MC-12-1986Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 180421 Permit Number: MC -10 -12 -1986
Scheduled Inspection Date: November 06, 2013 Permit Type: Mechanical - Residential
Inspector: Perez, JanPierre
Owner: PETERSON, DIRK & ELIZABETH
Job Address: 1350 NE 101 Street
Miami Shores, FL
Project: <NONE>
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132050230020
Contractor: CAPITAL GENERAL CONTRACTORS & DEVELOPERS INC Phone: (305)827 -6211
comments
MECHANICAL WORK FOR NEW ADDITION AND
INTERIOR REMODEL INSPECTOR COMMENTS False
November 05, 2013 For Inspections please call: (305)762 -4949 Page 3 of 34
Inspector Comments
Passed IE
Failed
Correction
Needed ❑
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
November 05, 2013 For Inspections please call: (305)762 -4949 Page 3 of 34
Miami Shores Village
Building Department OCT 19 2012
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: MECHANICAL
JOB ADDRESS: 1350 N.E. 101 STREET
Permit N Cp �1 t 1 ` "
Master Permit CfA
City: Miami Shores County: Miami Dade 4p: 33138
Folio/Parcel#. 11- 3205 - 023 -0020
Is the Building Historically Designated: Yes NO Flood Zone: '41F 0 ss A
OWNER: Name (Fee Simple Titleholder): DIRK PETERSON & ELIZABETH PETERSON phone#:
Address: 1350 N.E. 101 STREET
City: MIAMI SHORES State: FLORIDA Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: CAPITAL GENERAL CONTRACTORS DEVELOPERS, INC. phone# 305 -827 -6211
Address: 480 W. 84th STREET, SUITE B -106
City: HIALEAH State: FLORIDA Zip: 33014
Qualifier Name: CARLOS A. BELLO Phone#. 305 - 827 -6211
State Certification or Registration #: CMC1250161 Certificate of Competency #:
Contact Phone#: 305 - 827 -6211 Email Address: CGC @CAPITALGENERALCONTRACTORS.COM
DESIGNER: Architect/Engineer. A & I ASSOCIATES Phone#: 305 - 310 -5030
Value of Work for this Permit: $ BJ�i T�%: Sgqu�uare/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration 3f4ew ❑Repair/Replace
Description of Work: ,AaL-1 - MJO A d VAT 1 T -'-,- A 5, Ae'YL o4o 5,
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
CCF $. CO /CC $
DBPR $ Bond
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
❑Demolition
TOTAL FEE NOW DUE $ ✓ . 4
V�'�v- v ��
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) N/A
Mortgage Lender's Address
City
State
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
EMPROVEMENTS 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 properly 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 the absence of such posted notice,. the
inspection will not be approved and a reinspection fee will be charged.
Signature ( ) Signature
Owner or Agent ' Contractor
The foregoing instrument was acknowledged before me this 8th The foregoing instrument was acknowledged before me this 8th
day of October , 20 by Elizabeth Peterson day of October , 20 by Carlos A. Bello ,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign: /. la&
Print: 016a L. Cruz
My Commission Expires:
APPROVED BY L\
OLGA L. CRUZ
of Florida
My Comm. Expires Sep 23, 201
Commission V DD 894805
Bonded Through National Notary Assr
ld 1 V20011 !/ Plans Examiner
NOTARY PUBLIC:
:/
L. Cn
Commission
4---y rumit; - i rida
Comm. Expires Sep 23, 2013
ammisslon # DD 894805
Bonded Through National Notary Assn.
Zoning
Structural Review Clerk
Revised 3 /12/2012XRevised 07 /10/0Wevised 06/10/2009XRevised 3/15/09)