MC-11-850Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 159662
Permit Number: MC -5 -11 -850
Scheduled Inspection Date: March 26, 2012
Inspector: Perez, JanPierre
Owner: HUBER, PATRICK & XIMENA
Job Address: 1150 NE 100 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: VAN KIRK & SONS INC
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: Pool Heater
Phone Number
Parcel Number 1132050190420
Phone: (954)755 -4402
Building Department Comments
POOL HEATER INSTALLATION
(?\-/ (///,
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
March 23, 2012
For Inspections please call: (305)762 -4949
Page 7 of 37
Miami Shores Village
Building Department L MAY ) . 011
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: MECHANICAL
OWNER: Name (Fee Simple Titleholder): 'V L i t-L Phone#:
Address: t L 1) ® z-r
City: r \t A.rs State:
Tenant/Lessee Name: Phone #:
Email:
Zip: 1'
JOB ADDRESS: Ill ". u o D S
City: Miami Shores County: Miami Dade Zip: -/Z 1 "I E
Folio/Parcel #: 1 l 4 0 '
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: Ntr 4-ft-1 4 �` %,m)sji Phone #: Sof ° —7S6 O
Address: =+ 04 `-Q l a:6t°' d L
City: 6:14-aCtr,-1. State: Zip: 334 2-.
Qualifier Name: fo,S1 ' T ? • �e ° L Phone #:4:13' 5.$ '4,4 0
State Certification or Registration #: Pee. ®4, 51 S Certificate of Competency #:
ct
Contact Phone #: -7 ®s -Email Address:
DESIGNER: Atekiteet/Engineer: . tsa il C�, - 1 ?- Phone #:•95•H= q S l
Value of Work for this Permit: $ . p 0 0 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration
41New ❑Repair/Replace
❑Demolition
Description of Work:
** ** * ** * *** * * ** **** * ** ** **** ***** * * r ; - s'*** ********** ******* * * ** ******* * * ****** ***
Submittal Fee $ Permit Fee $ ' 01 CF $ 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) /0 1 A-
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 properly 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 an a reinspection fee will be charged.
Signature
0
ent
The foregoing instrument w/as a owledged before me
day of ��,20 if (,byy AV-(14., 6
who is per I1 known to me or who has produced
As identification and who did take an oath.
My Commission Expires:
Contrac
The . rep ing instrument was ackn
day o /���� 011_, by
who
ersonally
known to me or who has produced
as identification and who did take an oath.
NOT ' UBLIC:
Sign,.
...,.,.•• Expires: FEB. 02, 2013
My Commission ExpirroNVxa umarrrtcaonnvaco,arc,
* * * * * * * * * * * * * * * * * * * * ** . * * *: * * * * ** ; * ** ;: *************** ***, x+ x****** * **+x+x:x*************** :**** **x *** *********
APPROVED BY
Plans Examiner Zoning
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Clerk