PL-13-0127n
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972 i �! `� \
Inspection Number: INSP - 184650 Permit Number: PL -1 -13 -127
Scheduled Inspection Date: October 17, 2013 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: tWAergv*Md
Owner: STANLEY SUMMER, ANASTASIA Work Classification: Addition /Alteration
Job Address: 408 GRAND Concourse nAll? Z
Miami Shores, FL 33138 -2463 Phone Number 3051758 -2542
Parcel Number 1132060170090
Project: <NONE>
Contractor: CERTIFIED FLORIDA PLUMBING Phone: (954)579 -5618
Isuua
Comments
NEW TOILET SHOWER SINK NEW BATHROOM ' ____ INSPECTOR COMMENTS False
Inspector Comments
Passed / ��,� > ���/$$$ CJ L,
IO
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
October 16, 2013 For Inspections please call: (305)762 -4949 Page 2 of 27
OR - 9
Miami Shores Village
Building Department JAN 2 4 2013
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4449
FBC 20 IC7
BUILDING Permit No. U S -
PERMIT APPLICATION Master Permit No._ _ t'3
Permit Type: PLUMBING
JOB ADDRESS:
City: 1VJmmi Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO o(� Flood Zone:
OWNER: Name (Fee Simple Titleholder): e, Phone#:
3
Address: ;Zd
City: State Zip:
TenandUmee Name: Phone#:
Email: -
en �y #-.
DESIGNER: ArchitectJEngineer. Phone#: `.O
Value of Work for this Permit: $ / g Square/Linear Footage of Work:
Type of Work: DAddress OAlteration M w ORepair/Replace ODemolition
Description of Work: / .f/ d°� R✓c��.
Submittal Fee $ / Permit Fee $ C�� CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training(Edncation Fee $ Technology Fee $
Doable Fee $ —Structural Review $
TOTAL FEE NOW DUE $ ' Y
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
Zio
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
DIPROVEMENT5 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 s to attachme Also, a cenywd copy of the recorded notice ement must be posted at the job site
for the first • c whit occu even (7) days QUr the building permit is 'sued In the abse such posted notice, the
inspectio all no approv and reinspection fee will be charged,
Si Si
Owner or Agent Contractor
The forego• • trument was acknowledged /before me d9s�L The foregoing instrument was acknowledged before me this' .
day of , 20U, by y (fi ~ l_ day of 20 ._, by yi/'f
who is personally known to me or who has produced f who is personally known to me or who has produced
As identification and who did take an oath as
NOTARY PUBLIC:
Sign: t ��
Print:
My Commission Expires:
APPROVED BY
enisS/�
CP :• Commission 0
� • . EE 113059 ,.
Plans Examiner
Structural Review
(Revised3 /1=012)(Revised 07 /10/07)(Revised 06110'M)(Revised 3(15!04)
leui
Notary Pubw state of Florida
Suzanne (3iovandl
�=salon DD943919
Od2013
Zoning
Clerk
Miami Shores Village
Building Department
10050 N E 2nd Avenu
Mjarru Shores. Flonda 3313
Tel: (303) 79.i 220
Faa: (305) 7j6 897
Permit No.
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Job Name
I
PLUMBING CRITIQUE SHEET
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