PL-11-339Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
1
Inspection Number: INSP - 156497 Permit Number: PL -2 -11 -339
Scheduled Inspection Date: February 24, 2012
Inspector: Hernandez, Rafael
Owner: PORTNER, TINA
Job Address: 870 NE 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: NELSON G CLIVE PLUMBING INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060050140
Phone: (954)801 -6038
Building Department Comments
PLUMBING WORK FOR ADDITION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
vy,
February 23, 2012
For Inspections please call: (305)762 -4949
Page 2 of 12
Miami Shores Village
-
Building Department FE
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tek (305) 7952204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
P e r m i t N o . �I l C2) 9
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): .7 1 6 a 'Fort he C Phone#: 3 ®5 g®1' I O Lf
Address: *870 .i E 19, 5
city: iVt 4 6144: 5 I4 (e5 State: i— ( zip:. 5 3 t 32
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 7 0 V E ol S T
City: ll+iiaini Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically : Yes NO X Flood Zone:
CONTRACTOR: Company Name: C4 -2.71/ '44 pA, phone#: y-} 11} — "i.5/
Address: /0-2/45' Cd -
City: /v n4
State: ,-�eA•4
T.tp: 3.5
Qualifier Name: Phone#:
State Certification or Registration #: P2 05Voii Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 1 i O ° v co Square/Linear Footage of Work:
A
tifsiew DRepaidReplace ODeniol'ition
r did
Submittal Fee 4 Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Trandng/Education Fee $
Double Fee $ Structural Review $
ccF $ c0/cc $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
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 FI.F.CTRICAL 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.
er or en
The foregoing instrument was acknowledged before me this i 7
day of 3.14 ev.m 20 //, by 7 G e
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUB : d C:
Sign:
Print:
My Commission Expires:
Contractor
The foregoing instrument was acknowledged before me this 11
day of 20 IL, by
who is personally known to me or who has produced rL bt.
identification and who did take an oath.
TARY PUBLIC:
APPROVED BY
**************** a******* e*********** * * * * * * *** * * * * *e * * * * * * * * * * * * * * ** *axe * **
/� Plans Examiner Zoning
Structural Review
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk