PL-14-1086It
4 -
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-213122 Permit Number: PL -6-14-1086
Scheduled Inspection Date: November 24, 2014 Permit Type' Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: SEGAL, ILAN Work Classification: Gas
Job Address: 500 NE 96 Street
Miami Shores, FL 33138 Phone Number
Project: <NONE> Parcel Number 1132060140700
Contractor: EMPIRE PLUMBING COMPANY Phone: (305)531-7017
euliding Department comments
INSTALL Tank less HAS HEATER WITH UP TO 50' OF GAS Infractlo Passed Comments
PIPE INSPECTOR COMMENTS False
Inspector Comments
Passed Eq,
Failed
Correction ❑ �
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid
November 21, 2014 For inspections please call: (305)762-4949 Page 9 of 44
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 20
Master Permit No. y_a i - 1096
Sub Permit No. p ( i Li " i o F6
❑ REVISION ❑ EXTENSION ❑ RENEWAL
LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 50c) m E 9i& 54 re -e 4
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: (��-® (A D 14 O 16 C, Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
OWNER: Name (Fee Simple
City:
Tenani
Email
®® K) e, `&
Construction Type: Flood Zone: BFE: FFE:
regi
SecicLl Phone#: cO J 5C),9 (QADrv?
1QAO 1 V'10 r e$ State: T t0 C ( tNR Zip: Ca `z�E_
CONTRACTOR: Company Name: L Mpl C M' V iV��fYlel Lid a Phone#: (3c)(5-5317-66"
Address:I_�
�// /
City: � i0.N 1 . i- / State: (O i'' i d-� zip: � (13
Qualifier Name: L �( e r+ 0 C 2 / Phone#: 60_5 J-3/ � f
State Certification or Registration #: C)0'1 -f J l (0 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: ,+� City: State:
V
Value of Work for this Permit: $ frl ' ® Square/Linear Footage of Work:
Type of Work: F-1AdditionLSI .Alteration ❑ New ❑ Repair/Replace
Description of Work: 1V\,
V
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
CCF
DBPR $
UU r�
Zip:
Demolition
L_ �=9
Bond $
TOTAL FEE NOW DUE $ ( o
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved andAreinspection fee will be charged.
Signatu
1117
The foregoing instrument waVVacknowledged before me this
1 day of 20 by
—:04 Vq Gla I who* ersonally know o
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sigri%
Print: ry
Seal: 7i ��$F1069t54
Bores March 7,2D18
Boa�ThuT Falelm�oel Ono
Signature\i�
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of H cLtA F 20 J by
`So&4 E t1owL • who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
""••• YAJAIRASM
MY WWISSION i FF 055390
Sign: EXPIRES: DwWber21, 2017
• u• a
Print: ydt\4o 07- 47
Seal:
as
APPROVED BY S L ! r Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)