RC-13-1531 (3)Miami Shores Village
Y 8 2014
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
FBC 20
BUILDING Permit No. 'A�?e �7_/g -1.5-9/
PERMIT APPLICATION Master Permit No t_-- 14 — 9 4 2—
Permit Type: PLUMBING
JOB ADDRESS: ��`
City: Miami Shores County: Miami Dade Zip: '391
Folio/Parcel#:
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple
NO Flood Zone:
Tenant/Lessee pName: - _ / Phone#:
Email: Ci���%� T g a-01 a ow
A34�= �2,
EVA
CONTRACTOR: Company Name: ILASS tt' iZ /)L l)1'� 2 BjA'6 Phone#: 36 ` q3d 7/ NO
®
Address: ®6S_ / w®e ° /30 S
City: -/Inf eim / State: Zi _3316 _
Qualifier Name: %7�:T.f �= T�� Phone#:
State Certification or Registration #: C ` C 01160 f l0 Certificate of Competency #:
Contact Phone#: 3®S �� `�'®7 S Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 1000 . c -SLD Square/Linear Footage of Work:
Type of Work: ❑Address UAlteration UNew ORepair/Revlace ❑Demolition
Submittal Fee $ 15DPermit Fee $ /So' s CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $
W
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, 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.
A4
Signature Signature
�4
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this _qa
day of , 20 �7, by -�%1`l�l OOt1 C,0',e/+),4f/d0,
who i rson ly kno me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:C445���6"�
Print: C-,ff/e1S7 (10 11 A4
My Commission Expires:
day of
who is
to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: c4u�t�-- —Po:i�e4
Print: c, *12.1S7-/ ol2
pOfOMpRM My Commission Expires:
10% 9EE 871216 „ y pPORRAS
p�yS NtQy 3D, 2017.x` ' 'O• ply �11=ISS1pN s eE 871216
_. _` rn,aNe UndefYrtitecs . ±%. vn arc• AAav 30, 2017
APPROVED BY Plans Examiner .
Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-212125
Scheduled Inspection Date: May 27, 2014
Inspector: Diaz, Osvaldo
Owner: ENCARNACION, SHIRLEY
Job Address: 1125 NE 92 Street
Miami Shores, FL 33138 -
Project: <NONE>
Permit Number: PL -5-14-942
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number
1132050270380
Contractor: LASSETER PLUMBING CO INC Phone: (305)525-5075
tsuuamg ueparEment uommenrs
BATHROOM REMODEL.
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
S
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
May 27, 2014 For Inspections please call: (305)762-4949 Page 12 of 30