PL-13-1466Miami Shores Village
Building Department
11050 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: 13.5 21 A� ,Oy_/jy�
JUN 2 : aJ
BYem
FBC 20
Permit No. l 3
Master Permit No.
64? n7%6
City: Miami Shores County: Miami Dade Lip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO 141uod 'Lone:
OWNER: Name (Fee Simple Titleholder):O`e r Sa4�% Phone#:J��`���
Address:__
City: ,/d/�":� r" f,' Q%1S State:
Tenant/lessee Name:
Email.
'7 Monet. company Name:/®f�h�s��
,#.- /9'P / B /no/ s
Address: Zreaa A
City:
Qualifier Name:�� Ad L
State Certification or Registration #
IJ Soe%®
Contact Phone#: Email Address:
of Competency #:
DESIGNER: Architex tiEngine er: Phone#:
J
J
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work. L3Address _ LIAlteration ONew Rfi epair/Renlace (]Demolition
ksR�H+��@BQ�sash£�ask�tRsRs���a%R�nksR��AaRsR4�E«Qask�fi�+R kid+�+HaksA��?E�Bt�$eS�sR�kaR<'��#S+sk��AAe�skPR&��s&�sR��&S��s$giguksRsRsR$
Submittal Fee $ Permit Fee $ �ZS . CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond
Notary $ TraininglEducation Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $ 1%.14
r ♦ . t♦
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, E' l -C.....
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 14
„day of 2 , 2011 , by
who is personally known to me or who has produced
NOTARY PUBLIC:
Sign:
Print: t, S'"
My Commission Expires:
Contractor
The f�iniwturwumnent was ackn ledged fo thisday, 20 by
,Tho is pe onall�r k>o wttme or who has produced
"PROVED BY a --M<„ 3 Plans Examiner �OJ � Go ng
Structural Review Clerk
(Revised31I M12)(Revised 07/10/07)(Revisd 06d10PMXRevised :3/15109)
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-194440
Scheduled Inspection Date: November 07, 2013
Inspector: Diaz, Osvaldo
Owner: PETERSON, DIRK & ELIZABETH
Job Address: 1350 NE 101 Street
Miami Shores, FL
Project: <NONE>
Permit Number: PL -6-13-1466
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number
1132050230020
Contractor: DOLPHIN POOLS & SPAS INC Phone: (954)927-6537
Building Department comments
PLUMBING TO INSTALL A NEW CHLORINADOR AND Infractio Passed Comments
NATURAS GAS HEATER. I
INSPECTOR COMMENTS False
Inspector Comments
Passed Df_
Failed �1Z. NY`I✓ SAS
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
November 06, 2013 For Inspections please call: (305)762-4949 Page 8 of 40
e '
Miami Shores Village
CCF
10050 N.E. 2nd Avenue NE
DBPR Fee
$2.25
Miami Shores, FL 33138-0000
$2.25
Phone: (305)795-2204
Project Address
Permit Fee
1350 NE 101 Street
Miami Shores, FL
Parcel Number
1132050230020
Block: Lot:
DIRK & ELIZABETH PETERSON
Owner Information Address Phone Cell
DIRK & ELIZABETH PETERSON 1350 NE 101 ST
MIAMI SHORES FL 33138-2611
Contractor(s) Phone Cell Phone
CAPITAL GENERAL CONTRACTORS 1 (305)827-6211
Type of Work: PLUMBING
Type of Piping: GAS_ ------
Additional
.___Additional Info: WATER_ & POOL HEATER i
Bond Return :
Classification: Residential Scanning: 1
Fees Due
Amount
CCF
$1.60
DBPR Fee
$2.25
DCA Fee
$2.25
Education Surcharge
$0.60
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$2.40
Total:
$162.30
Valuation: $ 2,400.00
Total Sq Feet: p
Pay Date Pay Type Amt Paid Amt Due I
Invoice # PL -8-13-48690
08/05/2013 Check #: 2759
08/12/2013 Check #: 2785
$ 50.00 $ 112.30
$ 112.30 $ 0.00
Available Inspections:
Inspection Type:
Final
Press Test
Review Plumbing
Applicant Copy
For Inspections, Call (305) 762-4949 or Log on at https://bldg.miamishoresvillage.com/cap/.
Requests must be received by 3 pm for following day inspections.
NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
additional restrictions applicable to this property that may be found in GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
the public records of this county. DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
August 12, 2013 2