PL-13-1761Inspection Worksheet I �J-1 I `�
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 196574
Scheduled Inspection Date: January 23, 2014
Inspector: Diaz, Osvaldo
Owner: CARMEN RODRIGUEZ ALTIERI, DANIEL
00007
Job Address: 510 NE 95 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor:
STAR -LITE POOL BUILDERS
5waling Department comments
PLUMBING FOR NEW SWIMMING POOL
Permit Number: PL -8 -13 -1761
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
1132060140830
Phone: (954)747 -3377
January 22, 2014 For Inspections please call: (305)762 -4949 Page 4 of 22
Miami Shores Village
Building Department
90050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit TAx: PLUMBING
JOB ADDRESS: 510 ONE 95 STREET
AUG U 5 20i3 P �
BY ���t V •
FC
Permit No 1 V J
Master Permit Ng17?? 13--1-759
City: Miami Shores County: Miami Dade Zip. 33138
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO X Flood Zone:
OWNER: Name (Fee Simple Titleholder): DANIEL PEREZ , R• MVI a ri phone#: 305 - 788 -6419
510 NE 95 STREET
City: MIAMI SHORES
Ste: FL Zip: 33138
Tenant/Lessee Name: pho :
Email:
CONTRACTOR: Company Name: STAR -LITE POOL BUILDERS phone# 954747 -3377
Address: 10875 NW 52 STREET SUITE 8
City: SUNRISE State: FL Zip: 33351
Qualifier Name: RONALD M BIXLER phone#: 954747 -3377
State Certification or Registration #: CPCO56418 Certificate of Competency #:
Contact phone#. 954747 -3377 Email Address: stadftepoolbldrs@hotmall.com
DESIGNER: Architect/Engineer. DAVID FAERMAN phone#.. 561-445 -1787
B
Value of Work for this Permit: $1000.00 SquardL%ear Footage' of Work: ty Z- IT !S L" f-
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: PLUMBING FOR NEW SWIMMING POOL
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
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 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
Signature / - ` signature,
Owner or Agent
The forego instrument was acknowledged before me this
day of , 20 9— by N M lh +(24l ,
who is personally known to me or who has producedi
As identification and who did take an oath.
NOTARY PUBLIC:
Sign
print D E A MASKER
My Commission Ex °y1 t , DALE A MASKER
. ;= Commission # EE 099428
Expires June 6, 2015
y __. 0.'m 8ordedTlwTroyFainI 8043 -7019
Contractor
The foregoing instrument was acknowledged before me this
day of 11V 20 fa by RONALD M BIXLER
who is personally knowr�tg me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: /Al� her y[ 'l/ /
Print DALE A MASK
My Commission Commission # EE 099428
•°_� Expires June 6, 2015
ft'-W R. Troy F.0 b.. M,18&7019
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised3/1212012)ftvised 07 110/07)(Revised 06/10/2009)Qtevised 3/15/09)