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PL-12-778Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 172998 Permit Number: PL -5 -12 -778 Scheduled Inspection Date: September 28, 2012 Inspector: Hernandez, Rafael Owner: FORBES, JOHN Job Address: 304 NE 99 Street Miami Shores, FL Project: <NONE> Contractor: SUBURBAN PROPANE sunaing uepartment comments SET LP TANK ONLY AND HOOK UP TO EXISTING LINE BY OTHERS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)757 -7750 Parcel Number 1132060135600 Phone: 305 - 891 -8393 September 28, 2012 For Inspections please call: (305)762 -4949 Page 4 of 18 t _ Inspector Comments Passed Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid September 28, 2012 For Inspections please call: (305)762 -4949 Page 4 of 18 t _ Miami Shores Village Buildin g Department artment MAY a 12012 F 10050 N.E.2nd Avenue, Miami Shores, Florida 33138_ - - Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (30S) 762.4949 DING Permit NoY PERMIT APPLICATION Master Permit No. FBC 20 n Permit Type: PLUMBING OWNER: Name (Fee rSi�mple Titleholder): do d o ?'7 ��°' � � Phone#: Address: � 0 q 1j L7 1 S T_ City: M/4-m/ S/,4/2 &s State: !� C Zip: 3X11' Tenant/l,essee Name: Phone #: Email: JOB ADDRESS: 3 0 I �� S/ City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel #: Is the Building Historically Designated: Yes NO ?< Flood Zone: CONTRACTOR: Company Name: s –, L:: & Phone #: Address: JC% A),C- /,?6 1/–" Sr City: /"I' '_ � a / _ State: Zip: o i Qualifier Name: State Certification or Registration #: LAW // fP Certificate of Competency #: Contact Phone#: Tar-11 / _93 1. Email Address: Sad e/r��e�es� DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ �� — Square/Linear Footage of Work: Type of Work: DAddress DAlteration 51 ew A ORepair/Replace Description of Work: Submittal Fee $ Wm3 go Permit Fee $ /®� CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 reinspection fee will be charged V ' Signature (J 7 Signature �� Owner or Agent Contractor The foregoing instrument was acknowledged before me this 2 � The foregoing instrument was acknowledged before me this /' day of " L, 20!1--, by -SbV- --1 fW4 f-0 , day of ©-! r� , 20 W., by -!J / ! LIOL � o who is rsonally to me o who has produced, who is personally known to me or who has produced As identification and vyJM ►t*,an oath. as identification and who did take an oath. NOTARY PUBLIC: 1,$1 ra %''�, .. • ...e NOT Sign: (� v- ' 4, - Sign Print: '•.,�� -- �"'� s.: Print: <C 'O My Commission Expires: '�,, ••....`... 0 ���`` i,r' (;1 1 NAMM Z � My Commission Expires: TATE`4} ,f IAk �CORIdIaION 1E5, 2015 ktw APPROVED BY J6�9111J Plans Examiner Zoning —7 -7 Structural Review Clerk (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) BBAv0 aPP reE itaa tnr la to,Iar ad ea it is - I _ I PLGNBItdC GENERAL NOTES: ' '. dnr'a�r°x�maffi a¢ - - - - - -- 6il manses bmm WenaBtti[ Z g - -- ou"msmc°uc. 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