DS-07-406®Rs
Inspection Worksheet
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Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
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Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 1012212007
Inspector: Grande, Claudio
Owner: , JIFFY LUBE
Job Address: 8787 BISCAYNE
Project:
Miami Shores Village, FL
<NONE>
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: New
Block:
Phone Number
Parcel Number 1132060280450
Lot:
Contractor. PETROLEUM AND CONSTRUCTION SERVICES INC Phone: (954)942 -1117
Building Department Comments
REQUIRED CONCRETE ASPHALT WORK FOR SEWER
CONNECTION
Passed
Failed
Correction
Needed
Re- Inspecti
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Thursday, October 18, 2007
OCT 2 3 2001
Inspector Comments
MV /
W P 4-
st•
Page 2 of 2
Permit Status: APPROVED
Issue Date: 3/8/2007 Expires: 09/04/2007 Permit Number: DS- 3- 07-406
Owner's Name:
Phone:
Permit Type: Driveways /Sidewalks /Slabs
Work Classification: New
Job Address: 8787 BISCAYNE Boulevard
Miami Shores Village, FL
Contractor(s) Phone Primary Contractor
PETROLEUM AND CONSTRUCTION (954)942 -1117 Yes
Additional Information
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
$0.60
Education Surcharge
$0.20
Permit Fee
$150.00
Scanning Fee
$6.00
Technology Fee
$3.75
Total:
$160.55
Building Department File Copy
Applicant Signature
Parcel #: 1132060280450
Block:
Section:
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 1,000.00
Invoice Number Amt Due Amt Paid
DS -3 -07 -27707 $160.55
Total: COWS
'MAR 12 PAID
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.
(Receipt
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Number: DS -3 -07 -406 Owner Address:
Invoice Number: DS -3 -07 -27707 PO BOX 2967
Applicant: JIFFY LUBE HOUSTON, TX 77252
Company Name: COMMERCE PARTNERSHIP #1124 % JIFFY LUBE
iniri nC nnn Job Address:
8787 BISCAYNE
Miami Shores Village, FL
Date Payment Type Check Number Amount Change
Monday, March 12, 2007
03/12/2007 Check 2828
$160.55 $0.00
Total Payment: $160.55
Page 1 of 1
MAR 0 2 2001
BY: - "---- - - - - --
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit NoV5474%
00 I
------------- - - - - -- :As
BUILDING
PERMIT APPLICATIO t00Z 0 �dWa
FBC 2004
Master Permit No.
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) V / jLy L y �2 Phone # 9fV its s ®q 9
Owner's Address P' 0 • 130X 2-1'j,?
City WOU SAV -I State �� Zip % % Z r o
Tenant/Lessee Name Phone #
Job Address (where the work is being done) J7 F7 tfi J c ay n P p
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # // - 3 2 O 6 - 0 2*9 -- O'f fU
Is Building Historically Designated YES NO
Contractor's Company Name /�� fi o �e �� A� vI r�0 KS 7 �K L/I one # �? � � g � Z
Contractor's Address
City 'AVCJ ,r� State �L Zip 32- !D
Qualifier - Name , If ri%tOV a-1,1 "4 Phone # 1 '5- �4 Z 111
State Certificate or Registration No. C.?C 49Yr07 2- Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Da
Value of Work For this Permit $ /0 b O i-
Type of Work: Addition ❑Alteration
Describe Work: go- .7 ✓ c r- o n C
Square / Linear Footage Of Work:
J
v
❑ Demolition
* * * * * * * * * * * ** * * * * *�* * ** Fees: r**
Submittal Fee $ Permit Fee $ � � CCF $ e (00 CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ ,
Bond $
Structural Review. S
Radon $ DPBR $ Zoning $
Code Enforcement $ Double Fee $ 2 DA
�
Total Fee Now Due $: • W r
See Reverse side P.
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
Owner or Agent
The foregoing instrument was acknowledged before me this
day of Joe � , 20 D 7, by
who is personally known to me or who has produced_
As identification and who did take an oath.
NOTARY PUBLIC:
Y P e Gary Kilgore
Sign: ��° ommission # DD518327
Print: `"� o` Expires April
•in- leaarance,Inc. 800.385-7019
My Commission Expires:
Contractor
The foregoing instrument was acknowledged before me this
day of X-- J , 20 02, by oeld.. —1 /i!L
who is personally known to me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
:commission # DD518327
Print: oY Fxr 310
Or F%- Bonded Troy Fain - Insurance, Inc. 800.385.7019
My Commission E
APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning