PL-12-1005Miami 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
FBC 20 L3
Permit Type: PLUMBING
RECEIVED
A�
JUN 012011
2
LAY —
Permit No. 'PL4 2 — 1
Master Permit No. r e_a t cx:31
OWNER: Name (Fee Simple, Titleholder): T��i�l`.'w / tl" 1 �( kb 2& 7 Phone #Nea
Address: XO 1- (� C� - 9 c $-
City: k• iz *\ State: *O.- zip: ? .'(
Pi Pc
Tenant/Lessee Name:
Phone #:
Email: °s
JOB ADDRESS:
City: Miami Shores
Folio/Parcel #: 432130 ' t)V> ° b °
Is the Building Historically Designated: Yes NO >0 Flood Zone:
CONTRACTOR: Company Name: f'� G /��%�,!/� «�v //��; Phone#: ,.5.-2/91#6-#/
Address: c5 s'e �.
/�
City: A-t �/ State:
Qualifier Name: /� �C '! `Cv090-/l0.¢
County:
Miami Dade Zip:
Zip: .O3/3 .
Phone #: 14-0
State Certification or Registration #: Certificate of Competency #: € 9 /gOVIi /27
Contact Phone#: Email Address: D4 t tie-7`io, G Q ,V.
�1.
DESIGNER•( ngineer: VI POLK CAMP L`- Phone#: S 0 -` . S 7-8 ' 3 7
Value of Work for this Permit: $ 121 SIX)
Square/Linear Footage of Work: 'L
Type of Work: ❑Address ❑ Iteration ❑New ❑Repair/Replace
Derription of Work:
VACS Ckiikk
❑Demolition
Submittal Fee $ rmit Fee ' af�,,� CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 40.4. 4
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDmONERS, 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 QR 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.
Owner or Agent
The foregoing instrument was acknowledged before me this `3 ® The foregoing instrument was acknowledged before me thisZ1-
day of A f ' I , 20 l2. , by An ei r L c. kt- , day of �°tt 2t (,. , 20 12-, by i/ , ; (A
who is personally known to me or who has produced Flo Pad' who is p rsonally known to me or who has produced
.tits is L cerlSe5 As identification and who did take an oath. W. LAC' ot4 f itras identification and who did take an oath.
NOTARY PUBLIC:
Signature
Contractor
Sign:
Print:
My Commission Expires: le, 4)4 - zO I-
APPROVED BY
NOTARY PUBLIC:
Sign:
Print:
My C
Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15109)
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
V400M
Inspection Number: INSP- 191116 Permit Number: PL -6 -12 -1005
Scheduled Inspection Date: May 09, 2013
Inspector: Hernandez, Rafael
Owner: MORGAN, MARY
Job Address: 307 NE 95 Street
Miami Shores, FL 33138-
Project <NONE>
Contractor: A & C PORTELA PLUMBING
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)606 -2098
Parcel Number 1132060136000
Phone: 305/343 -2115
Building Department Comments
NEW BATH IN EXISTING BEDROOM AND REPLACE
SUPPLY LINES AND FIXTURES AS PER PLANS
Infractlo Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
May 08, 2013
For Inspections please call: (305)762 -4949
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