PL-14-1454 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL � I
Phone: (305)795-2204 Fax: (305)756-89723CcOE5_
r
Inspection Number: INSP-215450 Permit Number: PL-7-14-1454
Scheduled Inspection Date: July 14, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: WILLIAM J.JURBERG, R.ANDREW DE Work Classification: Pool - Private
once
Job Address:9350 NE 12 Avenue
Miami Shores, FL 33138- Phone Number (305)609-3851
Parcel Number 1132050070150
Project: <NONE>
Contractor: DREAM DESIGN POOLS INC Phone: (954)916-5337
Building Department Comments
SWIMMING POOL AND FOUNTAIN PLUMBING Infractio Passed CommentsINSPECTOR COMMENTS False
Inspector Comments
Passed EIK
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
July 13, 2015 For Inspections please call: (305)762-4949 Page 3 of 41
Miami Shores Village
Building Department JUL 08 2014
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 20/0
BUILDING Master Permit No.38?A/- Z�c._
PERMIT APPLICATION Sub Permit No'e
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�--yy�� 4-/�z /� CONTRACTOR DRAWINGS
JOBADDRESS: J� ' r 1r
City: _� Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO>Z
Occupancy Type: Load: 1�/�Construction Type: Flood Zone: BFE: FFE: / (�
OWNER: Name(Fee Simple Titleholder): • A��// &zt/ � Phone#: `• �L •(p:2-
Address:
Address: Z3t-i-0 A/&-,/,Z AVE1
City: (�!A-9 / State: - Zip:
Tenant/Lessee Name: Phone#:
Email: QQ
CONTRACTOR:Company Name: A ��� Phone#:�df
Address: --I'/.
XX
City: 1J VI/
� State: Zip: �32
Qualifier Name: Phone#:WK, 2.225 3
State Certification or Registration v 0,5-7f) :5 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 42tZ 0 o Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ `?�• j"r CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
4�
Signature � Signature��----'�
c, `Y
OWNER or AGENT CONTRACTOR
The foregoing instrument acknowledged before this The foregoing instrument was acknowledged before me this
day of ^—� 20 by day pf Z tr 20 by
who is���wn to �' 1�_) .,vAatrho is personally known to
me or who has produced as me or who has produced as
identification and who d' <e an ath. identification and who did take an oath.
NOTARY PUBLI • NOTARY PUBLIC:
Sig Sign: flfl
int: Prin : Q 1
l0µ,Pl6 i
°. Notary blic-State of Florida
Seal: • :My Comm.Expires May 23,2G1F Seal:
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NO
Commission # EE 173H: ap �ryPudkStateo►Florlda
Luis Ariel Duarte
;h Nat n.W- y 4,,ry t M, '
tn
9�$ r mmiaalon EE 183181
APPROVED BY 'C1 �L Plans Examiner Zoning
T
Structural Review Clerk
(Revised02/24/2014)