PL-13-2770F—.
Inspection Worksheet
Miami Shores Village 9
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 204314
Scheduled Inspection Date: January 23, 2014
Inspector: Diaz, Osvaldo
Owner: ,
Job Address: 70 NE 99 Street
Miami Shores, FL 33138-
Project: <NONE>
Permit Number: PL -12 -13 -2770
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)970,4124
Parcel Number 1132060131050
Contractor: REGOSA ENGINEERING SERVICES INC Phone: (786)262 -2964
comments
CAP OFF PLUMBING
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 22, 2014 For Inspections please call: (305)762 -4949 Page 9 of 22
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
FBC 20 Ct�
Permit No.? L�I 3 — '?�l -1 90
Master Permit No. PC 13��'j (01
JOB ADDRESS: �O &/F, I� og t e'z% �
City: Miami Shores County: Miami Dade Zip:
Foho/Parcel #: ( I — 3ZIO&— " 1 aco
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titlehollde�r).:.�- Pe/ \/5NW Rte, Lz Phone #:
Address:: �� �i,, " S -To %-:T
1 A
City: mi "m S"�s State: Zip: 3 3446
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company �Name:
(J
Addrew 7�V cri \ Sr S4
City:
Qualifier Name: , ) _ Phone,
State Certification or Registration #: c C 1 Certificate of Competency #:
Contact Phone #�U y0 Z � )6 7 Email Address: T0& 0R r4
DESIGNER: Architect/Engineer: Phone #:
Q3
Value of Work for this Permit: $ , ? <.. Square/Linear Footage of Work:
Zip: 3auco
6262. 6W
Type of Work: ❑Address . ❑Alteration ❑New ❑Repair/Replace ADemolition
i1 �A�. ����
Description of Work � m>� TA.��" u S A� ow> q0o 1 i f j
Submittal Fee $ Permit Fee $ ®Sej' CCF $ CO /CC $
Scanning Fee $ Radon Fee $
Notary
Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $ ti C/ - /�!
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: ' A ' s a condition to the issuance of a building permit with an estimated value ex e. 'ng _$2500,' the .applicant must
promise in good faith tat a copy of the notice of commencement and construction lien law brochu a ill die 'delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commence en t must be posted at the job site
for the first inspection ch curs seven (7) days after the building permit is issued. In the s ce of such posted notice, the
inspection will not be p d and a reinspection fee will be charged.
< a-
Signature Signature
v Owner or Agent
The foregoing instrument was acknowledged before me this , ®�
day of J)et-e1m6r 20 J& by 0-6 sioc L ®t Ic o
who is ersonally kn to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: kimbrxl �.
My Commission Expires:
APPROVED BY
KIMBERLY MARENCO
MY COMM"04 N EES50M
EXPMS November 08, 2016
The foregoing instrument was acknowledgeii:before m6this �
day of V 20 by
who ' onally kno to me or who has produced
Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: (J 1
My Commission
Commission #EE53278
My Commission Expire:
Zoning
Clerk