PL-13-2270t
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
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Inspection Number. INSP- 200659 Permit Number: PL -10 -13 -2270
Inspection Date: April 17, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: MACDONELL, ORRIN S CHARLENE Work Classification: Addition /Alteration
Job Address: 9760 NE 5 Avenna Rnarl
Miami Shores, FL
Project: <NONE>
Phone Number
Parcel Number 1132060171480
Contractor: LEYVA PLUMBING SERVICES INC. Phone: (772)871 -5893
Building Department Comments
BATHROOM REMODEL
InfractJo Passed Comments
INSPECTOR COMMENTS False
Passed
Inspector Comments
Failed ❑
l
�
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
April 16, 2014 Page 1 of 1
Miami Shores village
Buildin g Department
artment
10 050 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: PLUMBING
OCT �� � J ..
FBC ZO l®
Permit NO' _;Pilo
Master Permit No. - 00--*Q
JOB ADDRESS: 1i (0 ® AJ, f • ��
City: Miami Shores County: Miami Dade Zip: 3332
Folio/ParceW
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder ): 0 ti .J M saphone#:73 o `J S� ��
Address: 0
City: /K A M / 2-10 R S' ' State: �= % zip: 3 l �{
Tenant/Lessee Name: 1 Phone#:
Email: S A /J11 N l? 1 /� JC- JY �' �1t (3 � CC �
CONTRACTOR: Company N �ry�� ?I to 1b® "I Phone#: -794W& 6014
Address: i60Z�� men - � �'�°
City: P,0, • tuck•,'! State:
Qualifier Name if A 641-rt Phone#• /6 5Z bfZY
State Certification or Registration #: Cf'� /�� 5 ��� Certificate of Competency #
Contact Phone# � � � Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ (I `P�' �' SquarelLinear F of Work:
Type of Work: UAddress DAlteration ONew pair/Replace ODemolition
Description of Work b4fonn
Submittal Fee $�`°' ° ° Permit Fee $ ®��' ® CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Tndning/Fducation Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
FJ-
1
Ronding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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
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 properly is subject to attachment Also, a cernfied copy of the recorded notice of co ncement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit ' issued MCA absence of such posted notice, the
inspection will not be approve and a reinspection fee will be charged
Signature Signatare - - \ \ Owner or Agent ntractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of a 2 2013, by CV444t4 M' bN'L-"— day of , 20)1-,by Kk d \'AhA\ ,
who is personally known to me or who has produced /"who is personally known to n or who has produced
As identification and who did take an oath. as identification and who #id take an oath.
NOTARY PUBLI ,,,►uw NOTARY PUBLIC:
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Sign: � Sign:
Print: s r T h of c = Print: Comm ExOn M
My Commission Expires: = �pmmiSSlon ?Q = M Co
FC42Mdalon OD 997843
EE113059 N y
TE of F \\\\..
APPROVED BY
®ej ° 9,/ 1 Plans Examiner
Structural Review
(Revised3 /12/2012)(ReAsed W /10W)(Revised 06/1QMW)(Revised 3/15H19)
Zoning
Clerk