PL-12-549■
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 171733 Permit Number: PL -3 -12 -549
Scheduled Inspection Date: April 11, 2012
Inspector: Hernandez, Rafael
Owner: LEGO, JAMES REGIS
Job Address: 163 NW 100 Street
Miami Shores, FL
Project: <NONE>
Contractor: PSG PLUMBING SERVICES, INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1131010230310
Phone: (305)796 -7304
Building Department Comments
REPLACE HOT WATER HEATER TANKLESS IN GARAGE.
Passed
.:1
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
April 10, 2012
For Inspections please call: (305)762 -4949
Page 17 of 25
BUILDING
PERM
FBC 2
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
RECEIVED
MAR 302012
i_= I .
Permit No.
CATION Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): / G� Phone #:
Address: �/ &3 A) A) 4 00 .� tree f
City: �1 / 4 i t �o � State: F
Tenant/Lessee Name: Phone #:
Email:
St-I9
Zip: 3 3 /
JOB ADDRESS: /lO 3 / O O s tie e
City: Miami Shores
County: Miami Dade
Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: p S Cam. )9/. M L g n Phone #7 //4~ to 11" S.-
Address: 3 g °J 2 iv e4..) .N1
City: JAI /1/i- State:
Qualifier Name: , Ird b Sc c,`O 4-7.,.., ,...-, A.
State Certification or Registration #: Certificate of Competency #:
Pr
Phone #:
Contact Phone #:
Zip: 33os"'y
rt pc. 6-252
Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 6 00 Square/Linear Foota a of Work:
Type of Work: ❑Address ❑Alteration UNew epair/Replace _ / ❑Demolition
Description pf Work: Ty (i4e.l 0 � /� 7(e e e (7. v. l <'/e
• 64Q4 <-Q
****** * * *** **+x***+x******** *** ** :***** ** Fees * * ** x**** ****** ***** * ***** ****** **** * * * * ****
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
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, BOIl.FRS, 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.
e
Owner or Agent
The foregoing instrument was acknowledged before nie this .2 2-
day of n?. -veJ. , 20 t2.., by
who is personally known to me or w has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission E
ti mot y
i g, %, 4�- Expires 07113/2018
Signature
ntractor
The foregoing instrument was acknowledged be
day of fr.►81 ,20 by / i
who is personally known to me or wh,dfas produced
L. L as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Co
m �` My Commission EE1121
u02
Sfij 11F 1I pipes 07/13/2016
,•,
**** *** * * * * * *** * *** **** * *** r************************************************* **** *** * ******* ************ * * **
APPROVED BY 3 °3° `/°L Plans Examiner Zoning
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Structural Review
Clerk