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PL-06-3047Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -36688 Permit Number: PL -12 -06 -3047 Scheduled Inspection Date: April 08, 2013 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: RESPONDEK, CAROL Work Classification: Addition /Alteration Job Address: 1162 NE 105 Street Miami Shores, FL Phone Number Parcel Number 1122320280150 Project <NONE> Contractor: DISCOVERY PLUMBING CORP Phone: (786)271 -1191 Building Department Comments PL FOR 2ND STORY ADDITION Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 05, 2013 For Inspections please call: (305)762 -4949 Page 42 of 42 ° Miami Shores Village CCF 10050 N.E. 2nd Avenue Change of Contractor Fee Miami Shores, FL 33138 -0000 " Phone: (305)795 -2204 Project Address Parcel Number Applicant 1162 105 Street 1122320280150 Miami Shores, FL Block: Lot: CAROL RESPONDEK CAROL RESPONDEK 1162 NE 105 ST MIAMI SHORES FL 33138 -2108 Contractors) Phone Cell Phone DISCOVERY PLUMBING CORP (786)271 -1191 Type of Work: PLUMBING Type of Piping: Additional Info: Bond Return : Classification: Residential Fees Due Amount CCF $4.20 Change of Contractor Fee $75.00 Education Surcharge $1.40 Notary Fee $5.00 Permit Fee - Additions/Alterations $245.00 Permit Technology Fee $6.13 Scanning Fee $3.00 Total: $339.73 Building Department Copy Invoice # Invoice Total Amt Paid Amt Due PL -2 -07 -27461 $264.73 $264.73 $0.00 PL -3-10 -37208 $75.00 $75.00 $0.00 Check #: 5489 March 05, 2010 2 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 FBC 20 Permit Type: PLUMBING ECEI��, R BY: ....................... Permit No. fl- j 2• o G. ';py7 Master Permit No. ?s? 06.143 7 Owner's Name (Fee Simple Titleholder) Ai io-K r. ca, oi Sjpibk4c6►Phone # 150!5 $�� • 6rFi7�f Owner's Address X16 2 WE 1 p�� street" City 1M� S � State _ (=( Zip '3 13� Tenant/Lessee Name Email Phone #, Job Address (where the work is being done) 1162- U E t o�� - sttC'LT7 City Miami Shores Villa County Miami -Dade Zip 33 t 3 FOLIO / PARCEL # 1 L 22-27 a 7 1p, r% iV__ n Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address / 3 -k M t-� S Phone # Flood Zone City !d,A c 2�. -s_, " State z� Zip 3 3 ` Qualifier Name A .iD It-j p Phone # '7C -11 % State Certificate or Registration No. -C F C Certificate of Competency No. Contact Phone t1 ZW� c--t_�P_ E -mail Architect /Engineer's Name (if applicable) Value of Work For this Permit $ �d 5­0C. Type of Work: ❑Addition ❑ Phone # Square / Linear Footage Of Work: []New ❑ Repair /Replace ❑ Describe Work: W ,a 9/.,// '�' c� �, � L��•�_ --, ✓� � , = ; `�. ���.. ^cam _ a ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees********** * * * * * * * * * * * * * * * * Submittal Fee $ Permit Fee $ Z 3 ' /- CCF $ CO /CC $ Notary $ Scanning $ Double Fee $ Structural Review. $ Training /Education Fee $ Radon $ DPBR $ Violation date: Technology Fee $ Bond $ Total Fee Now Due $ See Reverse side -4 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) 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 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. Signature Ownefor Agent G The foregoing instrument was acknowledged before me this day of i > 20 10, by A p()P 1 pF,-�e who is personally known to me or who has produced P, ( C As identification and who did take an oath. Signature ontractor The foregoing instrument was acknowledged before me this day off%&4e4 4 , 20 U , by -AN COQ- �, 1 1. Y7 r' c,L- who is personally known to me or who has produced — 0 as identification and who did take an oath. NOTARY PUBLIC: �uuillr NOTARY PUBLIC: Sign: Si n: ,a ���� 1 1U �► /iii Print: _ __ — Print: c`a.• v /c><— My Commission Expires:, ; o v: �Q ; My Commission Expires APPROVED BY fT Plans Examiner Zoning Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked 1162 NE 105'h Street Miami Shores, FL 33138 25 January 2010 Mr. Mike Vega Vega & Son Plumbing Inc. 10925 SW S& Avenue Miami, FL 33156 Dear Mike; �18013IIWIED MAR 0 5 2010 Thanks for your recent proposal for the second phase of plumbingfor our addition. We've decided to go with another plumbing contractor to do the work since it seems that Mark is so busy these days. Thanks again for your proposal. We wish you the best for the coming year. Sincerely, l�- Allan Respondek ru ru tr° I a tc.y e _ Fee C3 cOse, ;ari a cosec) 3 � rq _ en to — I r a s Sod„ t - - - -- ®; PO I Y �x /.�''Yi"�i�- gRPor "' xuw.dsk s.Y �,.+„„c�,.,.. a% �m..-.•. s-. �c .'w....aJVU- cr.Y....:;...sa_., Ir Er m S. Q M ems, aEva;t e= �cicc nar : scu{rc� -- iisra ^.;Cin::oa.',?3.i 7=�21;i.`8y - - • .. �® . qsg WAS SAM" low 94 VeAm"ema 10050 NE 2nd Ave Miami Shores, Fl 33138 Phone 305.795.2204; Fax 305.756.8972 www.miamishoresvillage.com HOLD HARMLESS PROPERTY LOCATED AT:_ /! 62 AIK /o S *' S ('rc�T DATE: ! • 2V5 - 20 10 As legal owner of subject property, I request the cancellation of permit number issued to for the following reason: eel ; Pc bWA Date of last inspection: o 1 hereby apply as owner - builder, or au hori a (new contractor) , to apply for such permits as necessary to construct or complete the construction on subject property. I agree to hold Miami Shores Village, its agents and authorized personnel harmless and relieve them from any responsibility or liability for any legal action or damage, cost or expense (including attorney's fee) resulting from the cancellation of the existing permit or the issuance of a new permit. I furthermore assume responsibility for the correction, if required, of work performed under the permit for which I am requesting cancellation. (Owner's ignatur ) ek- (Print Name) State of Florida County of Dade: The undersigned, property. (Prime Contractor -Only if subcontractor holds permit or if change of qualifier) /IN 6 cr'At U U -�;' c 10-5 (Print Name) 0%III iI,II/l/V eta /z being the first duly sworn, deposes and says that he /she i he above Sworn to and subscribed before me thi Notary Public, Sate of Florida at Large Miami Shores Village Building DepaINOMITZ PAR 0 5 2910 Change of Contractor Permit No. 6P C • X437 Owner's Name (Fee Simple Titleholder) A { wwft t ca"I SDAW hone # OS • 8g It G e 74 Owner's Address 1 %ren- 2 AiE I a„'� __wee t - City iii mow. i S kere s State a- zip 3-31-59 Tenant/Lessee Name M /A Phone # Job Address (of where the work is being done) t 162 %:E 10 1p, St City Sk1`¢'s County F! zip 13 Legal Description I " 32 5 AMO I!% Contractor's Company Name cz 0,e !L_T �l a .., n- a Phone # Zk k D-11-11 11 Contractor's Address Q '3'i m6 S — L/ �f -0, �)- &t0 Ci State ( Zip 3 3 / 72 �1 Qualifier o4 -.--C. -: -0 "-e- Describe Work: -g,1`-s I hereby certify that the work has bee& abandoned and /or the contractor is unable or unwilling to complete the contract. I hold the Building Official and the Village of Miami Shores harmless from all legal involvement. Signature Owner or Agent Signature Contractor The foregoing instrument was acknowledged before me/ this �°� The foregoing instrument was acknowledged before me this � �f► °� !�� � �j'�9 �@ �S day of i 20 L. b 2 of L 20 b 4 who is personally known tome or who has produced. d 0 who is personally known tome or who has produced U As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: 3t 4t 4t 4t 4t 4t 4t 3e4t 7Y Bt lE 4t 3e 324! 9tBi 4t ]it3t Ar 3e dt 9t 9eYt Rev. 09/19/03) NOTARY PUBLIC: \�.�`;1�•• •• - ;� Print: My Commission expires: fi> k' 9t> kfTCfttkits4ftSttk$ 8r& sYfto44t4t$ fttYi4ft9t4t4t3t3t3t9taFt 'tie4tSit an oath. or10 -25 -2008 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies- that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 12/21/2008 PERSON: MECIAS FEIN: 650824075 BUSINESS NAME AND ADDRESS: DISCOVERY PLUMBING CORP 13300 SW 47 ST # 205 MIAMI FL 33175 SCOPES OF BUSINESS OR TRADE: 1— CERTIFIED PLUMBING CONTRACTOR EXPIRATION DATE: 12/21/2010 ANTONIO IMPORTANT: Pursuant to Chapter 440 . 051141, F.S., an officer of a corporatlew who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant t6-Chapter 440.0511121, F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113 ►, F.S., Notices of election to be exempt and certificates of election t0 be exempt shall be subject to revocation if, al- any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 �su�aDEr LIrsrc 2o1ri TLASS . TAXCt�LLEC�OFE`AI�i%�L?R1A U.S:Pf>ST�1GE E 146 W. RLAGtLIaii ST " PAID 1�t1.01fJE# A��51 MIAMb.FL PERIOIT NO. 231 402854'4 THIS IS NOT A BILL — DO NOT PAY RENEWAL RECEIPTMM 420464-0. sUSINESS-A t LOCATION . CC # %IP 40 0345 SCOiI -fav PLUMBING CORP DI 13300 Sly_ 47 ST 205 33175 UNIN DADE COUNTY OWNER DISCOVERY PLUMBING CORP WORKER /S S 1Tr PLUQB'81NG CONTRACTOR 1 IFFY IS ONLY A LOCAL i ARNESS TAX RECEIPT. rr - - X)m NOT PERMIT THE 4OLVM TO VIOLATE ANY _ ... .. .. �DSMIG REWLATORY OR WPM -LAWS OF THE DO NOT FORWARD . COUNTY OR Cirm NOR DOES. rr EXEMPT THE HOLDER DISCOVERY PLUMBING CORP PErMrr OM,wv ANTONIO MECIAS PRES REGUIRED BY NOT A oERnFICATION OF 13300 SW 47 ST 205 THE " °L°ERS °eALt�ICA MIAMI FL 33175 PAYMENT RECMVED OflI I IDAM COUNTY:TAX COLLECTOR: 10/02/20y09 . •0223OV01 $88i111111111121 181838 all 000082.50 t11 Si181t1t8811$6118[i$1D8fit14i028 SEE OTHER SIDE Ac# 4476545 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESS.ONAL CONSTRUCTION INDUS'T'RY . LICENS:ING:' 1 1' - LICENSE NBR Q7Q7 Zlr!7/2009 090038658 B625g2 The BUSINESS ORGANIZATION Named below IS ;QUALIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2011 (THIS IS NOT A .LICENSE TO PERFORM TnTORR: TIiIS ALLOWS THE COMPANY TO DO BUSINESS ONLY IF IT HAS A QUALIFIER.)* DISCOVERY PLUMBING CORP 13300 S.W. 47TH STREET UNIT #205 MIAMI FL 33175 kTION SEQ#LO9071700633 CHARLIE CRIST GOVERNOR - CHARLES W. DRAGO � DISPLAY AS REQUIRED BY LAW SECRETARY ACS STATE OF FLORIDA_ . t P DEPARTMENT Off' A1tTD PROFESSIONAL C{aN'i'�1�LTSTRY: LICENSSNG REGULATION BOARD SEQ# L08080900337 DATE BATCH NUMBER TCEN a g� 08 09/2008 08001 .0940 - -- CF.,.C�14X,694 9 ~. The PLUMBING CONTRACTOR Named below IS CETMFIED: Under the provisions of - :Chaptdr Expiration date: AUG 31, 2010 MECIAS, ANTONIO i l91 DISCOVERY PLUMBING CORP 3181 SW 129TH AVE MIAMI FL t CHARLES W . DRAGO CHARLIE -CRIST = _ SECRETARY GOVERNOR p {;p1 gS iJIRED BY LAW Mar 05 2010 10:45RM BESTWRY 3055951881 P.1 DATE (MMlDONYW) �,..,.,_ • _ _ CERTIFICATE OF LIABILITY INSURANCE _ 03M511,_ THIS CERTIFICATE tS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGWTS UPON THE CEf�TiFICATE HOLDER. THIS CERTIFICATE DOES NOT-AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT, Bthe Certliicate IHIIdeF IS an ADDITIONAL INSURED, the paltcy#n) RUM be srldmwd. ffAUBROGATION IS WARPED, suhjeetto the terms esd condtllolur o9the PWCY certain P011CIM may rMire sn 004forsement A stohnuent on8ft coffliedo does not confer tights to the � cerdROate holder fn Hen of Such andoreemenNal. PRODUCER Beslway Insurance Group 12218 SW 8 Street Mleml, FL 33184 Phone (3{)6)895-5727 INSURED Dbmmy Plur g*g. Corp 13300 SW 47th Street # 205 M -Iami, FL 33175- (306) 486,9105 Fax (3D8)595 -1881 II IRER[3t AFFORD= COVM M INaplreatw AMERICAN VEHICLE INSURANCE COMPANY COVERAGES CERTIFICATE NUS: REVISION NUMBER: _ THIS IS TO CERTHY THAT THE POLICIES OF NSURMCE LISTED BELOW 84EN ISSUED TO THE INSURED PE RED NAMED ABOVE FOR THE POLICY RIOD INDICATED. NOTWITI- ISTANDING ANY REQUIREMENT, TERRA OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VM RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, = EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM& A R, TYPE OF DISURA E P PtxtUT UP E7iP LIMITS . GENERAL LIABILITY ® COMMER (AI. GENERALLPALnY ❑ ❑ CLmAS -mm ❑ O=R ❑ ` — _NUMBER 839-QO 03H &/2009 0315/2010 _ EACH OCCURRENCE .� $ — PERSONAL & AW INJURY ❑ _. —.. —. _— GENERALAGGX-GATE $ MNLA0l3REGA' E LUT APPLIES PER ❑ POLICY El ? T ❑ Loc -- $ PRODUCTS - C IDP AGO - -- $ AUTOMOBILE !lABBJTY ANY AUTO — COMBINED SINGLE LMT (Es aa*JMt) —� $ BODILY INJURY (Pw pm m) S ❑ ALL OUYPtED AUTOS —� I3 $ $ _ .. ❑ SCH EDU':.ED AUTOQ ❑ HUM AUTOS NON -OWNED AUTOS � BODILY INJURY (PW PROPERI DAN%W ;PrxacciQm�tj $ A ❑ UZURELLAIJI i ❑ 0(: UR EACH OCCURRENCE Omm UA43 ❑ CLAIM84%M 'OEDUmT01.1$ _ AGGREGATE $ ❑ A NIA OMMPTION DFOPERATIONSI LOCATIONS I VEHICLE8 (Aliach AC=101, A*Wanm Rwnnb Se CERTIFICATE HOLDER - — CA SH SHORES VILLAGE TH MIAMI SHO � AC 10050 N.E 2 AVE 4 MIAIIAI SHORES, FL 33138 rAUT ACORD 25 (2009108) $F 300.000 300.000 Receipt Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Number: PL -12 -06 -3047 Invoice Number: PL -2 -07 -27461 Applicant: CAROL RESPONDEK Company Name: Owner Address: 1162 NE 105 ST MIAMI SHORES, FL 33138• Job Address: 1162 105 Street NE Miami Shores Village, FL Date Payment Type Check Number Amount Change Friday, February 9, 2007 02/09/2007 Credit Card $264.73 $0.00 Total Payment: $264.73 Page 1 of 1 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Permit Status: APPROVED Issue Date: 2/812007 Expires: 0810712007 Permit Number: PL -12-06 -3047 Owner's Name: CAROL RESPONDEK one: Permit Type: Plumbing - Residential Work Classification: Addition /Alteration Parcel #: Block: Job Address: 1162 105 Street NE Section: Miami Shores Village, FL Contractor(s) Phone Primary Contractor VEGA & SON PLUMBING INC Yes Additional Information Type of Work: PLUMBING Type of Piping: Additional Info: Bond Return Classification: Residential In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Amount CCF $4.20 Education Surcharge $1.40 Notary Fee $5.00 Permit Fee - Additions /Alterations $245.00 Scanning Fee $3.00 Technology Fee $6.13 Total: $264.73 Building Department File Copy •n y _ Applicant Signa re 1122320280150 Lot: PB: Total Square Feet: 0 Total Valuation: $ 7,000.00 Invoice Number Amt Due Amt Paid PL -2 -07 -27461 $264.73 Total: cc- I �ak SEB 09 PAS NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ` Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING OdNoz- ^ L Permit No. PERMIT APPLICATION IfC.11. Master Permit No. 62 2-(26-5— I L43-1 FBC 2001 Permit Type (circle): Building Electrical f Plumbin`g7 Mechanical Roofing Owner's Name (Fee Simple Titleholder) I L Owner's Address 1 i G,) k"P t t-,< ft'° Phone # 3 CS ' 62:7 n City yrcvv�t ��ara_State FL Zip I JG Tenant/Lessee Name Phone # Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO y,/ Contractor's Company Name V F- 6.4 5 y1V P L 0 M b) e # '( j ' Contractor's Address —1 05 15- k/ go 4 yE City P l lV E IQ S 7 State �� Zip 3,3/16 Qualifier %� / % � � , ly & 6-A State Certificate or Registration No. k r 0 0 3 i� 07''1 Certificate of Competency No. C,)Cf) 0 0 C Z-- 4 5 Architect/Engineer's Name (if applicable) t*ac{�. ^-r �� Phone # � % • • i C7 $ Value of Work For this Permit -7, ��% x �, S/� Square Footage Of Work: Type of Work: ZAddition ❑Alteration ❑New ❑ Repair/Replace ❑Demolition Describe Work: It i D A p0M a -I QAI OA/ 1 x(10 tit A04 !)l X O PM j (j /) /7/0A/ CJ Af %= %/Q r l- IJf7BQ . Submittal Fee $ Permit Fee $ CCF $ 4- 20 CO /CC. Notary $ S' Training/Education Fee $- I . qo _ Technology Fee $ �• Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $_ 'L(ri `t • J FEB 0 9 PAID (Continued on opposite side) Cc_ 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. Signature Signature / /�,�- %,Ji.�x+.X . t� ner or gent Contractor The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced As identification and who did take an oath. 1R The foregoing instrument was acknowledged before me thisj&l day of 1 ­�VC. , 20 Ct by S f0,9k , who is personally known to me or who has produced (r J t /C- V2M Y 13 $b as idemifcation and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: L Sign: Sign: Print: Print: All My Commission Expires: My Commission * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY l02 %V 0' . _<2l Plans Examiner Engineer Chc Oi/13/03 Zoning -y ADDENDUM TO BUILDING PERMIT APPLICATION (AN A£PLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL ME CHAN I CAL ITEM BATH TIE BIDET UNIT ! FEE ITEW IMiT SWITCH OUTLETS LIGHT OUTLETS FEE ITEM IAdIT SPACE HEATERS CENTRAL HEATING FEE DISHWASHER DISPOSAL DRINKING FOUNTAIN FLOOR DRAIN GREASE TRAP INTERCEPTOR LAVATORY LAUNDRY TRAY CLOTHES WASHER SHOWER SINK, POT /3 COMP. SINK, RESIDENCE SINK, SLOP TEMPORARY WATER CLOSET �� ' RECEPTACLES SERVICE TEMPORARY SERVICE SIZE IN AMPS SERVICE REPAIRAMETER CHANGE APPLIANCE OUTLETS RANGE TOP OVEN WATER HEATER MOTORS D- 1 FP MOTORS OVER 1- 3 1P MOTORS OVER 3- 5 HP MOTORS OVER 5- 8 HP MOTORS OVER 8- 10 HP MOTORS DO 10- 25 HP A/C (WINO) A/C (CENTRAL) DUCT WORK REFRIGERATION PROCESS AND PRESS PIPING UNDETRGRaX TANKS ABOVE MOUND TANKS U.F. PRESSURE VESSELS STEAM BOILERS HOT WATER BOILERS MECHANICAL VENTILATION TRANSPORTING ASSEWLIES ELEVATORS/ESCALATORS FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 If VIOLATION INDIRECT WASTES A/C WINDOW REI,NSP,ECT)ON WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER . FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW IHST. GENERATORS ' TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS •SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOG( UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS GRAINFIELD, 4' TILE/RES. - VIOLATION PUMP & ABANDON SEPTIC TALC .. REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA GRAIN ROOF INLET I SOLAR WATER HEATER I FIRE STANDPIPE i I POOL PIPIIG I E I LAWN SPRINKLER SYSTEW. GAS RAFRGE I METER SET (GAS) Gas PIPIk ^.• Inspection Date: 0510212008 Inspector: Levrock, James Owner: RESPONDEK, CAROL Job Address: 1162105 Street NE Miami Shores Village, FL Project: <NONE> Permit Type: Plumbing - Residential Inspection Type: Underground Rough Work Classification: Addition /Alteration Phone Number Parcel Number 1122320280150 Block: Lot: Contractor: VEGA & SON PLUMBING INC Phone: (305)598 -8880 Building Department Cnmmpntc PL FOR 2ND STORY ADDITION �OD® I pec or Comments Passed 4 Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled until re- inspection fee is paid. Thursday, May 1, 2008 Page 1 of 2