PL-14-1364Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-229810 Permit Number: PL -6-14-1364
Scheduled Inspection Date: April 07, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: HANSEN, DENNIS Work Classification: Addition/Alteration
Job Address: 10642 NE 10 Place
Miami Shores, FL 33138 -
Project: <NONE>
Phone Number
Parcel Number 1122320280860
Contractor: AA MASTERS MECHANICAL AIR MOVING AND ENGINEERIN Phone: (305)559-7004
Building Department Comments
BATHROOM FIXTURE INSTALLATION KITCHEN SINK '411"' - rasseo t.ommenis
WATERLINE FOR FRIDGE INSTALL NEW BATHROOM INSPECTOR COMMENTS False
VANITIES
nspector Comments
Passed CREATED AS REINSPECTION FOR INSP-229014. CREATED AS
REINSPECTION FOR INSP-214851. work concealed need to expose and
call for inspection
plumbing qualifier shall meet with chief inspector
Failed ❑ to many items to list
no further inspection until qualifier comes in
items not corrected
Correction
Needed
Re -Inspection
Fee -
No Additional Inspections can he scheduled until
re -inspection fee is paid.
April 06, 2015 For Inspections please call: (305)7624-949
Page 21 of 63
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
FBC 20 O®
BUILDING Master Permit Noy
PERMIT APPLICATION Sub Permit No. 0 0
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ` to,__kq__ 1\31E;_ � r-> F (—
City: Miami Shores County: Miami Dade Zip: 1 ��
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee SimpleTitleholder): � 'h"i ��� Ste, Phone#: ` I -S JA 0Z LA
^
Address: t- 3 ® � (10CP Q -4 It -0 D GR_^
City: V3 ?3 --POA V11\(N1„�_State: TrL-- Zip:
Tenant/Lessee Name:
Email:
hone#:
CONTRACTOR: Company Name:
04A
M /I sT��
MZCI ` A1C`' Phone#.�._Q b I(Y6c
Address: % S k -j
/0
C�e
City: X4 f -'t 0-1 State: / zip:_.:3 3 1' 6
Qualifier Name: Y_ -/-', Phone#: 76 }e:S3 O
State Certification or Registration #r—p a C Yc�-Certificate of Competency #:
DESIGNER: Architect/Engineer:
Valu�-OfWbr _for. this Permit: -
Type of Work: ` ❑ Addition
Alteration
(°
Specify color of color thru tile:
Submittal Fee $ c ®, Permit Fee $
Scanning Fee $
City: State: Zip:
Sq uare/Linen$ ota"e-nf Work:��
❑ New ❑ Repair/Replace
1
❑ Demolition .
CCF $ CO/CC $
fl
Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ o
Sb
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
Zi
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 ence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. Rn f
Signature Signatur
OWNER or AGENT CONTRACTOR
The foregoing instruent was acknowledged before me this
2 day of ?� Q 20 by
who is personally known to
me or who has produced lQuA ty eA s' /' as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
A �'.. �. uv-;. ' rit)SSE:AU
� ....
We of g instrument was acknowledged before me this
0- day of 4 U (I E 20 r by
:/O� kr 6 i2 -e- 0114A , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUB
JORGE ROSSEAU
• MY COMMISSION #FPtIW45
Sign:R/I EXPIRES May 4, 2018
Von".•°` EXPIRES MaY 4. 201a
Print: Print:
urndaN utary servlce.com
Seal: Seal:
as
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)