PL-11-1251Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
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Inspection Number: INSP - 161943
Permit Number: PL -7 -11 -1251
Scheduled Inspection Date: January 18, 2012 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: DAILEY, RICHARD Work Classification: Addition /Alteration
Job Address: 10402 NE 2 Avenue
Miami Shores, FL 33138-
Project <NONE>
Contractor: OWNER
Phone Number (786)395 -3369
Parcel Number 1121360130650
Building Department Comments
Plumbing for Kitchen and Bath Renovation
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
January 17, 2012
For Inspections please call: (305)762 -4949
Page 8 of 49
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 A-II-his/ Permit No.
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Owner's Name (Fee Simple Titleholder) re /fr 4&2VJ
Owner's Address l ® ¥G /VC-- 2 ✓2c1 i2 -Q '
City r/! / 5fria State rf
Tenant/Lessee Name
Email
Phone #
2V6-3Fr- 3367'
Zip 3 3 / 3
Phone #
Job Address (where the work is being done) / eqe? °Z ye' 2 4 c1
City Miami Shores Village County Miami -Dade Zip 3 13 if-
FOLIO / PARCEL # 1 1 - / 7 3 ' "
Is Building Historically Designated YES NO Flood Zone
Contractor's Company Name G?-/ Ate OL
Contractor' s Address
City State
Qualifier Name
State Certificate or Registration No.
Contact Phone
Phone #
Zip
Phone #
E -mail
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $
Type of Work: DAddition
5-0 6 I
° Square / Linear Footage Of Work:
DAlteration :New ❑ Repair/Replace El Demolition
Describe Work: 009 e ®V ice-7 / / L 3 5/4, , PC- 050--re=
40eira. /3e 6.) 02-9-(,)(-- berto _groe,46e-- 405-ef-
T F"--01,1"- .4/3vrl /rV C12-41-4A— 5 /4Ce S-c) ¥
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees* * * * * * ** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Fee $ r5C 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 $
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 approved and a reinspection fee will be charged.
Q,'---/A
Owner or Agent — Contractor
The fo, g•. g instrument was acknowledged before me this, sue. The foregoing instrument was acknowledged before me this
1
day o A , 20 1 I , by , day of , 20 _, by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
Signature
NOT ' PUBLIC:
Sign: if %'� ,F J.. _ �_. "k-,/ �b
Print:
My Commission Expires:
4
AN
ee•,g
Q C
APPROVED BY � 13
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner Zoning
Engineer Clerk checked
(Revised 07/10/07) (Revised 06/10/2009)