PL-12-1456Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
r')- f5
Inspection Number: INSP - 176715 Permit Number: PL -8 -12 -1456
Scheduled Inspection Date: September 26, 2012
Inspector: Hernandez, Rafael
Owner: DOBRIKOW, HEIKO & ELENICE
Job Address: 270 NE 100 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: CABALLEIRO'S CORP
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060134450
Phone: (305)365 -8556
Building Department Comments
RESETTING MASTER BATHROOM TOILET, NEW
SHOWER PAN, RESETTING BATH SINK AND ADDING A
SECOND SINK TO MASTER BATH.
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
September 25, 2012
For Inspections please call: (305)762 -4949
Page 17 of 41
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
Permit Type: PLUMBING
JOB ADDRESS: ,240 NE 100' ST
City: Miami Shores County:
Folio/Parcel #: 1 - 3 20e-03-- I4 CO
-EZICgIVED
AUG 022012
FBC 2010
Permit No.
PL tl-145(o
Master Permit No. 1ZC- 2- I4
Miami Dade
Zip: ;3438
Is the Building Historically Designated: Yes Flood Zone:
OWNER: Name (Fee Simple Titleholder): 14EIK0 boBaitrow 5' EIENia A DWI' Phone#: 3� 8556'
Address: 240 NE 40014/ +
City: MI AMo 5fitiM5
Tenant/Lessee Name: .�
Email:
State: Fe--- Zip: 33 4 .
Phone#: �-
CONTRACTOR: Company Name: (AWE-LE( (O S Cog .P Phone#: 30 7 355855'
Address: ?__5 41 S (7 2 LT
City: fP-®/+/eS`>eA State: FI- Zip: 30 3 Z
Qualifier Name: T-54A C_ a4 G1.-1 (Z-O Phone#: 305 365 8556"
State Certification or Registration #: C Fe 142 V 22S Certificate of Competency #:
Contact Phone#: 3 7 65 *55i( Email Address:
DESIGNER: Architect/Engineer: N/A Phone#:
Value of Work for this Permit: $ 2/ 100 Square/Linear Footage of Work:
Type of Work: DAddress []Alteration ONew ORepair/Replace ODemolition
Description of Work: 0v4 M,+S7Q PATFI AXNAi `i�it.er wok/ 5ilauf� PAL! l /26Wflv4 x!rn4
Si vYC grin AISSIWN A 5Eea h si, vg To /141s76( 94T
Submittal Fee $ 5-1) . 00 Permit Fee $ /5?) ' CCF $ CO /CC $
9Pr1 D
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAT. FF.F. NOW IMF. S 11 12 30
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) I A
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 commence . x- %` i a construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certifie recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7 • ••- . tiding permit is issued. In the ab ce of such posted notice, the
inspection will not be a arged.
Owner o
The foregoing instrument was acknowledged before me this06
n
day of3u 20 , by fit Ylc(i 1( /kS
who is nally known to or who has produced
Identification and who did take an oath.
2
NOTAR
Sign:
Print:
MyCsits,s'o•E' -s.
*** **
APPR
.,,,!P , DOUGLAS F. HALLIDAY JR.
`"1:. '° ,� -,,. Notary Public - State of Florida
•= My Comm. Expires Jun 17, 2014
, Bonded Thro National Notary Assn.
I ,,p
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of 3v
who is : =
, 20 1?- , byc GdG4ttEt412,-1
rsonally known
o me or who has produced
as identification and who did take an oath.
NOT
Sign:
Print:
�_
Nib aoliPMPP"
My Commission Expires:
.,a a _Al, -Al,
0tt"IV��,, DOUGLAS F. HALLIDAY JR.
� � µY P V i
1P e!'�i
_� �. Notary Public - State of Florida
- �•" J 1 2014
�x�x�xx�a�s�x��xa�x�� ms��x�x�x�xa�a 3�3� k1:
•�,o„, �,oa ,, Commission # S `
�rF l �.
Bonded Through National Notary Assn.
Jea -
Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
****a< *****
Zoning
Clerk