PL-13-725Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 189081 Permit Number: PL- 4- 13-725
Scheduled Inspection Date: May 07, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: GRIFFITH, WILLIAM Work Classification: Addition /Alteration
Job Address: 795 NE 97 Street
Miami Shores, FL Phone Number (305)401 -6279
Parcel Number 1132060142360
Project: <NONE>
Contractor: CFC1428617 A & C PORTELA PLUMBING Phone: 3061343 -2115
Bunning Department comments
INTERIOR REMODEL
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
May 06, 2014 For Inspections please call: (305)762 -4949 Page 1 of 34
Miami Shores Village
Building Department
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: PLUMBING
JOB ADDRESS:
APR 10 0 2Aj3
FBC 20 k-3
Permit No. SL -1 -7°-°
Master Permit No. (2-t 3
City: Miami Shores County: Miami Dade zip:
Folio/Parcel #: _� c .3 014-
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): C.
21 �( ' W Phone # &0() id'
Address:
City: K�, JAL State: Zip:
Tenant/Lessee Name: a t / /1— Phone #:
Email:
CONTRACTOR: Company Name: jf � d ��.1�- �V��1A'1 �n�'% Phone#: �lx— l 6� 0 '7 7J
Address: X,,LS !CLI- 43 N4-
city: U'� ►� �° State: AFL zip:
Qualifier Name: `Ufiv d Toe to I r, Phone #:
State Certification or Registration #: G t 4a�1 Certificate of Competency #:
Contact Phone#: �� —��" D"��� Email Address: PdV'el°` 119MAA ZJ e!61'�1.
��
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this.Permit: $ 1 �.�c9�% Square/Linear Footage of Work:
Type of Work: - OAddress OAlteration ONew EIReepair/RReeplace ODemolition
Description of Work: �fC9� ? C-�Z— i� 9T —t
Submittal Fee
Scanning Fee $
Permit Fee $ I . CCF $ CO /CC $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
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 noti of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is is ued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
w
w_
Signature Signature `��
—� -1 JL-
Owner or Agent Contractor
The fore oing instrument was acknowledged before me this ,- The fore oing instrument was acknowledged before me this
day of , 20, by C°tl day of , 20 (, by ,� f �' L [✓�i'
who is personally known to me or wh as produced w(h�o is ersonally knot�wn tome or who has produced
{LpI -' `K��' 5-7 s id kkt�on and who did take an oath. ��s ` ���� go- �ds identification and who did take an oath.
NOTARY
Sign: " —144 "_
Print:
My Commission Expires:
NWA ILL PAS7WA
• yy07
APPROVED BY Plans Examiner Zoning
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Clerk