known to me or who has produced y p ced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 3;n 6 etXP1RES May 02. 20;15 zi c'.�, KENNETH 8 KOTAUK. (401) 395-0153 My Commission Expires: * * * * ** * ** *** * ** * *** * *** ** *x:: *, APPROVED BY * ** (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3115/09] Contractor The foregoing instrument was acknowledged before me this l2A • day of U , 20 fj_, b■ __Ht1-42 (15 II hY1., who is personally known to me or who has produced as identification and who did take an oath. Plans Examiner Structural Review NOTAR Sign: Print: • KENNETH 8 KOTALIK 153 My Commission Expires: COMMISSION # EE089935 MRFA May 09, 9t)1R f Zoning Clerk