PL-12-899Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
12--'1 Z9
Inspection Number: INSP - 173804 Permit Number: PL -5 -12 -899
Scheduled Inspection Date: August 15, 2012
Inspector: Hernandez, Rafael
Owner: DINAR, SHOLMI & REBECCA
Job Address: 10110 NE 4 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: RAFLO GENERAL CONTRACTOR
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060135250
Phone: (305)951 -6941
Building Department Comments
REMOVE BATHROOM AND CONVERT TO STUDY AND
RELOCATE BATHROOM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
August 14, 2012
For Inspections please call: (305)762 -4949
Page 7of34
Miami Shores Village
Building I
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
MAY i $ 1012
Permit No.
Master Permit No. rae---1
"PLi Z- bpi y
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): 2e.beCCq /PIq r Phone#: 3 ®S - 710 ' 36 /
Address: 10110 N.8. qn, 4ve .
City: /-1 //9141 1 %A t) reS State: 7 'L Zip: 3 3 /38
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: / 0110 N. F • y 4 V'e
City: Miami Shores County: Miami Dade Zip: 33/68
Foliu/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: Z3Pi0 tied/ C: , rttc, 0( Phone#: 305. 95.l • (o9•1
Address: 3001 5co71 Oce4i) 7%21 U>r
City: /lO //Y tQ cj State: FL Zip: 33 01 El
Qualifier Name: '//n d l* 19ri1 S • /Me )'hone#:
Statc Certification or Registration #: G /428 q (a3 Certificate of Competency #:
Contact Phone#: 30S- 9S1• tp 9ci / Email Address: rRe/4 fittlliihVa @ C ht 1 l • GOh
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ C'` 041i:J Square/Linear Footage of Work:
Type of Work: UAddress teration UNew URepair/Replace UDemolition
Description of Work: ! `1L.7.:,lb-' �/� '
r`e>
,ter. / / .
Submittal Fee $ Permit Fee $ 2/5 CCF $ CO /CC $
scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
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 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.
Owner or Agent
The foregoing instrument was acknowledged before me this a
d a y by • 2—A e e7x7ikp,,4? ,
eyc ir'vittlit4w orgluced
.ropy take an oath.
NOTARY PUBLIC: a p'2102101/
personally known to
Print
7 'ce
nnni;ll No-
/
My Commission Expires: ' 7�d44 lu1100
Signature
72.■"
O
Contractor
The foregoing instrument was acknowledged before me this i?
as i eit;' i � � '" " ,ke an oath.
NOTARY PILBLiGz V210VgglIZ016
Si
'•.lF7i
'ri'' -
Print:
My Commission Expiffbs, „ F f( /rmm ll 10`\\
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10107)(Revised 06 /10t2009)(Revised 3/15/09)