PL-13-23952� 13 -2343
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 212786 Permit Number: PL -10 -13 -2395
Scheduled Inspection Date: May 21, 2014
Inspector. Diaz, Osvaldo
Owner: ROGERS, SHAUN D & NADINE M DAVE
Job Address: 121 NE 100 Street
Miami Shores, FL
Project: <NONE>
Contractor: PSG PLUMBING SERVICES, INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)756 -7345
Parcel Number 1132060132040
Phone: (305)796 -7304
Building Department Comments
REPLACE SINK, GARBAGE DISPOSAL AND DISH
WASHER
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
0�
Correction
Needed
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 201755.
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
May 20, 2014
For Inspections please call: (305)762 -4949
Page 30 of 30
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 rq1,7;
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20 LC)
Permit Type: PLUMBING
1TJD
Permit No [ ✓ [ 5
Master Permit No. 2-C --13 '.13q3
OWNER: Name (Fee Simple Titleholder): e / ith "eV ,� r" 5 Phone#: »3 °
Address: /W LW (WV—
City: Affig4 / 1 State: Zip: , 7.
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: f at !VC" /00 ."? p.
City: Miami Shores County: Miami Dade Zip)7 /L
Folio/Parcel#:
Is the Building Historically Designated: Yes NO X. Flood Zone:
CONTRACTOR: Company Name: 5 C. (,cA.ttit.df r it ) 6 M+ d C Ydhone #: • " 7(J) If
Address: 3 $T7� -;. Q.iiri / ar. f"
City: 10.4 --- 4 G COLA State: zip: 3 3a3 %.,
Qualifier Name: ‘.7%.0 4.0 �► tact Z. � � Phone#:
State Certification or Registration #: (1"� (i-( 6 Z 5-7 Certificate of Competency #:
Contact Phone#: 3 o5"-796 -73 a iff Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ ()D C) Square/Linear Footage of Work: 1 L�
Type of Work: Address °Alteration °New, SJ Repair/Replace °Demolition
Description of Work: 7P ot`K 4e l�'Wl,1 �e �$cd�r� yam' 63..eb e
****+ x* ************** ***** ************** Fees** ******* ********* ********* * **** ************
Submittal Fee $ Permit Fee $ i /50 . CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ J O ! ' c
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 F.T.RCTRICAL 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 $2500, the applicant must
promise in good faith that a copy of the ice of commencement and construction lien law brochure will be delivered to the person
whose property is sub• 'c • • attach t. Alss a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspecti n whit occ rs seven ' ) days after the building permit is issued. In the absence of such posted notice, the
inspectio , will not < approv: d a a pection fee will be charged.
Signature / : il_ %lam _ _ ignature
O s r Agent Contractor
The foregoing instrument was acknowledged before me this \12 The foregoing instrument was acknowledged before me this / l
day of rJ , 20 ‘3 by t1 - \V . oS''-`r$ , day of , 20 13, by •
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
otv. 4u11, MARK
MY COMMISSION # EE 163931
Sin * * Sign:
Print: Print: E vic2 \(%C @f Bonded Rau Budget Notary Seim
who is personally known to
as iden fic
NOTARY PUBLI
My Commission Expires:
or who has produced
tion and who did take an oath.
° I�-
4.) : •••• % ° `I .EN MONIES DE OCA
My Commission Expires: 4.
MY COMMISSION # EE 094840
EXPIRES; June 15 2015
ces
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009XRevised 3/15/09)