PL-13-2824 Inspection Worksheet u
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-237388 Permit Number: PL-12-13-2824
Scheduled Inspection Date: June 23, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo Inspection Type: Final
Owner: WILLIAM J.JURBERG, R.ANDREW DE Work Classification: New
once
Job Address:9350 NE 12 Avenue
Miami Shores, FL 33138- Phone Number (305)609-3851
Parcel Number 1132050070150
Project: <NONE>
Contractor: PALMER HOLDINGS, INC Phone: 305-310-4673
Building Department Comments
INSTALL AND SUPPLY WATER AND SANITARY LINES Infractio Passed Comments
FOR RESIDENTIAL SINGLE FAMILY RESIDENCE AS PER INSPECTOR COMMENTS False
PLANS
spector Comments
Passed CREATED AS REINSPECTION FOR INSP-204702. partial approval for
TCO only
revis� um j isometric
/
Failed
Correction
Needed
Re-Inspection
Fee X15
�211
No Additional Inspections can be scheduled until
re-inspection fee is paid.
June 22, 2015 For Inspections please call: (305)762-4949 Page 38 of 38
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Miami Shores Village
Building Department7BY:
.7 20 33
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949
FBC 20 2
BUILDING Permit No. p [ 7 —282y,
PERMIT APPLICATION Master Permit Nom__ 16 5-6
Permit Type: PLUMBING
JOB ADDRESS: 9, Z 2 A J E l2�
City: Miami Shores County: Miami Dade Zip: �� J
Folio/Parcel#: 2,0DO 0
Is the Building Historically Designated: Yes O Flood Zone:
OWNER:Name(Fee Simple Titleholder):ie��y ( f'C�S Phone#: .3D_--'- .S;02
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: �ZU\A 43e. Phone#:305.'M -M'L
Address:
City: State: ' Zip: -
Qualifier Name:
Phone#;, ..qg� 2 ��
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address: ?? ,,`` --�,(,� Q
DESIGNS . Arc ' e t/Enginee�aQc�f}Y�0 Phone#:JQ� ,L"'�y Z
rThi $" S are/Linear Footage of Work: S
Type of•Work: ❑Address/,.' �IAlte ation ew ❑Repair/Replace ❑Demolition
M • ,
Descriptin�of.,Wprk:
rd.�Z
Submittal Fee$' (/ � Permit Fee$ J C'F$ 4 CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$ .
TOTAL FEE NOW DUE$
Bonding Company'o N1ama(iftapolicable) N
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 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 Signature .,.1'-----
i
Owner or Agent Coiltra for
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this],
day of ,20 ,by day of 20 ,b:y
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. aside and who did take an oath.
NOTARY PUBLIC: NOTARY C:
Sign: Sign: MARTIN J.PALMER
Notary Public•State of Florida
Print: Print: r. M.z My Comm Fxpires May 22 201g
"� a'f. Commission N EE 173842
My Commission Expires: My Commission E ifs i ,°P'� Bonded Through National Notary Assn.
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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