PL-10-1614Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 154074
\O-AG6C
Permit Number: PL -9 -10 -1614
Scheduled Inspection Date: December 10, 2010
Inspector: Hernandez, Rafael
Owner: HUNTER, MARK
Job Address: 1245 NE 93 Street
Miami Shores, FL
Project: <NONE>
Contractor: HABER & SONS PLUMBING INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Gas
Phone Number (917)604 -8328
Parcel Number 1132050270070
Phone: (305)461 -8653
Building Department Comments
GAS LINE FOR KITCHEN
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 151068. not ready
December 09, 2010
For Inspections please call: (305)762-4949
Page 12 of 13
URUPE:;- / PROFt2INE PO BOX i 2i99 :c ANFORD, FL 32008 305- 891 -8393
E •<<<Y TI.': Ik ON ,TURN QFf - SYSTEyM
P1 s OPEN NEW . WANING IN G QLDRE 100 GLS .. CALL FIRST AT
`W 25218 ::L.OG` 10/14 10
•CCT€*: 1 133.,3
=* Ea= =i CONNOR
NE 93 ST
T=411! SHORE. -L 33138
13:23 <5CHED> 0 / 15 / 10 13:25 Tech: 03
S #:1 DI'V:1 TY•F :1 ZONE:33138 14:54 14- Oct -10
TEL : i 3051318-6853
305 -318 -6853 j,'
* * * * * * * ** * **
SOY: 50 L TX PT:4
3 1EFA CONNOR 1845 NE 93 ST . MIAiMI SHORE 33138
pF10-1(014
DEC TV:Tiny/2h
1 3.2o10 AY
Y
SIZE
EQUIPMENT DATA
CODE
DESCRIPTION OF WORK DONE
LES
WATER
CAP
Less
WATER
GAL
#1
#3
DOT
#
ASME
GWC
DOT
#
ASMg
GWC
D07
#
ASME
GWC
r!? .,�.o ' .._ ;-r2 . �p� .� ' .
fjt- '. . 4 P `' •a.'�..•ei - ,` •<..n
,, .4t. 1 i `.s.e -✓� m r;, "" N' `i.
+ ,T, °� t. p 1
, v J �- , ' .r y r
v
2
100
42
0
0
0
357
150
❑
❑
❑
476
200
57
❑
❑
❑
714
300
85
El
❑
❑
1000
ago
120
❑
❑
❑
200V
57V
'
❑
❑
171
CODE
DESCRIPTION' r /
AMOUNT
-
420V
120V
❑
❑
❑
/7.--g,;.2 ,/ - "-'
125
250
❑
❑
❑
❑
❑
❑
325
❑
❑
❑
500
❑
❑
❑
1000
❑
❑
❑
r
OTHER
VESSEL 'pen
❑ C
DT
❑ 0
❑ T
• C
❑ T
MFG DATE
MOIYR
YR
mom
YR
MONA
YR
y
MO/YR
MO/ YR
I
MONK
RECERT DATE
dd
yX a 1 1:
❑ 1 'No Mark°
❑ 2 S
❑ 3 °E°
•
❑ 1 °No Marts
❑ 2 °S°
❑ 3 °E°
■
❑ 1 `No Mark'
❑ 2 °S°
❑ 3 °E°
•
RECERT TYPE
SCHEDULE SERVICE FOR
}
j '9 .
..
In y lime tel
° 1 .r
Total Material
TANK/CYLINDER INSTALLED DATE
Total Labor
MFG. SERIAL NO. % FULL
f' i "°'t D(
� f uS, � �n� � (� I
T/C # 1 Serial No.
Material /Labor Tax
T/C # 2 Serial No.
Gals. Propane @ I$
TANK/CYLINDER RRIGIOVED --DATE
T/C # 3 Serial No.
Sales/Locai/Muni Tax
MFG. SERIAL NO. %FULL PLEASE PAY THIS AMOUNT
CHECK HERE IF •
ADDITIONAL SHEETS
PAYMENT TYPE
CASH El
CHECK ❑
VISA ❑
M/C ❑
DISC ❑
CC Authorization #
AMEX ❑
FURNACE BOILER SPACE HEATER WATER HEATER RANGE CLOTHES DRYER FIREPLACE LOGS OTHER
MAKE /MFR
MODEL NO
SERIAL NO
SYSTEM TESTS
SINGLE STAGE INTEGRAL TWO STAGE THREE STAGE
1 Regulator Data I
LEAK TEST (3 Min.)
PRESSURE TEST (10 Min.) I
OPERATION TEST
Sing/Int/1stStage 2nd Stage 3rd Stage
Mfg.
START
FINISH
START
FINISH
EQUIP. USED (MAN HP GAUGE / OTHER
Model
.
EQUIP. USED HP GAUGE
I&WC FLOW 1 I.
■ PSI LOCKUP / � • G-
SINGLE/.
INTEGRAL
TST-STAGE
EQUIP. USED • MAN ./I. / OTHER
Date/Code
�I ^
'. TIME c.) •
-' ' TIME 1,
TIME
'
WC • PSI '`• - t
The undersigned: Knows how to turn off
the propane gas supply valve in case of
emergency. Has smelled propane and
can detect its odor. Understands the
service that has been performed. Has
read and understands the above
statements and the safety information on
the back of this form.
�' • ;'
PSI
EQUIP USED HP GAUGE
EQUIP. USED MAN / HP GAUGE / OTHER
2ND
STAGE
EQUIP. USED MAN / TB / OTHER
• WC FLOW
TIME
TIME
• PSI LOCKUP
• WC •
•
PSI
PSI
EQUIP. USED HP GAUGE
EQUIP. USED MAN / HP GAUGE / OTHER
EQUIP. USED MAN / TB / OTHER
• WC FLOW
pl
G ; Y: („).4.
iistom'er Signature Date
3RD
TIME
TIME
• PSI LOCKUP
STAGE
■ •
•
WC PSI
PSI
DISCLAIMER: The scope of Suburban's work is set forth above. It does nc4 1) include an inspection of equipment, piping, the internal workings of sealed equipment and /or
structural components for Latent, manufacturing or other detects; 2) cover items not visible and accessible to the service technician; 3) attempt to determine it any item is subject to
a rurnu r„stnmor R urthn, arknnwiwrinac taut C, ihnrhon'c wnrk ,, nnnt ha rnnatniarl to riwtani nr nrnvant t t Ira rtntenta nr haooeninna arisina from mina. use. casualty or otherwise.
- - -- ...Sekel
r , %
1 I_
Signatur Date
PLEASE SEE REVERSE SIDE FOR IMPORTANT SAFETY INFORMATION. ThOnk You!
Miami Shores Village 2 mamma
Building Department
SEA 0 9 2010
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 BY
BUILDING
PERMIT APPLICATION
FBC 20
Permit No. C- e° 1 L) - t r61
r Permit No. PL-71 0 -1 Gf S/
Permit Type: PLUMBING /,
OWNER: Name (Fee Simple Titleholder): a, r lL 1,u r FQ r Phone#: 305 —15 6 — 1164-
Address: 1?145 me 673,°d 9+'
city: Irl l arYU 3 Y w 1 S state: 1ItsY i da
Tenant/Lessee Name:
Finail:
zap: 33 i '
JOB ADDRESS: WAS E Cl31rb
city: Miami. Shores County: Miami Dade
Folio/Parcel#:
Is the Building Historically Designated: Yes NO X Flood Zone:
CONTRACTOR: Company Name A 1j1Jt S PLma..* .n)(7... Phone#: ge6. Lk 1. &Q 53
Address: LAIN ® kko '-M P e•
y:
City: t�1�►AM1. ' 1
Qualifier Name: c )ose- t°i 'r igdr..de,
State Certification or Registration #:
Contact Phone#:
DESIGNER Architect/Engine'
zip: 65156
State: F\ .
Zip: qy3 I 4'2
Phone#. SOS ► Q 3 QU
Certificate of Competency #: S C4 1 'a le. 2
.mail Address: i laie°ghobP m$auCj TA. r ud-
a 1 SON Phone#:q .566.`7Q.R$
Value of Work for this Permit: $ "lb Square/Linear Footage of Work:
Type of Work: UAdd- reessss^ $liAlteration °New Repair/Replace
Description of Work: 1 �� ( A-�l -1 -10 ('J f t-' 3 1 11 h AAS4-?I QF AT CC „
3 ►
°Demolition
******** ********* *s****** * ******** * **** Fees************ a ***************************** **
Submittal Fee $ Permit Fee $ ,i/` d CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
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
LNIPROVEMENTS 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 rochure will be delivered to the person
whose property is subject to attachment: Also, a certified copy of the recorded notice of c must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In ' absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Owner or Agent
The fo oin: instrument was acknowledged before me this 411- The foregoing instrument was ac owled = , before me this 8
uu
day of �..' 20 • by t' t4A , day ofaegiVAEIL 20 t_0_, by ar) - `
who is . nally known to I. • who has produced o is own : me or who has produced
as identification and who did take an oath.
NOTARY PUB
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
My Commission
MY COMMISSION # DD854159
EXPIRES: January 25, 2013
I-aao sawTARY FL Notary Discault Assoc. Co.
* * *** * ** #its ** *** **** ***** * *** ***
APPROVED BY
Plans Examiner Zoning
Structural Review
(Revised 07 /10107)(Revised 06/10/2009)(Revised 3/15/09)
Clerk
DEPAR719
mywrcrognmslaCENSE NER'
06/04124'10 k4O455183 `: ,_C 'CU5it65,
ehe ?LNEG ': ar.RA.OR
Tamed below 3S .EERTIEIED
rader the ;movieion of Chapter',
=xpiratioa date: kHG 31, 2012 xTy.
SEW Zia # 06040 07
1MEER, JOSE
HABER f SONS PLDMBING INC
5171- S W 5TH TERRACE
MIAMI
EL 33134
CHARLIE CR2ST
GOIIEWOR
DISPLAY AS REQUIRED SY LAW
HABER &
wc. Typ. ;of ems
SS 'SAP 4BI
wes NOT mum
=nay oft .ayes, pm
� WO LICENSE 4
BY LAW IS
SEE OTHER SIDE
DO NOT FORWARD
HABER & SONS PLUMBING INC
JOSE HABER
4106 NW 37 AVE
MIAMI FL 33142