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PL-12-611q Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ■ Li 20 Inspection Number: INSP - 172110 Scheduled Inspection Date: August 28, 2012 Inspector: Hernandez, Rafael Owner: THOMAS, MARIE Permit Number: PL -4 -12 -611 Job Address: 470 NE 103 Street Miami Shores, FL 33138 -2457 Project: <NONE> Contractor: Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060170720 Building Department Comments KITCHEN AND 2 BATHROOM REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 27, 2012 For Inspections please call: (305)762 -4949 Page 4 of 17 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): `7 ®i f Phone#: Address: y 7 b / , / b,s — City: i4 . J4 o ►—ei State: l( Zip: 3 /3 �G /d Tenant/Lessee Name: Phone#: Permit No. l—'; r G l •2 Master Permit No. p� C / - Email: JOB ADDRESS: City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes `17d /03�1 County: Miami Dade Zip: Flood Zone: CONTRACTOR: Company Name: VA) E- Phone#: 9& —5go 5‘93 Address: Si/7/ /lid 24/1 e„.-/- City: .504 f/ sf State: Zip: 2332:2— Qualifier Name: /V r ch € /. 'A/6 R.dN € Phone#: 9S-W-1/46..20 S6 73 State Certification or Registration #: eFe. -0"/.1•78'7 Certificate of Competency #: Contact Phone#: 2541 O 5‘q..5 Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 5/ ) Square/Linear Footage of Work: 9Z0 Type of Work: ClAddress OAlteration Description of Work: UNew DRepair/R O lace Demolition `b, -74-j ( X 1 brci-t « * * * * * ** ** * * * * * * * * * * ** * * ** ** ** * ** *Fees * * * *. ''� ***** * * * * *** ** * *s ** * *r * * * * **** * * **** Submittal Fee $ / /�� 2Permit Fee $ 2 9-5"; -5• © CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ :9'\ 14 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 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. Signature .A_ del e l er o,/Agent The foreg ing instrument was acknowledged before me this day of . , 20. ?, by V140".4 4 uowrt'.0 who is perjonally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission xpires: * * * * * * * * * * * * * * * * * * * * * * ** F re ERIK ROSARIO Notary public, State of Florida . $0 6i SD8 *ilE ** comri. expires Dec. 21, 2012 APPROVED BY I Plans •1 Signature /7` `'4 'r Contractor The foregoin instrument was acknowled ed before me thi day of `L , 20 /Z by " maim e- do who is personally kwn to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission �y�v'G I MARCIA WEST :.= MY COMMISSION # DD 830879 . EXPIRES: November29, 2012 IF Bonded Thru Notary Public Underwriters gor * * * ** * * * * * * * * * * * ** ".sa.paa ,ten .mom.» 11,c Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3 /15/09) -- PERMIT #: 12coo I, Contractor o Owner o Architect Picked up se other Address: Miami Shores Viiiage Building Department RECEIPT DATE: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1) snict-71 I�t hale,00142/r From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Buildin • • - •artment to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: