PL-13-2400r
1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 201764 Permit Number: PL -10 -13 -2400
Scheduled Inspection Date: October 30, 2013 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: DONALDSON, EDITH Work Classification: Solar
Job Address: 1569 NE 104 Street
Miami Shores, FL Phone Number
Parcel Number 1122320320160
Project: <NONE>
Contractor: SUN STAR ENERGY LLC Phone: (561)287 -1118
Comments
DISMOUNT AND REPLACE PANEL
INSPECTOR COMMENTS False
October 29, 2013 For Inspections please call: (305)762 -4949 Page 16 of 26
Inspector Comments
Passed
aC l�
Failed
Correction
Needed
❑
Re- Inspection ❑
Fee
No Additional Inspections can
be scheduled until
re- inspection fee is paid.
October 29, 2013 For Inspections please call: (305)762 -4949 Page 16 of 26
1*
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BUILDING
Miami Shores Village
Building Department OCT 2 2 2M
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 LO
PERMIT APPLICATION
Permit Type: PLUMBING
Permit No. �
Master Permit No. � I-
� U '_� —c9 LJ l7
JOB ADDRESS: 16- C:� 1) cz, � I C) `4 qfz_
City: Miami Shores County: Miami Dade Zip: 331 3
Folio/Parcel #: I I- 111 Z_ ° 6-Z L 9 0/&- 0
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 4U o �k c-,n,,1 k <cz4 Phone #: 3 ° i
Address: C S 9 n )V-:t- 1 0 (t _I-C '� : e,
City: � �v,° ��� (Ae% State: - Zip: 5 _4) --
Tenant/Ussee Name: Phone#:
Email:
CONTRACTOR: Company Name: i� e� �°; ," <�e "� L—)= <Z, Phone #: �� • 2�� ' / / /
Address: -7 L 3 r c- b1 -SD m�
City: n .5 _�5 —State: �r— \ Zip: 1 t
Qualifier Name: ►n-- 'iF Phone #:
State Certification or Registration #: t-c I W Z�o Certificate of Competency #:
Contact Phone#: �L Y °'252 ° I 1 / cTb' Email Address:
DESIGNER: Architect/Engineer. Phone#:
Value of Work for this Permit: $� ®� A Square/Linear Footage of Work:
Type of Work: OAddress DAlteration pNew jRe air/Repla a ODemolition
Description of Work: 5 YY1 Vu e 'V c- -,-% 4A z> j �,
��x�x• �����x��x�x��x��x���x�x�������x�x����m�xa��nx��x• x�F�����a��m�m�x�x�����x���x�x�xa��x�x����x��� *�x��m��xwu�����
Submittal Fee $ Permit Fee $ �� ®. ® CCF $ CO /CC $
Scanning Fee $
Notary $
Radon Fee $
Training/Education Fee $
DBPR $ Bond $
Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ l0q.
. ft
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
Il"ROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMNCEMENT."
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 roved and r inspection fee will be charged.
Signa a Si tune
i
Owner or Agent ontractor
The foregoing instrument was acknowledged before me this
day of 20 i3, by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: tary ublic - State of Florida
My Commis my Comm. Exp res y
F Commission # EE 203923
The foregoing instrument was acknowledged before me thisO°t —14 �
day of i -1- . 20 n, by 2 �V�
who is personally known to me or who has produced
as identification and who did take an oath.
APPROVED BY Plans Examiner
Structural Review
(Revised3/12/2012)(Revi 07 /10/07)(Revised Mq0/2009)(ReOwd 3/15/09)
NOTARY PUBLIC:
Sign:
Print: WAS
8! le of Floofrida
My Co y Comm. Expires May 31, 2016
Commission # EE 203923
Zoning
Clerk
4o
TmonA
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PERM a ]!C -1 3 � G.
Miami Shores Village
APPR.OlvED
BY
DATE
ZONING DEPT
tit
BL G DEPT
SUBJECT 10 CGNIPI.1010E WI M ALL FEDERAL.
cTgTE A.NL) C( IAN f rit LAS AND REGULATIONS