PL-14-1357Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL I
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number. INSP-214792 Permit Number: PL -6-14-1357
Scheduled Inspection Date: August 12, 2014 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Owner: FERNANDEZ, MARTA
Job Address: 163 NW 102 Street
Miami Shores, FL
Project: <NONE>
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1131010230060
Contractor: TWIN BROTHER Phone: (305)332-1969
Building Department Comments
REMOVE AND REPLACE PLUMBING FIXTURE lnfractlo Passed comments
INSPECTOR COMMENTS False
Inspector Comments
Passed Eg�
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional inspections can be scheduled until
reinspection fee is paid.
August 11, 2014 For Inspections please call: (305)762-4949 Page 11 of 39
Miami Shores Village
Building Department JUN 24 �t4
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 201,E
BUILDING Master Permit No.v_ C-14 1
PERMIT APPLICATION Sub Permit No_
1
F-1 BUILDING
❑ ELECTRIC
❑ ROOFING
❑ REVISION
❑ EXTENSION
❑RENEWAL
PLUMBING
❑ MECHANICAL
❑PUBLIC WORKS
❑ CHANGE OF
❑ CANCELLATION
❑ SHOP
zip:
Folio/Parcel#: ktt az) ° 0'27:;1-
Coco
Cob®
Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
CONTRACTOR: Company
Address: V-0110
City: r,
Qualifier Name:
FL
Phone#:
one#:
State Certification or Registration #: e; -:e_ 0 %/ >" Certificate of Competency #:
-30-5; ;1132 /4(0Y
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $?DOOt Square/Linear Footage of Work: Lis
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: � QAea, &C P LU NA Sk &j t, n yrVYz-k—_-?'
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
77"—
Scanning Fee $
Technology Fee
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $
CONTRACTOR
DRAWINGS
JOB ADDRESS:
1
City: MiaShores
Miami Dade
zip:
Folio/Parcel#: ktt az) ° 0'27:;1-
Coco
Cob®
Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction
Type: Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
t - `�"�
�-� ��2
�-
Phone#:®JJ' CJ 1 I
Address:
City:
State:
Zip: sit
Tenant/Lessee Name:
Phone#:
Email:
CONTRACTOR: Company
Address: V-0110
City: r,
Qualifier Name:
FL
Phone#:
one#:
State Certification or Registration #: e; -:e_ 0 %/ >" Certificate of Competency #:
-30-5; ;1132 /4(0Y
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $?DOOt Square/Linear Footage of Work: Lis
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: � QAea, &C P LU NA Sk &j t, n yrVYz-k—_-?'
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
77"—
Scanning Fee $
Technology Fee
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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
2 d day of _ 20 by
Mal-li
who is personally known to
me or who has produced FLyL#-FG55"5g5'G4-S9'3a-0
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal: e-% REBECA M. PASn"
MY COMMISSION 0 EUM24
EXPIRES: Fehuwy 07, 2017
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
_23 day of 20.144 by
Xl 0A�te2 who is personally known to
me or who has produced 't!NL-* 52n \,E, as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal: ao°'�"" REBBCAM.PASTRANA
MY COMMISSION S EEVM24
EXFqRES:F&r=y07.2017
APPROVED BY Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk