PL-13-2119Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972 D
Inspection Number: INSP- 199440 Permit Number: PL -9 -13 -2119
Scheduled Inspection Date: October 16, 2013 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Owner: CHRISTINA POULOS, RAYMOND SLATE
Job Address: 10 NW 110 Street
Miami Shores, FL 33168-
Project: <NONE>
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360030010
Contractor: MG EXCELLENCE SERVICE CORPORATION Phone: (786)247 -7067
Building Department Comments
REMOVE AND REPLACE SINK
Passed E3"
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
INSPECTOR COMMENTS False
Inspector Comments
(3 lc- gz) 1?3L� - t o- - r 6 -12)
October 15, 2013 For Inspections please call: (305)762 -4949 Page 17 of 48
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.�' 2 I `�
PERMIT APPLICATION Master Permit Nofzc13 21 � 9
Permit Typ 4 LUMBING
JOB ADDRESS: 1) U W
City: Miami Shores � �County: Miami Dade Zip:
Folio/Parcel #: ( — l o Jl23—
Is the Building Historically Designated: Yes NO X - Flood Zone:
OWNER: Name (Fee Simple Titleholder): t Phone#•
Address: loisi5 Cotlini5 Poj�L 100 LA
City: State• Zip:
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Narne• sU 1 &*one#: =Mo `-i' 19 0 ?-
Address: l r�
City: St Zip:
Qualifier Name: t Phone #:
State Certification or Registration #: QEL I L4 7_ Certific to of Competency #:
Contact Phone#: 3Qzt'CTMmai1 Address: `02 ee��
DESIGNER: Architect/Engineer: Phone #: ,
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Address DAlteration ❑New ORepair/Replace ❑Demolition
T___��a2_� _l •21_1__
Submittal Fee 0 Permit Fee $ /50° CCF $ CO /CC $
Scanning Fee $
Notary $
Radon Fee $
Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Sigma Signature
Owner or Agent ll ll ontractor
The fore ping instrument was ackr,�,.Q,)wledged before me this l lXl The fore ing instrument was acknow ged.before me this
day of , 20 ` , by7 o1�V'V1 f d � � day of , 20 tE ' a-
who is ersonally kn o m - has produce who is ersonally known me �r,wl,o was produced
As identification and who did take an oath.
NOTARY
Sign:
Print:
My Commission E ires:�
a$zj
Noftry Pub tote of Florida
Helsel Alvarez
My cotnmiealor EE 186011
M R ! iiSdT9t2016
x�N�He�k�c> K�a> k�k9� #��S�c�askNs�ksk�k+Nskxeaksk at �tl�ur& �a1� .Ye�k,imx�e,Nrha��sk�ea�cv.�aa
APPROVED BY ( Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06/10 /2009)(Revised 3/15/09)
identification and who did take an oath.
NOT
Sign:
Print:
My Commission Expires:
4"I", N*, Notary Public State of Florida
Heisel Alvarez
�� MY Commission EE 195091
Art� °° Expires 05 /2812016
Zoning