PL-13-2259Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-229479 Permit Number: PL -10-13-2259
Scheduled Inspection Date: March 12, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: OLIVA, TERESA Work Classification: Pool - Private
Job Address: 301 GRAND CONCOURSE
Miami Shores, FL 33138 -
Phone Number (305)807-1210
Parcel Number 1132060133850
Project: <NONE>
Contractor: PALM BEACH DESIGNER POOLS INC Phone: (561)308-2302
Building Department Comments
POOL PLUMBING Infractlo Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed __17] CREATED AS REINSPECTION FOR INSP-227269. PROVIDE CHECK
VALVE FOR WATER FILL
Failed
Correction L'
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
March 11, 2015 For Inspections please call: (305)762-4949 Page 19 of 32
Miami Shores village
Building Department
90050 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
R,101
Permit Type: PLUMBING
JOB ADDRESS: � 0
V,//nr4_r-4 t--
df "aye IB
�r
FBC 20 JV
Permit No.VLA9 J 9
Master Permit No. W13 e S 0'4"
City: Miami Shores County: Miami Dade Zip: 5 J D
Foho/Parcel#: d 1— 31 C (a ' 6 (3 3 91 'o
Is the Building Historically Designated: Yes NO Flood Zone:
5r#11
OWNER: Name (Fee Simple Titleholder): � ''� �k 0 1"-;14 Phone#: W — MCD
City: �� i � i State:
Tenant/Lessee Name: Phone#
Email:
CONTRACTOR: Company Name: � G� IC.,` amu® I � I �J Phone# �� J` ^���1 i�
Address: X10,') ,1 r .
City:
Qualifier Name: Phone#.
State Certification or Registration #: L i _ 1 i 0 9 q Certifica�) of /Competency #:
Contact Phone#:1 "' �� Z, _ Email Address: z
DESIGNER: Architect/Engineer: ��i� �e� r '� Phone# _
Value of Work for this Permit: $ souarelLinear Footage of Work:
Type of Work: OAddress OAlteration U6ew ORepair/Replace
Description of Work:
XAIn%rti
Submittal Fee $ Permit Fee $ r�®e s CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
ODemolition
TOTAL FEE NOW DUE $ 0 ID
1Bondmg'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 appr90 and a reinspection fee will be charged
Signa
ture�'� Signature �?
Owner or Agent
The foregoing instrument was acknowledged before me this
day of _ I , 20 13 , by 'URSA�14
who is personally known to me or who has produced Ff✓
t J. LA y, -As identification and who did take an oath.
NOTARY PUBLIC:
Contractor
The foregoing instrument was acknowledged before me thisq
day of E)c,-6G .2013 -,by 4; B p a
who is personally known to me or who has produced EL
b #-t,JV `,1Cis identification and who did take an oath.
NOTARY PUBLIC:
r I — 0 p KERVIENB OQSTALY
Notary Public, State of Florida KERVIENS DOSTALY
Sign: 4LCommkolont EE 167413 Sign: Notary Public, State of Florida
m.
9XpIfeS FOD. 706 EE 167413
Print: 16 Print: b. 7.2016
My Commission Expires: My Commission Expires: '
APPROVED BY Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/1=009)(Revised 3/15/09)
Zoning
Clerk