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MC-12-1277Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 175714 Scheduled Inspection Date: December 03, 2012 Inspector: Perez, JanPierre Owner: DENIS, CAMILLE AND MARIE Permit Number: MC -7 -12 -1277 Job Address: 10330 NW 2 Avenue Miami Shores, FL 33150- Project <NONE> Contractor: CUSTOM POOLS Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Pool Heater Phone Number (786)426 -7904 Parcel Number 1121360161090 Phone: (305)255 -5315 Building Department Comments REPLACE GAS HEATER Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 30, 2012 For Inspections please call: (305)762 -4949 Page 4 of 29 4 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 201. O RECEIVES JUL 1 1 Permit No. m G 12 e I ii Master Permit No. r — 0--15 Permit Type: MECHANICAL � OWNER: Name (Fee Simple Titleholder): �+ + AIL: /L LE. 04415 Phone #: Address: /01 /O &h W 2 AVG- City: Mt Mt ' 1-1C)/ S State: PL- Zip: fft 3� Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 1 D 3 "39) 3J + W Z std e City: Miami Shores County: Miami Dade Zip: ",/, FoliolParcel #: Is the Building Historically Designated: Yes NO ✓ Flood Zone: CONTRACTOR: Company Name: �¢, c� s "ra Pc Oc S Address: 1 r/ Z "iJ <% 5& i 3` I I T l© i> Phone #: 5 5. 5 316-- City: i" U∎ 1 State: L Zip: 3 t F C Qualifier Name: N8 t4 ill) tit. P( EKtrQ Phone #: % 05 ~ z 5r5-G3/5 State Certification or Registration #: C 47C —66'6 13 Certificate of Competency #: Con. ontact Phone #: " �J .. 114 32 'S Email Address: DESIGNER: Architect/Engineer: 1 /7 Phone #: Value of Work for this Permit: $ 2,4 ZOO Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration Fo ❑N ew tyRepair/Replace Descripton of Work: tal l -ACA 4 4 5 t` -f E All 1 96,oam (3 rcL L (P ❑Demolition * * * * * * * * * ** : ******* * ** * * * ** ** *******F a** ********** * * *********** * ****** * * ** ** * **** 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 $ 110 " 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 urs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approv a reinspection fee will be charged. Signature 11 ` /. Signature �1ri Q - :r Agent Contractor* The foregoing instrument was acknowledged before me this /111 The foreg s g instrument was acknowledged before e is 71( day of e./ 4 4/ , 20 /Z, by O,, A M 1 LL D E&1 16!' day of J , 20/x; by ° U314tl! M ` '' 440 , who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PU l r IC: ,� NOTARY PUBLIC: Sign: Print: My Co ission Expires: .'enL N I 11 ►1�_ MY COMMISSION # EE 129686 EXPIRES: Jemeaty 10, 2016 Banded Thni Nuii r Public Undenvdttre My Commission Ex ***V * * * *s ****a *4kkkkkkkkNkdNkKN**** HkkkNkkkkkKtl** kkkk kkkk+kkkkkk*** Plan miner kkkkkBNkkkkkkNkkNkkkkkkNk+NkkkkFkkk*** Zoning APPROVED BY Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)