PL-11-2096f
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)/95 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 166584
Scheduled Inspection Date: November 18, 2011
Inspector: Hernandez, Rafael
Owner: LORVINSKY, LUCKNER
Permit Number: PL -11 -11 -2096
Job Address: 65 NW 107 Street
Miami Shores, FL
Project: <NONE>
Contractor: THE NEW MIAMI SHORES PLUMBING
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Repair
Phone Number
Parcel Number 1121360070430
Phone: (305)751 -2446
Building Department Comments
REMOVE AND REPLACE SANITARY LINE UNDER HOUSE
40 FT.
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
November 17, 2011
For Inspections please call: (305)762 -4949
Page 6 of 7
1\-W 1°9' Miami Shores Village
Building Department
- 10050 N.E.2nd Avenue, Miami Shores, Florida 3313$
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type; PLUMBING
Master Permit No.
Owner's Name (Fee Simple Titleholder) �A'%7 N/Y�L /Li I Cie #t'J -51-1(... t�
Owner's Address 1`1 - i e 1�°} 1. 11. L
City 01 2OV60` State t Zip 8 /So /
Tenant/Lessee Name®® Z '1 £ -_e_'O ' e ,i c� Phone # C W t`a,� 3 / 3 - 4-C3 i
Email p 14 ke �1 e ,
GC Address (where the work is being done) G `� N) 1✓✓ ) 0 � 1 s i
City Mid Shores Vi laze County ,�,� Miami
- Dade„_
FOLIO / PARCEL # / 1 . ) 3 OD � — 0 L 3 0
Is Building Historically Designated YES NO .
-T a I 1S I /
Contractor's Company Name ) L l I
Contractor's address 0 0 k � ) '7
State �((
Qualifier Name 0 U I I I r7
City ) I
State Certificate or Registration
Contact Phone
Flood Zone
('off) s) ?4
Zip %
Phone #
o. . Q q a c Certificate of Competency No.
e -mail
Name (if applicable)
Phone #
Value of Work For this Permit $ 41000 Square / Linear Footage Of Work:
ddition DAlltteration ONew Repair/Replace
Type of Work:
Describe Work:
f.k
0 Demolition
Submittal Fee $" ;0! _ Permit Fee $
Notary $
Scanning $
Double Fee $ Violation date:
Structural Review. $
Ern*****************
** * * * * * * * * *** * * **
/o c T
Training/Education 'ee $
Radon
* * ***** ***** *** * * * *..
CCF $ CO/CC'$
Teebnology Fee $
DPDP $ Bond $
n+:al !we Now Due S'
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 soured for ELECTRICAL WORK, PLUMBING, SIGNS,
WET POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: 1 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 notke of commencement must be posted at theft* 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 rjnibe approved and a reinspection fee will be charged.
Signature
&kit sir.
Owner or Agent
The foregoing instrument was acknowledged before me this 10
daY of/VA ,20j,by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 14"6"44-
My Commission Expires
*****************
APPROVED BY
7
„Add-
• KENNETH 8 NO/AUK,
%4 MY commosoN0011,2,35
EXPIRES may °zoo
Convector
The foregoi instrument was acknowledged before me ibis Ls>
day of Aktar ,20JJ,by
who is personally known to me or who bas produced
Ft-
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: VIVA,"
Print
My Conuniss
Eni
***********************
ik"fiIf Plans Examiner
Engineer
(Revised 07110/07XRevised IO2e09)
1
--7113(f
KENNETH B KOTAUK
MY COMMISSION # ESOSS935
EXPIRES May 02,2015
ligantagatatialintEeleM--.
Zoning
Clerk checked