PL-11-500Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 168681 Permit Number: PL -3 -11 -500
Scheduled Inspection Date: January 13, 2012
Inspector: Hernandez, Rafael
Owner: LONGMAN, JOHN
Job Address: 333 NE 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: SUBURBAN PROPANE
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Gas
Phone Number ()_-
Parcel Number 1132060136370
Phone: 305 - 891 -8393
Building Department Comments
INSTALLATION OF GAS LINE, TWO TANKS LP TO COOK
TOP AND FUTURE GAS GENERATOR
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- 157455. not ready
January 13, 2012
For Inspections please call: (305)762 -4949
Page 8 of 9
3Y4 tACtAkia
BUILDING
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) 00)-P-, 4 ° Ae-� Phone # 38 S° 7S-3 48 lP
Miami Shores Village 5RglEgWT
Building Department Al MAR 2 2 2011
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.
8T: 0•0•0 OOOOOOOOOOOOOOO
Owner's Address A-11- /Z 6
City /17//7 % 6i 1;e •
State
Zip Ot3 /3
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done) a 3 3 Ale- V"-Z.. 67--
City Miami Shores Village County Miami -Dade Zip ..3./ 5 S7
FOLIO / PARCEL #
Is Building Historically Designated YES
NO Flood Zone
Contractor's Company Name 6c.'60d'40dz' s004V Phone #
Contractor's Address /415/ Ai/G1 01
F-os
City )/ "//11/4/"1/ State Zip 5 .3r
Qualifier Name ‘5C1j /J4'% iairecu°,1r- Phone # 3c95
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ CI Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: i CU -1-1 rIe — 0, - 1 O h KS L- (p • - fC C k To p ,
Una pfrure Ct®,0 aenor-caTbE -
******* * ** * * * * * * * * * * * * * * * * * * ** * * * * * * ** *Fees* * ** * * * * ** **
Submittal Fee $ Permit Fee $
Notary $ Training/Education Fee $
Scanning $ Radon $ DPBR $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ 1 i
0 ' ) 0
CCF $
CO /CC $
Technology Fee $
Bond $
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 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 rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appr , and a reinspects ee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 1 5,
da , ,✓r At 20 1l , by ,%f'Gc°S A07 714
ho is personall
wn to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Signature JA t ",(,.//
Contractor
The foregoing instrument was acknowledged befoore a tthisr9
day of Lj ,4 (C _, 20 J I , by SU 1Il Ua 1 f at r{ ,
who is personally known to me or-who has produced
as identificand who did take an oa
NOTARY
Sign:
Print:
My C
* *** e******** *****: Y** ****** ***** *****************************fie***
APPROVED BY
A/�0 Plans Examiner
(Revised 07 /10 /07)(Revised 06/10/2009)
Engineer
""m , .x�res.
CARMEN MARTINEZ,...
,
. %a otary Public - State of Florida
• 4 MY Commission Expires Jun 15, 2011
'"s aaCP. Commission # DD 667494
o
Zoning
Clerk checked
CITY
COPY
at,
Miami Shores Village
APPROVED BY
ZONING DEPT
DATE
BLDG DEPT
sl113,1FC,T TO COMPLIANCE WITH ALL FEDERAL
,; 1 ATE_ AND COUNTY RULES AND REGULATIONS
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