PLC-11-967Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 173866 Permit Number: PLC -5 -11 -967
Scheduled Inspection Date: May 23, 2012
Inspector: Hernandez, Rafael
Owner: , BARRY UNIVERSITY
Job Address: 11300 NE 2 Avenue NEW DORM
Miami Shores, FL 33138 -0000
Project: BARRY UNIVERSITY
Contractor: RIGHT WAY PLUMBING CO INC
Permit Type: Plumbing - Commercial
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360010160 -37
Phone: (954)423 -0000
Building Department Comments
SITE PLUMBING
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 160297. not ready
/(SST,L,<.
May 22, 2012
For Inspections please call: (305)762 -4949
Page 19 of 23
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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder):
Address: (,
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(30D o'e_ 7,`p'� k951
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City: 1° \1 /.;.k si0 '8 ; c-&-i) State: F L- Zip:
Tenant/Lessee Name: ,'-Y° I, Phone #:
B6_-1-1
Permit No. F'Lc.- 1 1
P
Master Permit No. [R —
Ark .\ \ <•;`.A-‘
Phone #:
Email: e o d 'ss4s��'�'
JOB ADDRESS: WE__ kAe.
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City: Miami Shores County: Miami Dade Zip: FIB
Folio/Parcel #: it - ;oi J,k4, 000 0 0 40
Is the Building Historically Designated: Yes NO 1 Flood Zone:
CONTRACTOR: Company Name: kie \Aw
Address:�,�
City: 11-4. State:
Qualifier Name: crnl ( R
Certification or Registration #:
Phone #: ( 4i\ l+k, °'C t c
Contact Phone #: - H -3 ° °me, Email Address:
DESIGNER: Architect/Engineer:
zip : 333
Phone #: ?PI -144 3 --co oc,
Certificate of Competency #: CFF b L 1 )
ricpptrtoi.,rp.h;'J
Phone #:
Value of Work for this Permit: $ 5-00- 0 to Square/Linear Footage of Work:
Type of Work: ❑Address CIA Iteration New URepair/Replace UDemolition
Description of Work: `kN-e
************************ ******+ x**** **** Fees*** ******+ x******** *********** * *** *** ***x:****
Submittal Fee $ Permit Fee $
Scanning Fee $ ( Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /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 FT.RCTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AII'IIAVIT: 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be app and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 02$
day of% ,2011_,by P, '3 � '" 5 ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* * * * * * * ***** ** **** *:Tara &*
APPROVED BY
4 Ric Notary Public State of Florida
S Cheryl Beide Gerber
gr My Commies on DD968128
'ken, or Expires 05/08/2014
Contractor
The foregoing instrument was acknowledged before me this c2 S
day of , 20 ...IL_, by 7/ ®? / C.
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissi
phi 0.: MY COMMISSION # DD736991
• os° EXPIRES January 06, 2012
39 8-0153 FlorideNotaryServioe.com
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