PL-11-1769Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 164863
Permit Number: PL -9 -11 -1769
Scheduled Inspection Date: February 28, 2012
Inspector: Hernandez, Rafael
Owner:
Job Address: 10500 BISCAYNE Boulevard
Miami Shores, FL 33138-
Project <NONE>
Contractor: A CAPITAL PLUMBING LLC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Repair
Phone Number
Parcel Number 1122300010500
Phone: (786)346 -5020
Building Department Comments
REPAIR A CLEAN OUT
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
February 27, 2012
For Inspections please call: (305)762 -4949
Page 4 of 20
[I- Js.cu9."
BUILDING
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
PERMIT APPLICATION
FBC 20
REC
SEP 277 2011
BY -e c
Permit No. t 1- 11 (9
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): S' ice% 1 /7i - Phone #:
Address: `O. ,,4 41 vh,
City:'' State: 4 Zip: 93/4. ^
Tenant/Lessee Name: Phone #:
Email: ititY /ul1— t t
JOB ADDRESS:
City: Miami Shores
County: Miami Dade
Zip: 33/3k.
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
Address:
City:
NO Flood Zone:
(op/fa/ P /C% m6tr) % L/ Phone #: 7r e- 34/47f-020
5
Qualifier Name:
State Certification or Registration #:
Contact Phone #: $.4/14 t
DESIGNER: Architect/Engineer:
State: ,F Zip: 3 3 / 3 7
/, y2 a f' , f $ P q 4 Phone #: 7 Sib ° 3 6 -.5-a zo
AFC�i�-
Ili 2 - 7 9/3 Certificate of Competency #:
Email Address: 4cQp,'if" 4//I ,r)i/./ c� ✓ 2 9 el/4'443'o. ec'l-
Phone#:
Value of Work for this Permit: $ 20 4 0 0 Square/Linear Footage of Work:
Type of Work: OAddress
D scription of Work:
OAlteration
UNew Oltepair/Replace
ODemolition
******** * * * * * * * * * * * * * * * * * * * * * *** * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ + � Permit Fee $ .0(9 CCF $ CO /CC $
Scanning Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Radon Fee $ DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW D
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 approve nd a reinspection fee will be charged.
er or Agent
The foregoing instrument was acknowledged before me this /1
day of , 20 fo , by
me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Signature i7
,
Contractor A
The foregoing instrument was acknowledged before me this 2
day of , 20 GI, by7-0(--i- 1 41'26 CSC
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC: \\\`eniS S )1,�p %�,,
s•
▪ 03I 1, 2
.En
Sign:
Print:
My Commission Expires:
Commission 9
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OO�F FI.�.���•
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APPROVED BY �// �l,`r -��' Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07XRevised 06/10 /2009)(Revised 3/15/09)