PL-14-630Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-209932 Permit Number: PL -3-14-630
Scheduled Inspection Date: November 04, 2014
Inspector: Diaz, Osvaldo
Owner: TIMS, DONALD & MELANIE
Job Address: 301 NE 93 Street
Miami Shores, FL 33138 -
Project: <NONE>
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Pool - Private
Phone Number
Parcel Number
1132060136230
Contractor: REGENCY POOL & SPA OF FLA INC Phone: 954-424-0134
t3uuaing lueparltment comments
POOL PIPING
INSPECTOR COMMENTS False
Inspector Comments
Passed E�' k
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
November 03, 2014 For Inspections please call: (305)762-4949 Page 5 of 33
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795MM Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (303) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
Ma��1n
"c 2(PL
Master Permit
JOB ADDRESS: 301 NE 93 Street
City: Miami Shores County: Miami Dade Ap. 33138
Folio/parcel#; 11-3206-013-6230
Is the Building Historically Designated: Yes NO XX Flagyl Zone:
OWNER: Name (Fee Simple rdeholder): Donald Tims & Melanie Chung phone*
Addrem;301 NE 93 Street
City; Miami Shores State: FL zip; 33138
Tenantflxuw Name: Phone#:
Emafi:
CONTRACTOR: company Name: Regency Pool and Spa of FL, Inc phone* 954-583-7373
Ate; 6507 NW 13 Ct.
City; Plantation state: FL .33313
Qualifier Name: Rafael Imbert phone#: 305-684-3804
State Certification or Registration #. CPC056811 ONdfifcate of Competency #:
Contact Phone#: 954-583-7373 Email Address: midam@regencypool.com
DESIGNER: Architect/Bn&ew Qfella Taboada/Aquadynamics phone#: 305-667-8975
Value of Work for oris Permdt: $ 7/` SgreaJnear Footage of Work
Type of Work: OAd&m ULteration _ 011ew ORepair/Replace
Description of Work:
Submdttal Fee $ Permit Fee $ 1 2z 15 - CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Edncetlon Fee $ Tecbnology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
UDemolition
Bonding Company's Name (if applicable)
Bonding Company's Address
Ei
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 m this jurisdiction. I understand that a separate permit most be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I cel 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
MPROVEMENTS 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 certoed copy of the recorded notice of commencemew must be posted at the job site
for the first inspection which occurs seven (7) days after the buildbig permit u issued In the absence of such posted notice, the
inspec will not be approved and a reinspection fee will be charged
Signature Signature
or Agent
The foregoing instrument was achowledged before me thi�
day of fbarm—+ 20- by & yanl
who is Wally known t me or who has produced
As identification and who did take an oath.
NOTARY
'A%
who is personally known to me or who has produced
as identification and who did take an oath.
My`6mmission Expires: W CQN�am
EXPIRES: 4
eel Two Ns
•br Wli4tMW�U9�«t�uYIuMYWuh�M/�t4M*N�! WM�MIiWI+�MMO�QtiYMNF�M+�lMtPlti+
APPROVED BY :7 - F -/y Plans Examiner
Structural Review
Mwised311212012)0tcvised 07t1W9n0 Asad om=W)(Revised 3115�)
NOTARY PU BLIC:
Print~
My Con missio 1�•.,, RAFAEL A. PELLERANO
2�. B`�•s Notary Public - State of Florida
;. ; ; • My Comm. Expires Jul 21, 2016
z a' `o`o Commission # EE 211333
Zoning
Clerk