PL-14-1011Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL + IC)09Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-212595
Scheduled Inspection Date: August 27, 2014
Inspector: Diaz, Osvaldo
Owner: BROWN, JACKI
Job Address: 895 NE 95 Street
Miami Shores, FL
Project: <NONE>
Permit Number: PL -5-14-1011
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number (317)431-8575
Parcel Number 1132060142950
Contractor: DALE PLUMBING Phone: (786)663-1804
tsunamg uepartment comments
REPLACE FIXTURES RELOCATE KITCHEN SINK Infractio Passed CommentsINSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
0
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
August 26, 2014 For Inspections please call: (305)762-4949 Page 2 of 14
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
MAY 15 2014
n
:
FBC 20 16
BUILDING Master Permit No. ' %! -
PERMIT APPLICATION Sub Permit No.� t%/ A/ — 16 ;
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION F-1 RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
p CONTRACTOR DRAWINGS
JOB ADDRESS: 8 l 'g I�%f✓ �J"� ' STpCs's�-'r
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): C.K 13 kOPhone#: 7
Address: lV IF 15 rAE_ T
City: M 1"6 1 :5 NOR &__5 State: FL Zip: 3_3j"_58
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ✓'a �C/H ' V f pjc Phone#:
Address: f-a'�/-/`VAJ 9i
City: "/.V"- S'i�t3/�Gc1� State: D.e ! D Zip;
Qualifier Name: 150� aiAd�.�/i✓s Phone#: 78'ft"
State Certification or Registration #: ej'G /4-2 >og 7 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
6G3 /roti'
Address: City: State: Zip:
Value of Work for this Permit: $ e• z C -v Square/linear Footage of Work:
Type of Work: ❑ Addition 0 Alteration �❑ New Repair/Replace ❑ Demolition
Description of Work: � /� X cJ zz tz.r d GA ;;r� At 7 -ch'— W -sWk
Specify color of cco�l^,or/thru tile:
Submittal Fee $ J (J ' l Permit Fee $ ' x= CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
DBPR $
Notary $_
Double Fee $
Bond $ D
TOTAL FEE NOW DUE $ (7
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City x 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.
r
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day ofGi.1% 20 C by
who i nally known`
me or who has produced
i
Signature
CONTRACTOR
The for going instrument was acknowledged before_ /me this
day of 20 W , by
as me or who has produced
who is personally known to
identification and who did take an oath. identification and who did take an oath.
as
NOTARY PUBLIC: NOTARY PU LIC:
Sign U ,( Sign:
Print: Lug VK Print: t/Vit,
Seal: Seal: FA Ey
Aa A4PAFJVV
LAURA FARLEY_ ,, LAURA
/ MY COMMISSION # EES3276 .�% MY COM1vI[SSSON # EE53276
'til EXPIRES: March 16, 2015 EXP1R£S: March 16, 2015
t 3•NoTARY R Notary Di—at Aaeoo, Co.
APPROVED BY 6'S'i `f Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)