PL-13-2755Inspection Worksheet
Miat"ni Shots V111$g4
10060 N.E. 2nd Avenue Mini Shores, FL
Phorse.:(306)785 04 Pax,. j7664q -72
Inspection Number i 3P- 204100 Permit-Number. PL-12-4-34M
Scheduled Inspection Date: aril 08i 2014 Permit '%' : Piutrilsirtig - RWdenifal
Inspector: Dlaa, oev o
(rts�►eCii�ri 7�`y�►+6; �iri�tl
Owner: WALES, GONZALO ll JOHANNA Work -Oass cS.ftr Additto '1/Aft-l" n
Job Address.- 371 NE 10 Street
Miami Shares, FIL 3313$- Phone Number
Dart hl�rrn�r 113'�3i3g370
Project: <NONE>
Contractor. THE NM! MIAMI SHORES PLUMBING � Phone: (805 )757.
Passed
ED""I"ns""torcommen's
d�
Failed
Correction
Needed
Re-Inspoction
Fee
No AM*ml kti toot Mn beaftduled WW
re4flSpedoA % IS "id
April os, 2014 For Inspections pig call; ($0,W624046` Pa „9 of 37
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:
DEC 09 2013
FBC 20
Permit No. P1 13-' 4 5:!;:-
Master Permit No.^-90- ' It-13 - 2430
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #: 11 — .143 Zo — 013 — 01
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): S Phone#:
Address:
City:
State:
Tenant/Lessee Name• Phone#: �d
Email: ���v%, c�d�
CONTRACTOR: Company Name: d ®b �V cd� cJ��Q��1.(.1.� Phone#:
Address: _ -30 0 Al W IVY
City: 9 State: e �� Zip: *a3 dt &-�IJ �
Qualifier Name: " nQ J 41 Phone#:
State Certification or Registration #: 9-F 12/ us— Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
v�+,�, oca
Value of Work for this Permit: $ � 11 I Square/Linear Footage of Work:
Type of Work: OAddress OAlteration II ONew tepair/Replace ODemolition
Description of Work: 2 ��d IG G7 eu-1 i r
Submittal Fee $ Permit Fee CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE X a
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
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 $ OTICE OF COMMENCEMENT."
Notice to Applicant. As a ci
promise in good faith that a
whose property is subject to
for the first inspecti0 ,whic
inspection will not bep�pro�
snn
!� 'on to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
,fiy of the notice of commencement and construction lien law brochure will be delivered to the person
achment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
and a reinsnection fee will be charged
owner or
The foregoing instrument was ac
day ofbaKVJ.VL 20 tt�, by _
before me, this
Signature
Contractor
The foregoing instrument was acknowledged before
� me this LM
day of JJUr�, 20�, by �ns �1 "I
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath.
NOT Cc
"a o' NATHALIE ANNE FERNANDEZ
* •° Commission # FF 42370
Sign: M
Print:
„ August 04, 2017
My Commission Expires:
identification and who did take an oath.
NO TAR Q
•r•�:" NATHALIE ANNE FERNANDEZ
Sign: ; Commission # FF 42370
y ommission Expires
Print: �� „:.;:a� A—miSt 04, 2017
My Commission Expires:
APPROVED BY / Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 110 /07)(Revised 06110/2009)(Revised 3/15/09)
Zoning
Clerk