PL-12-276r
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 170075 Permit Number: PL -2 -12 -276
Scheduled Inspection Date: March 09, 2012
Inspector: Hernandez, Rafael
Owner: GOLDBERG, ADRIENNE
Job Address: 9901 NE 13 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: SUBURBAN PROPANE
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Gas
Phone Number
Parcel Number 1132050090480
Phone: 305 -891 -8393
Building Department Comments
INSTALL GAS LINES AND TANK TO RANGE (BY OTHERS;
Passed
X
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
March 08, 2012
For Inspections please call: (305)762 -4949
Page 17 of 31
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
BUILDIN G Permit No. 2..21 19
PE ' ! PLICATION Master Permit No.
FBC
Per PLUMBING
Owner's Name (Fee Simple Titleholder) Phone #
Owner's Address 910/ ✓ /3-1-1'141/e
City hate Zip
Tenant/Lessee Name N 4
Email
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Phone #
99o1 ikiz_
County Miami -Dade Zip 9
Is Building Historically Designated YES NO Flood Zone
Contractor's Company Name Se4, G -46ev.41 e.-eve
i
Contractor's Address /t/ atJ,� /J ,7 (
Phone # gc'r- - / — ,7 y
City S to ,q Zip 3f //s
Qualifier Name r!/er.y Phone #
State Certificate or Registration No. 1/®G ®O //' C Certificate of Competency No.
Contact Phone far: Frfr" P-4.? !�5 E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $
S ware / Linear Footage Of Work:
S
Type of Work: ❑Addition ❑Alteration ❑ Repair/Replace / ❑ Demolition
Describe Work: a fi .6,� 6,44/17 �G,®✓� , ® ,CA," e (4' 'r)
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *** Fees * * * * * *** * * * * * * * * * * * * * ** * * * * *** * * * * * *** * * * **
Permit Fee $ Ai?) CCF $ CO /CC $
Submittal Fee $
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ 10(71•10
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 occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appro d and a reinspection fee will be charged.
Signature
er or Agent
Signature
Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 15
day of , 20 , by , day of Teb , 20 la; by
who is personally known to me or who has produced who is personally known to or who has produced
As identification and who did take an oath. as id- tification and who did t
NOTARY PUBLIC:
Sign:
Print:
C:
My Commission Exp
APPROVED BY
RI A OROPPER
5 MY COMMISSION # EE032278
o' EXPIRES October 05, 2014
......... FlorldallotarySereice.com
Plans Examiner
(Revised 07 /10 /07)(Revised 06/10/2009)
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Suburban Propane
1491 N. E. 130th Street
N. Miami, : L 3161
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BC Archltects AIA, Inc.
4942 LaJeune Road Su4B 288
Caret Gables, FL 33146
Teo 388.863.8182 Fax 388.883.6862
tam Lhense Number M11103380
m ONIECTarvs
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GROPPER
RESIDENCE
Interior Alterations
9901 NE 13th Ave
Miami Shores, Florida
33138
Dining Room
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Adam and Kari
Gropper
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Bedroom 2
Garage
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1491 N. L. 130th Street
N. Miin;i,` FL 3161
3Qa -3
ISSUERECCRO
ISSUED FOR MAT
BCA Comm. Num.
Scale:
Drawn:
Checked:
SHEET TITLE
0.81.011
Ground Floor Plans
Qualifier
Job Address q!o / NA' /34-
osed Ground Floor
(Longest Run? -ee
Total BTU's .7.3.oui)
PERMIT SET 09 -01 -2011
TO THE BEST CF RI8 AROHDECrT KNOWLEDGE THESE
PSIS COMPLY V.TTH tHH MINYSM STANDARDS OF THe
APPLCAe L8 81111.0NG 00088 RID UFO SAFETY STANOAROS
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93.494
BRICK 20' PARKWAY
MU*.
;;%Td;•,,'
N.E. 13th AVENUE,
4
rope ress:
9901 N.E. 13 AVENUE
MIAMI SHORES, FL 33138
Notes:
SEAWALL AND WOOD DOCK ENCROACH ALONG
REAR LOT LINE. BRICK PARKWAY ENCROACH
ALONG FRONT LOT LINE.
SURYSTOR'S CSRITTICATION • 1 KSSEST CERTIFY T14AT'TtS3 SOLNEOARY SURVEr IS A TRUE AND •
CORRECT REPRESENTATION CP A SURVEY PREPARED LINDER MY ClintOtialt IOUS COMPLIES MTH
THE LEW ORM TECN1NCAL 8TAUDAND A BET PORN SY TIE STATE Of FUSRU1A &ARO OP
PROFEEISIMAL LAUD ANR 101743 FLORSIA ASIARESTRATIVE CODE PURSUANT
TO 473 027, FLORIDA ST -
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MAP a lar MLIC,IIMI13411' 1AAN&ATUI1iAYL3 ¶HL LAIIGII,M1IAMMI, I5 Ct &IJCCYCW 8.14,2
Survey: A-22094
MIGUEL ESPINOSA LAND SURVEYING, INC.
10865 SW 190TH STREET
SUITE 3110
MIAMI, FL 33157
PHONE: (305) 740-3319
FAX: (305) 669-3190
LB*: 6463
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