PW-14-574Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-209557
Scheduled Inspection Date: June 24, 2014
Inspector: Rodriguez, Jorge
Owner: SYLVAIN, FRED
Job Address: 9100 NE 2 Avenue
Miami Shores, FL 33138 -
Project: CHURCH
Contractor: RODWINS PAVING
dunaing uepartment comments
TRENCH FOR UNDERGROUND PIPE
Permit Number: PW -3-14-574
Permit Type: Public Works
Inspection Type: Final
Work Classification: Public Works
Phone Number (305)759-6235
Parcel Number 1132060133200
INSPECTOR COMMENTS False
Phone: (305)253-5354
June 23, 2014 For Inspections please call: (305)762-4949 Page 8 of 35
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
June 23, 2014 For Inspections please call: (305)762-4949 Page 8 of 35
el
UNDER
IV
UND PIPE DETAIL 1
MAR J 4 1914
Miami -Shores VillageL
Public Warks Department
10050 N.E. 2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 y j
Public Works I — KNO.
Permit APPlicatidn
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Permit Type: Public Works WATER
Owners Name (Fee Simple Titleholder) Jd�V+� �+�% Pion
Owners Address t�)D6 t, -;E
CRY A rr siaie zip 3 3
Tenant(Lessee Name Phoned: � OS-- -4 5C1 - L4
Job Address (where the work is being done)! ` -,
city Miami Shores VfUage
Is Building Historically Designated: YES
Av
county Miami Dade ZIP
NO
Contractors Company Name 'C)'AtlrtrI-1 W V V+J �S-V�C Phone 87 30s- 3S$- 33 S
(�col-4� O
Contractors Address 0 °J , Os
city r `\AP's" stew ill— Zip
Architect/Engineers Name (if applicable) Phone
$ Value of Work For this Permit Lineal Footage of work:
Type of work: ❑ Addition ❑Alteration ❑ New ❑ Re palr/Replaoe ❑ De 6fion
Describe work I N a4Z— �r �e 1�� a fP2;���-,
Fees
Submittal Fee $ CS�D ° Permit Fee $
Nobrry $ Tralning/Education Fee $
Scanning $
Code Enforcement $
Total Fee Now Due $
(continued on opposite side)
CCF $
Technology Fee $
Radon $ Zoning Bond $
Struchual Plan Review $
Bonding Company's Name (f applicable)
Bonding Corti, pany's Address
City
Mortgage Lenders Name ('d applicable)
Mortgage Lenders Address
City
State
State
V
4
ZP
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 sew, red for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS and AIR CONDMONERS, 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 condNon to this Issuance of a Public Works permit with'an estimated value exceeding $2500, the applicant must
promise in good faith data, copy of the notice of commencement and construction lien law brochure will be delivered to the person whose
property is subject to ettachment, Also, a cerfified copy of the recorded notice of commencement must be posted at time job site for the first
inspection which occurs seven (7) days after the building permit is issued In the absence of sp$h posted notice, tine h1specWn wiff not be
approved and a reinspection fee will be cogrged, l
Signature
Owner or Agent
Signature
Contractor
The foregoing instrument was acknowledged before me this 0�0 The foregoing` instrument was acknowledged before me this
day of p �. 2Q�, by t �N �l� day of i 0�' , 20 4� by ��� N`� S
who emonaliy known o me or who has produced WhopersonaQ��o tome or has produced
as Identification and who did take an oath.
NOTARY PUBLIC:
My Commission
APPLICATION APPROVED BY:
11/17/2005
as identification and who did take an oath.
*NOTARY PUBLIC:
JESfJS LOPEZ My Commission Expires: P�jB jESG:. '..OE Z
My r,Onnn4ISSION #EE141677 s `^ . MV*rOMM1,4,,;KJN #EE141677
EXP'.-qES: OCT 26, 201 ' ` "&:RES: OC1 26, 2015
o m,�YSYStatalnsurinie - ate Insurance
7 7 l Public Works Director or
his designee.