PL-15-166Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-227060
Scheduled Inspection Date: June 18, 2015
Inspector: Diaz, Osvaldo
Owner: MONICA VEIGA, FRANK SICOLI
Job Address: 9204 NE 10 Avenue
Miami Shores, FL
Project: <NONE>
Permit Number: PL -1-15-166
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1132060060020
Contractor: J C PLUMBING SERVICES INC Phone: 305-796-4663
tsumiling Department comments
HOT WATER PIPE REPAIR.
Passed
Failed
Correction ❑
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid
INSPECTOR COMMENTS False
Comments
�G
June 17, 2015 For Inspections please call: (305)762-4949 Page 4 of 29
Project Address Parcel Number Applicant
9204 NE 10 Avenue 1132060060020 FRANK SICOLI MONICA VEIGA
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
FRANK SICOLI MONICA VEIGA 9204 NE 10 Avenue
MIAMI SHORES FL 33138-
9204 NE 10 Avenue
FL
Contractor(s) Phone Cell Phone
J C PLUMBING SERVICES INC 305-796-4663 (305)970-1612
of Work: HOT WATER PIPE REPAIR.
of Piping:
Tonal Info:
Retum :
kation: Residential Scanning: 1
Fees Due
Miami Shores Village
CCF
10050 N.E. 2nd Avenue NE
DBPR Fee
Miami Shores, FL 33138-0000
DCA Fee
Phone: (305)795-2204
Project Address Parcel Number Applicant
9204 NE 10 Avenue 1132060060020 FRANK SICOLI MONICA VEIGA
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
FRANK SICOLI MONICA VEIGA 9204 NE 10 Avenue
MIAMI SHORES FL 33138-
9204 NE 10 Avenue
FL
Contractor(s) Phone Cell Phone
J C PLUMBING SERVICES INC 305-796-4663 (305)970-1612
of Work: HOT WATER PIPE REPAIR.
of Piping:
Tonal Info:
Retum :
kation: Residential Scanning: 1
Fees Due
Amount
CCF
$1.20
DBPR Fee
$2.25
DCA Fee
$2.25
Education Surcharge
$0.40
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total:
$160.70
Valuation: $ 2,000.00
Total Sq Feet: 0
i
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL -1-15-54243
04/24/2015 Credit Card $ 110.70 $ 50.00
01/26/2015 Credit Card $ 50.00 $ 0.00
E►vauaoie inspections:
Inspection Type:
Toa Out
nd
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, D90RS-,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing informati is accu to nd t ork will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above -n ed co r th ork stated.
April 24, 2015
Authorized Signature: Owner / Applicant �tracto Age t Date
Building Department Copy
April 24, 2015 1
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department r
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 7JJAN
Tel: (305) 795-2204 Fax: (305) 756-8972 B
INSPECTION LINE PHONE NUMBER: (305) 762-4949 +
FBC 20 (O
Master Permit No. :R j — I ' J — 1
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
LUMBING ❑ MECHANICAL E] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: '?% Mr /0 ok
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): � �� % �� Phone#; 0
Address: S*W7C AS 4®ve'
City:
State:
Tenant/Lessee Name: Phone#:
Email: _
ao
�-
CONTRACTOR: Company Name: 3C \" p� k u ww 3i vj (a 03 6 Rki kC E S It4-c Phone#:
Address: 4800 5 ®C E A S o R U -M07
City: H P L R W oAl 9 S E R CI State: V L Zip: 33 ft ® 9
Qualifier Name: s u A W C,A ia.l O S � R_ 00 Phone#: 1113 6 — 2 5 -A - 02I
State Certification or Registration #: C I` C -- 4g26 2 Z'I Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 2 v v 0 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition
Description of Work: R c e a r -i 6%. ea .,L_ cle- \2 \ Qj b e- y- i � d e D !I ca '�r
ecA te0 PO -1 c✓ei4-er 9' Pe- ye-9ck�,-s
Specify color of color thru tile:,
Submittal Fee $
Permit Fee $
CCF $
Scanning Fee $
Radon Fee $
DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ '
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
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.
t
1
Signature Signature
OWNER or AGENT
The foregoing instrum t was acknowledged before me this
l day of &�� , 20 (�,f ' , by
644, - who is personally_known to
me or who has produced > -L. 1, as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: '" L
Print:
',
� :
HMCH H C. NUECK
Seal: Notary Public - State of Florida
My Comm. Expires Sep 30, 2011
�.',;F�F,a;;•• Commission # FF 184339
The foregoing instrument was
before me this
20 I S by
who is personally known rn
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Seal: _ ° Iff COMMISSION #EE874505
EXPIRES: MAR 14, 2017
OF Bonded through 1st State Insurance
APPROVED BY r%�� `orf -/-T Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk