DS-14-542Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 209321 Permit Number: DS -3 -14 -542
Scheduled Inspection Date: March 25, 2014
Inspector: Rodriguez, Jorge
Owner: RODRIGUEZ, LUZ
Job Address: 1095 NE 95 Street
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Miami Shores, FL Phone Number
Parcel Number
Project: <NONE>
1132060143630
Contractor: CHAMPION CONCRETE Phone: (305)252 -8055
umming uepanment comments
REPLACING EXPIRED PERMIT DS06 -2399
REMOVING OLD WALKWAY AND PUTTING IN A NEW
ONE IN FRONT OF THE HOUSE
INSPECTOR COMMENTS False
March 24, 2014 For Inspections please call: (305)762 -4949 Page 23 of 35
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 24, 2014 For Inspections please call: (305)762 -4949 Page 23 of 35
50S - -7 (b 2-
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 7MAR 19 2014
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PRONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: BUILDING
e5�-,"C 24
Permit No. �qs % t_1 — SW
Master Permit No.2 5 19 —
'11M106
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 07-_' Ea q fttU �a Phone #: ,�-> 77')2 °2 X
Address:
City: rni f i cn i s s State: $= 0 Zip: 55 152
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: C t � �%i�1�L Phone #: 252 tlV O
Address: //�� (®o l V ty'3 5�
J14 City: aDQ State: �- Zip: 33 +-%0
Qualifier Name: 4- � "1 n 4) Phone #: a
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 1r �� Square/Linear Footage of Work: !�
Type of Work: OAddition OAlteration . ONew ORepair/Replace ° Opemolitiop
Description of Work:
Color thru tile:
Submittal Fee
Scanning Fee $
Permit Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
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 deli eyed to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be osted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the abse ce of s h posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature (rte I. A — stF,
U
Owner or Agent
The foregoing instrument was acknowledged - befo�rJyme��%1436
day of, 20ff, by ��%� `• l�+W
who is personally known to me or who has produced
D. L • As identification and who did take an oath.
v
Signature
Contractor
The foregoing instrument was acknow dged before me this,/
E►day of , 20 a, by l Q
who its personally known to me ho has produced
� fll��aas identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: / FA4
Print:
My Commission
tddIICHELE RENNEW
Commission # EE 101767
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