PL-13-1430r,
6
Inspection Worksheet '
Miami Shores Village 119"R.P16f
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INS P- 194181 Permit Number: PL -6 -13 -1430
Scheduled Inspection Date: October 29, 2013
Inspector. Diaz, Osvaldo
Owner: KNOWLES, HAROLD & AMY
Job Address: 129 NE 109 Street
Miami Shores, FL 33161-
Project: <NONE>
Contractor: SOUTHWEST PLUMBING SERVICES INC
isuuamg uepartment comments
REMOVE AND RESET FIXTURES
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number
INSPECTOR COMMENTS False
Inspector Comments
Passed Eq'
Failed
K�
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- Inspection fee is paid
305 - 758 -8193
1121360040530
Phone: (305)232 -6203
October 28, 2013 For Inspections please call: (305)762-4949 Page 7 of 46
' Miami Shores Village
Building Department
40050 N.E.2nd Avenue, Miami Shores Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 JUN 2 4L20.4
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC �� —. - -- - --
BUILDING No.
Permit `� -1433
e 1
PERMIT APPLICATION Master Permit No. ` i � �j
Permit Type: ]�LVMBING
JOB ADDRESS:
G%1
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO X Flood Zone:
OWNER: Name (Fee Simple Titleholder):� _� C_ 4- Aiv%,�j W—yj®W rJ Phone#:
Address: l,3' 1041,0-11—
City: WlAw1l &nom State: Zip:
TenandUssee Name: Phone#:
Email:
CONTRACTOR:
Address:
City: W i 0 VIAL t State: 0 (`I CI Gl
Qualifier Name:. 0nict .5 Ul2'�t-uo> Phone#: -60
State Certification or Registration #: i'4�:e. C)P5-7 012 0 Certificate of Competency #:
Contact Phone#: — &oaO%3 Email Address: urnbirt . aei--
DESIGNER: Architect/Engineer:
v9*
Value of Work for this Permit: $ ?�D Square/Linear Footage of Work.
Type of Work: DAddress '`Alteration ONew Aepair/Replace
Description of Work: kwtd✓o. *%J -0 2.1-Ids?" d&O - "m4Dc , - A—W
Ale*-) 4,4 &,'
3o sr-
ODemolition
�o 0- L+t/G. ,
6</PA-le— O" TvQ
Submittal Fee $ 50 ` Permit Fee $ �� CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
Bang Co"iapany'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 iss the absence of such osted Lice, the
inspection will not be approve reinspection fee will be charged
Signature Signs
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this
day of J V " , 20 11, by A &L is ni o,,i le A ,
who is personally known to me or who has produced
NOTARY
Sign:
Print:
My Commission
APPROVED BY
As identification and who did take an oath.
W. Sm d
Comomft I EE 146517
The foregoing instrument was acknowledged before me this
day of ine 2013, by �� iiV�'lSLI✓� ,
who isgersonally known to me or who has produced
as identification and who did take an oath.
NPlans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
Sign:
Print:
My Commission Notary Pub"c State of FlorWa
Sharon Hueston
My Commission FF 026432
TExpires 06/0412017
Zoning
Clerk