PL-13-020307- 24 -'13 06:39 FROM-
T-605 P0002/0013 F -759
Inspection Worksheet a0
Miami Shores Village ) p 1
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (306)798-2204 Fax: (305)756 -8972
Inspection Number: INSP-185091 Permit Number: PL-2.13 -203
Scheduled Inspection pate: July 23, 2093 Permit Type• Plumbing - Residential
Inspector: Diaz, Osvaldo . Inspection Type: Final
Owner: FLEITES, DANNELLE Work Classification: Pool - Private
Job Address: 131. NE 910 Street
Miami Shores, FL 33161- Phone Number
Parcel Number 1121360040200
Project: <NONE>
Contractor: HL SERVICE & REPAIR INC Phone: (786)210 -8072
Building Department Comments
POOL PIPING
INSPECTOR COMMENTS False
Inspector Comments
Passed El'
Failed
Correction
Needed
Re- inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
July 22, 2013 For Inspections please call: (305)762 -4949 Page 3 of 34
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
Permit Type: PLUMBING
JOB
�
JOB ADDRESS: / 1 eve
FBC 20 CO
Permit No. L—, Z 2__c)�3-
Master Permit No
City: Miami Shores County: Miami Dade Zip:
Folio/Parcelk / I °?-1 (o oo Q a
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): :j � -t / ail. CL K (% Phone #:
aa____. / 'Z ) Flo t a / /A c ^I you
City: 4, t State: Cs Zip:
Tenant[Ussee Name: Phone# ,57' . T_.) e4-�3
Email:
CONTRACTOR: Company Name:' Phone#: 7 ° 1 b O� °`-
Address: / 14 -7 � �a
City:
Qualifier Name:
0
Zip: d
Phone #• �� 0
State Certification or Registration #: 3 `k mI D5 _`e6 Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ /5'' 6c% Square/Linear Footage of Work: z---F
Type of Work: DAddress OAlteration )ONew ❑Repair/Replace ODemolition
Description of Work:
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ 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. Asa coed' o to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith thaVa of t notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject t. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection s seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be p a reinspection fee will be charged.
A O er or Agent
The foregoing ins nt2was acknowledged before me this
day of 0 �, by �-�'• I'', - °
who is perso 1y known to me or who has produced
As identification and who did take an oath.
NOTA PUBLIC:
E'
Signature
Contractor
The foregoing instrument was acknowledged before me this /3
day of , 20 a, by 1'1 t G �� —t3
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: i Sign:
Print: �Aa) Ct _ � CC) � � . Print: S
My Commission Expires: My Commission ExpEEM**
,zQt�'r" MARIAACOSTA lA00STA MY COMMISSION # EE 141764 SION # EE 14176 EXPIRES: December 10, 2015 cor 10 S=W Ttn Nate P�qc 0mienw�rs s aksR
APPROVED BY `� �l Plans Examiner Zoning
Structural Review Clerk
(Revised3 /1212012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)