PL-11-1182Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
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Inspection Number: INSP- 161503 Permit Number: PL -6 -11 -1182
Scheduled Inspection Date: March 09, 2012
Inspector: Hernandez, Rafael
Owner: BORUCHOW, IRWIN
Job Address: 950 NE 95 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: NELMAR PLUMBING INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132050070120
Phone: (305) 261 -3942
Building Department Comments
PLUMBING FOR INTERIOR REMODEL
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
March 08, 2012
For Inspections please call: (305)762 -4949
Page 2of31
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33 t 38
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit No. P1--- 11- 1182-
Master Permit No. RC-- 1\ — 111.103
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder) qe()--k Phone #
Owner's MI � Ng 7c-
M
City t l 5 K State rzj zip -33i3&
Tenant/Lessee Name I v 6 Phone #
E -MAIL:
Job Address (where the work is being done) Si't' A---
City Miami Shores Village County Miami-Dade
FOLIO / PARCEL # 11.` ' c O' ®I`Z -O
Is Building Historically Designated YES NO
Contractor's Company Name — _ 67-C, 04 AR
Contractor's Address L 93-1( ?,.(.2
City_ I' 4 1i 1 1° State , � Zip 33/ $ r
Qualifier Name _ Lv (5 f- A., oo. I 2 Phone # 3 O = -z l-- 3 f c.nz
State Certificate or Registration No, R, F m 0 3 S".119 (p Certificate of Competency No.- /.906/ #6.7 4,
E- MAIL:
Zip 33( ICJ
Phone #
3or.- Q- -6/--3 4t2.
Architect/Engineer's Name (if applicable)
Phone #
Value of Work For this Permit $
Square / Linear Footage Of Work: 3 S'0
Type of Work: ❑Addition [Iteratign ❑New
❑ Repair /Replace ❑Demolition
Describe Work:' i (V0?)/ /06- �-
arePto,e_ oDE
******** *** * * * ** * * * * * * * * * * * * * * ** * * * * * ** Fees****** ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ 50.00 Permit Fee $
D
Notary $ Training /Education Fee $
Scanning $ Radon $
DPBR $
CCF$
COICC
Technology Fee $.
Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ 4 )J
See Reverse side -->
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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. l 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is iss.. In the absence of such posted notice, the
inspection will not be approved j, d a reinspection fee will be charged
Signature
r or Agent
The foregoing ins ment was acknowledged before me this
day of , 20 , by
who is personally known to me or who has produced
As identificatiop and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissioli
Signature
Contractor
The foregoing instrument was acknowledged before me this 2
day of St/t -' , 20 G (, by 1.._.v I3 f gook 5e-c2-
who is personally known to me or who has produced
as identification and who did take an oath.
*****xxxu'xu$x
145 DOW05145664.56
eSct, gibti , )1.v
ygtn 32 h W
APPLICATION APPROVED BY:
(Revised 02 /08/06)
R,
Plans Examiner
Engineer
Zoning