PW-11-1798Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 164988
Scheduled Inspection Date: November 18, 2011
Inspector: Hernandez, Rafael
Owner: SHORES VILLAGE, MIAMI
Job Address: 1485 NE 101 Street
Miami Shores, FL 33138 -0000
Permit Number: PW -9 -11 -1798
Project: <NONE>
Contractor: LASSETER PLUMBING CO INC
Permit Type: Public Works
Inspection Type: Final
Work Classification: Public Works
Phone Number 305/751 -1271
Parcel Number PUBLIC WORKS
Phone: (305)525 -5075
Building Department Comments
INSTALL 3/4' PRESSURE VACUME BREAKER ON
SPRINKLER SYSTEM
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 2 of 7
NOV-15-2011 14:43 FROM:
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1001 N.W. 116 STREET, MIAMI, PL, 33100.2200
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www.mlamidade.goviwasdlbarldIoimasp
in BUILDING
PERMIT APPLICATION
FBC 20
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
Permit No.RN!
n9'.3
L SEP 2 9 2011 j
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleho • er):
Address: =, • 17i City: I1
Master Permit No.
Phone #:
State: Zip:
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: / / O® / r'
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: 4.4-1-(45-7- ��� ��' hone #: ,�G►�'� `� '7�e
Address: 4 f / / 1 3 . )
City: // . " 044 ' State: fG , Zip: 33/6 i
Qualifier Name: Ae 4' 4,4- ,�5/1� 7—E/l Phone #: e- S''SeR 7S
State Certification or Registration # :4., /G e" t'a t9' 6 Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $
quare/Linear Footage of Work:
Type f Work ❑Address DAlteration New CIRepair/Repipce ODemolition
Description of Work: lfi -? 4t G 641 gS e.. ACc.,vv . {�(2. ,
fir+
*****************A0:4***** *************Fees************** **4**************************
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
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 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 for »_'uing1 nstrume t was acknowledge. ' fore e this The for
day of , , 20 ` , by ron ��. , day of
who is personally known to me or who has produced j ho is
As i entification and who did take an oath.
Contractor
strument was ackn
,20 11 , by
o me or who has produced
NOTA Y PUBLIC:
Sign: i_�_ /i
Print:
My Commission Expires:
fication and who did take an oath.
LIC:
Sign:
Print:
My Co
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C O\F state oti Flor
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�sMy �°mm,ss‘on # EE N 01 4SSn
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�S�y�na-
\ Bond
* * * * * * * * ** * * * *** * ** * *** ** **
APPROVED BY
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk