PLC-15-1797 47
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$'!Os Miami Shores Village 9 Penna' )PA ��� �q rlcl
10050 N.E.2nd Avenue NE A �iQR
Miami Shores,FL 33138-0000
moo` Phone: (305)795 2204 :: 5t8W1FP �E�
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FC6RlD �r', � i. .. Expiration: 01/27/2016
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Project Address Parcel Number Applicant
415 NE 105 Street 1122310430010
Miami Shores FL Block: Lot: ST ROSE OF LIMA CATHOLIC C
Owner Information Address Phone Cell
ST ROSE OF LIMA CATHOLIC CHURCH 9401 BISC BLVD (305)758-0539
MIAMI FL 33138-2970
Contractor(s) Phone Cell Phone Valuation-
PSG
2,200.00
PSG PLUMBING SERVICES, INC (305)796-7304
Total Sq Feet: 0
Type of Work:REMOVE AND REPLACE LAVATORY Available Inspections:
Type of Piping:
Inspection Type:
Additional Info:
Top Out
Classification:Residential Re Pipe
Scanning: 1 Main Drain
Heater
Water Service
Final
Water Main
Lavatory
Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80
Invoice# PLC-7-15-56384
DBPR Fee $2.25 07/17/2015 Credit Card $50.00 $ 112.30
DCA Fee $2.25
Education Surcharge $0.60 07/31/2015 Check#:2676 $ 112.30 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $2.40
Total: $162.30
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 conformit ith the , drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume resp sib ii for all w rk done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUM G, CHANICAL DOWS, DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: tha II th for g ' ormation is accurate and that all work will be done in compliance with all applicable laws regulating
constructio an i e re, I ri h bove-named contractor to do the work stated.
July 31, 2015
o . e Applicant / Contractor / Agent Date
Buil 'ng Department Copy
J 31, 2015 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-239361 Permit Number: PLC-7-15-1797
Scheduled Inspection Date: September 03, 2015 Permit Type: Plumbing - Commercial
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Work Classification: Addition/Alteration
Job Address:415 NE 105 Street
Miami Shores, FL Phone Number (305)758-0539
Parcel Number 1122310430010
Project: <NONE>
Contractor: PSG PLUMBING SERVICES, INC Phone: (305)796-7304
Building Department Comments
REMOVE AND REPLACE LAVATORY Infractio Passed Comments
INSPECTOR COMMENTS False
JOB ADDRESS 10500 N.E 5 AVE
ST. ROSA LIMA CHURCH CONVENT
spector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 02,2015 For Inspections please call: (305)762-4949 Page 11 of 35
e
Miami Shores Village
7 20,5
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 tO
BUILDING Master Permit No. L C
PERMIT APPLICATION Sub Permit No. 1 -7
❑BUI DING ❑ ELECTRIC F-1ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWALPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP
�J CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zia: -33 43,�
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): � Phone#:
Address,/ '-Cz�
City: //iQ�"�/��.�s�f'� State: /./i.-a c? -P Zip: 3
Tenant/Lessee Name: -'/ Phone#:
Email: �� «� �Cf�CJ�C oed'y,
CONTRACTOR:Company Name: P56 t?(,j 6--f 6 i A)C 5ZC—kj C4 " C Phone#:
Address: G� /� �� w / Z s -.57-
City:.
7-
City: c/� ` 6)Gam, State: Zip: 3 a os-`/
Qualifier Name: � � �c-(Z�-CQ� Phone#: 3c�S- 7 '.73a`I
State Certification or Registration#: Pf �� 6 Z,> 7 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for thi llIFT!R!"$ 2c0 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration New ❑ Repair/Replaccee5'Demolition
De on of W �dCJt/ � 2 /- Gum /�i7�
SGi1�f
Specify color of color thru tile:
Submittal Fee$ �� Permit Fee$ U. CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ I '
(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: 1 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.
Signature i Signature
/,0"—
,Q"IAGENT QONTRACTOR
The foregoing instrumentwasacknowledged before me this The foregoing instrument was acknowledged before me this
day of .�v\ j 20 )S by day of u by
L�L,
?=6 ca� r r,who is personally known to who is ersonally kn�own
me or who has produced So—yr as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: `'C ✓�_ `` N�OILEON.//////��i. Sign:wl
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Print: q o �C.VV� ;�o��eer 19,?Oj9cs`:*� Print: G •�M•�oNfxp�. ��
Seal: *' g ;�_ Seal: -me
to �� 'V, *FF0847544b Sao
1,r/ j!'•a•Rhq•-P'`�GO�� •.4" N��
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)