PL-12-220Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 169756 Permit Number: PL -2 -12 -220
Scheduled Inspection Date: March 23, 2012
Inspector: Hernandez, Rafael
Owner: SCROGGINS, MATHEW
Job Address: 445 NE 93 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MARS POOLS
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Pool - Private
Phone Number (305)757 -2147
Parcel Number 1132060140390
Phone: (954)214 -2844
Building Department Comments
PLUMBING, POOL MAIN DRAIN, POOL SKIMMER AND
POOL PIPING.
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 4 of 15
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder)
Owner's ddress
City
Tenant/Lessee Name
E -MAIL:
BY:
CEIbED
FEB 07 2012
Permit No. ?L1
Master Permit No. B'1't' s S
Phone # q� 6 (- 9iwV
Zip
Phone #
Job Address (where the work is being done) !�5-- /lc
City Mi • Sh res Vill a County Miami -Dade Zip 9� 7
FOLIO / PARCEL # 1)- 0 k 0 I Li–
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
ly)ar5 I2iI6 Vic,
0 i 36-
State Certificate or Regis
1%
E -MAIL:
State A
do i No C /754 4.
Phone # g4
Zip a51
Phone # 2'Sy8 /V— gict
Certificate of Competency No.
Architect/Engineer's ame (if applicable) Phone #
Value of Work For this Permit S( t 00
Type of Work: ❑
Descri g. ork:
Won h
Square / Linear Footage Of Work:
tio��//nom� S% New
Repair/Replace
AeMA Pg
ition
***** *+toad *a *fie * *****ie*+ rat **i**,rir**&rt*****F ********* ********* ifY*** *,r**,►i***i*@,tfY**** * **
Submittal Fee $ Permit Fee $ 22 S
Notary $
Scanning $ Radon $
Training/Education Fee $
DPBR $
CCF $ CO /CC
Technology Fee $
Zoning $
Bond $ Code Enforcement $ Double Fee $
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 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 and a reinspection fee will be charged
Signature
Owner or Ag
The forego' g • ent was ac . •w1e, _ ! before me this
day of 20Z2Z by
who is personally known to me or who has produced
As identification and who did talc an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * **
*
N. MY COMMISSION # DD961586
..,s f SIRES: April 19, 2014
1400.9•NOrARY /Pd• •..u.....
APPLICATION APPROVED BY:
(Revised 02/08/06)
Contractor
The foregoin instrument was acknowledg; s bef�rT me
day of 20%, by. ,t ,f,, l�wg17f
who is personally known to me or who has produced 5963 5
4401/02- 6 as identification and who did take an oath.
NOTARY PUBLIC: .\``` o e� I
i s S��` / ///
. : 0 ,
res••./0
Sign:
Print:
My Commission Expires:
' %,'/111111 FL � �°
03/06 ' 01
ROTARY PUBLIC .
u,. om!rrssi
' DD7g on >/
�y,' 5901,. ��•
Plans Examiner
Engineer
Zoning