PL-13-489 09-04-'13 06:22 FROM- T-711 P0001/0004 F-998
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 ' �4 W_
Inspection Number: INSP-198303 Permit Number: PL-3-13-489
Scheduled Inspection Date:September 03,2013 Permit Type: Plumbing-Residential
Inspector: Diaz,Osvaldo
Inspection Type: Final
Owner: SMITH,PATRICE AND SCOTT Work Classification: Addition/Alteration
Job Address:358 NE 101 Street
Miami Shores;FL 33138- Phone Number
Project Parcel Number 1132060135280
: <NONE>
Contractor. RAFLO GENERAL CONTRACTOR Phone:(305)951-6941
Building Department Comments
PLUMBING WORK FOR INTERIOR REMODEL Infractio Passed comments
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-195518. CREATED AS
REINSPECTION FOR INSP-187232. FSCP 706.3 APPROVED PIPING
FOR CONNECTOR REQUIRED
Failed El FBCP 301-ESCUTCHEN AROUND PIPE
GROUT OR CAUCK
ALL FIXTURES SECURE D/W PROVIDE CLEAN OUT COVER
Correction CANCELLED BY SANDRO 8/112193
Needed
Re-Inspection
Fee I--�
C1-- -I<
No Additional Inspections can be scheduled until
re-Inspection fee is paid.
August 30,2013 For Inspections please call: (308)762.4949 Page 16 of 19
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
FBC 20
BUILDING Permit No.
n
PERMIT APPLICATION Master Permit No. "
Permit Type: PLUMBING
JOB ADDRESS: 3 Jq A
City: Miami Shores County: Miami Dade Zip: 33 /
Folio/Parcelk
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): 5�c-n4Jr— So") J in. Phone#:
Address: 'S 5"6 r)e. (C)
City: i Ct L-Lt< S o vet' State: rL- Zip: 3 13 4
Tenant/Lessee Name: Phone#-
Email:
CONTRACTOR:Company Name: f%L d Phone#- j77/e`7 y/
Address: �?0 4
� / c�re�U Ale--
City: //- O / 1'c4 4)42C-state:
%
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 inspecti n which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not a approved and a r ction fee will be charged.
Signature Signature � ^
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me th�L
►►►ia�avr��
day o ,zo_,bye�b t� ��t�,�^.4"ten of ,�*X o ,20_,br
o is personal own to me or who has produced A tes personal known to me or who has produce`®���e 'a�r"t19p�
I • — ��� � ,gyp i r ,`'`s�, ®;,
As identification and who did take a�np2 b�th7�2.016kt
— as identification and who takg ap U 6'°
NOTARY PUBLIC . J UU[[
NOTARY PUBLIC: _ WOTARY PUBLIC: = NOTARY PU6lIC
. Commission # _ _ 0
%crj •. EE160045 OQ-�.� = Commission #
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Print• i�►iu�u Print -� �e-�'� �. '��i�, F. F .SXN®o
My Commission Expires: My Commission Expires:
APPROVED BY � Plans Examiner Zoning
Structural Review Clerk
(Reviwd3/1=012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)