PL-11-848Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
l
Number: INSP - 159655 Permit Number: PL -5 -11 -848
Scheduled Inspection Date: March 23, 2012
Inspector: Hernandez, Rafael
Owner: HUBER, PATRICK & XIMENA
Job Address: 1150 NE 100 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: VAN KIRK & SONS INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Pool - Private
Phone Number
Parcel Number 1132050190420
Phone: (954)755 -4402
Building Department Comments
POOL PIPING FOR NEW POOL INSTALLATION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
March 22, 2012
For Inspections please call: (305)762 -4949
Page 1 of 15
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Expiration: 03/14/2012
Applicant
1150 NE 100 Street
Miami Shores, FL 33138-
1132050190420
Block: Lot:
PATRICK & XIMENA HUBER
1
Owner Information
Address
Phone
Cell
PATRICK & XIMENA HUBER
1150 NE 100 Street
MIAMI SHORES FL 33138-
Contractor(s)
VAN KIRK & SONS INC
Phone Cell Phone
(954)755 -4402 (786)326 -2747
Valuation:
Total Sq Feet:
$ 700.00
422
1
Type of Work: PLUMBING
Type of Piping: POOL
Additional Info:
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.80
$3.37
$3.37
$0.20
$225.00
$3.00
$0.80
$236.34
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL -5 -11 -40906
05/11/2011 Check #: 36055 $ 50.00 $ 186.34
09/16/2011 Check #: 36382 $ 186.34 $ 0.00
Available Inspections:
Inspection Type:
Main Drain
Final
Rough
I
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
September 16, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
September 16, 2011 1
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
MAY
BY:
BUILDING Permit No. l ____ 64-6
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): ? arr L , Phone #:
Address: 1 - 10 0 d •
City: Y\ d State: Zip: •33 f
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: ! 1 - 1 ® %-r •
City: Miami Shores County: Miami Dade Zip: 3Z. 13
Folio/Parcel #: 1 l S 0 1 ® 0 4-
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: \f a Lk . �o Phone#: 50-e - se - 4 -4-('Z.
Address: Z 1(44 ` f f .
City: -°GLA State: • Zip: '3'%
Qualifier Name: t. P. . Phone#: RS-4' °`ASS -
State Certification or Registration #: S' 5C. Certificate of Competency #:
Contact Phone#: s i S ° ,,,vo Email Address: C, 4.y-0 1,4, ('Jc.P c1 ' c r
DESIGNER: Architect/Engineer: , '°X - atiAdig ,1 $ `a' Phon r ® S-47
if 'ao. e ®r
Value o f Work f o r this Permit: $ t Square/Linear Footage of Work:
Type of Work: DAddress UAlteration UNew DRepair/Replace DDemolition
Description of Work:
************** ********+x********** ******F + x*+ xa+**** +x+x*•xm*******:x ***** ** * * ***** ** ***. * **
Submittal Fee $ Permit Fee $ 22 J CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ ) YD' *5+
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 FT FCTRICAL 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.
Signature
Agent
The foregoin instrument was ac wledged before m this
% Z t ,
day of `-' ,20 It, by 1 dit 661t 1,
who is personalA,In to me or who has produced
As identification and who did take an oath.
My Commission
Contra or
The fo going instrument was ackn edged befog met this 3_
day of
or who has produced
as identification and who did take an oath.
NOTARY ' UBLIC:
,s
A. /j /. 6V A'' A 4,41 Sri !::
Sign:
9�,,,��.,•., atr. la
Prin +;: Commission #M B45967
, Expires: FEB. 02, 2013
My Commission Exp D� TRaU ogo1 RiG=At&
* * ********* * ** * *** ********* *****+x *+ *** *********** * * * ** * * *** *** **+ x****** ****+ u**+x***** ******* *** * *** * * * *x * **
APPROVED BY
(� Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Zoning
Clerk