PL-12-5970Y
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972 a ? ...,"' k
Inspection Number: INSP- 172016 Permit Number: PL -4 -12 -597
Scheduled Inspection Date: May 25, 2012 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Owner: MILLER, EDDIE
Job Address: 2 NE 108 Street
Miami Shores, FL 33161 -7036
Project: <NONE>
Contractor: PSG PLUMBING SERVICES, INC
Building Department Comments
REPLACE KITCHEN CABINET SINK FAUCET
DISHWASHER AND GAS VENT
Inspector Comments
Passed
Failed El
Correction ❑
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspection Type. Final
Work Classification: Addition /Alteration
Phone Number (305)807 -4045
Parcel Number 1121360110080
Phone: (305)796 -7304
May 24, 2012 For Inspections please call: (305)762.4949 Page 3 of 10
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
FBC 20
Permit Type: PLUMBING
OWNER: Name � (Fee Simple Titleholder):
0#t &4i,
Address: /v � /<( SiLr' t P
-CE - :_v
APR 0 5 2012
I
Permit No.
12 49�
Master Permit No.��
City: . - .aQ�S State �� Zip;
Tenantk,essee Name: Phone #:
Email:
ea(S,,e 6 vol OS / tive-s- 9 , G
JOB ADDRESS:
/V 4-
/ d ?
7 e ee-�—
City: Miami Shores
County:
Miami Dade Zip: 32 / G
Folio/Parcel #:
Is the Building Historically Designated: Yes
hONTRACTOR: Company Name:
Address: _�vFZ
City: f2e�
Qualifier Name:
NO - Flood Zone:
_3®.s= 1?9f.- 73® 41
State Certification or Registration / c/ 9, &-",1, °� ~% Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 10200 Square/Linear Footage of Work:
Type of Work: ❑Address DAlteration ❑New �epair/R place
Description of Work: zo
S i hJ 4 d C Q- 4-
e+
Submittal Fee $ Permit Fee $ L60' CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
ODemolition
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 rei ee will be charged.
Signature Signature
-
0 r or Agent Z�o for
The foregoing instrument was ackno dged s _,� The foregoing instrument w wled ged before me this
day of �� , 20 , by day of r [ L , 201? , by
who is personally known to me has roduced who is personally known to me or who has produced
As iden cation and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign
Prin
My
APPROVED BY
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
/T
NOTARY PUBLIC:
Sigi
-Prin
My
Plans Examiner Zoning
Structural Review Clerk