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PL-15-898 (2) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-232675 Permit Number: PL-4-15-898 Scheduled Inspection Date: May 27, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: , STEPHEN C MUMBY JTRS Work Classification: Addition/Alteration Job Address: 171 NE 102 Street Miami Shores, FL 33138- Phone Number (646)246-3448 Parcel Number 1132060131840 Project: <NONE> Contractor: LASSETER PLUMBING CO INC Phone: (305)525-5075 Building Department Comments REPLACE FIXTURES ON EXISTING ROUGH Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed 6t, Failed , 2 Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. May 26,2015 For Inspections please call: (305)762-4949 Page 5 of 26 Miami Shores Village Building Department s 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 AP G 2015 Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 20 BUILDING Permit No. U PERMIT APPLICATION Master Permit No': Permit Type: PLUMBING JOB ADDRESS: ( � 1 o S . City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel#: 3 Is the Building Historically Designated: Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder)' ��t=`" v -S-412 & —Phone#: `A'46 ._2_446 Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACT/OR: Company Name: �� `r� F'V- Q Phone#: Addres�s:9&�5 A115:1 �h� S City:/(/��/! 4( ,4 i'� �t�q State: ' Zip: Qualifier Name: Phone#: 3K6'62_6'" 2,5'_ State Certification or Registration#: C_.F' © 4 t 6oQ6tzpCertificate of Competency#: j Contact Phone#: � &O Email Address: C//��15' --";; / �� DESIGNER: Architect/Engineer: Phone#: d Value of Work for this Permit: $ �o_ O Square/Linear Footage of Work: Type of Work: ❑Address Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: r —'� X�C� ES `S 1/v ** ****+ ** ****** ******** ******** ees c ys Submittal Fee$ 0'- Permit Fee$ �•''`' CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 10�•�� Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City 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 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 faiththat copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject t atta ent. Also,Acertified copy of the recorded notice of commencement must be posted at the job site for the first inspection i occur seven ) days after the building permit is issued. In dw absence of such posted notice, the inspection will not be ap oved and a rei pectton fee will be charged. Signature Signature C-7 Owner o�nt Contractor The fore/going instrument was acknowledged before me this The foregoVinstrument was acknowledged before me thi day of .0to 2 >by �2��j� �� y day of 20 6�,bY, r^� /� ��*- who is personally known tome or who has produced _. who is personally known to me or who has produced/r-pz— As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: nnt: My Commission oP `eG Notary Public Staie of Florida My C7,0�1 Joanna Phi Feliciano V�,; NoP2ry Public of Florida Ay Cor is ion FF 52753 r u �n0 W loan r t f9j}of ez©� E:comes 31112/20';8 N J c My C n isGi. i F'n8-- ?_ APPROVED BY �.�4 ?/-/s Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)