PL-14-1956 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
nspection Number: INSP-236988 Permit Number: PL-9-14-1956
Inspection Date: June 23, 2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: WILLIAM J. JURBERG, R.ANDREW DE Work Classification: Gas
nnec
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
NEW GAS LINE AS PER PLANS Infractio Passed Comments
INSPECTOR COMMENTS True
Inspector Comments
Passed EY' CREATED AS REINSPECTION FOR INSP-219194. provide drop test for
final
Failed
Correction ❑
Needed
h' 2q r7"
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
For Inspections please call: (305)762-4949
June 24, 2015 Page 1 of 1
AROU N DTH E Around The Clock Gas Service, Corp.
AW 133-3.7 NW 107 Ave unit 17
�! Hialeah Gardens, FL. 33o18
'ITAM SERVICE Phone: 305-231-3632 ext 301
Fax: 305-233--418o
STATE LIC# LPG17356
CLASS# 803
DROP TEST CERTIFICATION June 23, 2015
To: Whom It May Concern in the City Of Miami Shores Plumbing Department.
This is to certify that Around the Clock Gas Service Corp. an authorized Advantage Dealer of
Teco Gas has performed a drop test at the following site and tested all the appliance
connections. The gas line has been checked to the standards of the 2010 Florida building
code, SECTION 406 (IFGS) INSPECTION,TESTING AND PURGING 406.1 GENERAL
and properly tested to meet the standards of NFPA 54.
The work was performed for:
R Andrew De Pass
9350 NE 12 AVE
Miami Shores Fl,33138
Test Pressure: 8.0
Lock up pressure: 14.2
Operating pressure: 14.0
Test time: 10 Minutes
If you should have any questions regarding this matter please do not hesitate to call us.
Sincerely,
A�mautryv Gonzal z STATE OF FLORIDA COUNTY OF MIAMI DADE,SWORN TO&
CEO SUBSCRIBED BEFORE ME THIS _ SDAY OF—T--I--< 20 13-
Around The Clock Gas Service Corp. AMAURYc ,PERf{CtYfE
Q.� -.
_ •' SSION#EE867375
• P1P%W.D�brllf9&)23.SIA YPUBLIC
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B-0153 FloridallotaryServiice com
Miami Shores Village I ; `-` T -�
SEP 08 2014
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 2010
BUILDING Master Permit No.aC ' ''
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: V Iy Oji I� b�Q_
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1 3 20 5 Q0 v1 0 N S d Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): //1 A:1R�`� �' Phone#:
Address: n �� �� ,
ZCity: state: ip
�` J
Tenant/Lessee Name: Phone#:
Email: (� (�
CONTRACTOR:Company Name: '-� 1l �UNNi ��'b c oo�1 Phone#: �a(� - C�
Address:
City: ? State: f_7L. Zip: U
Qualifier Name: oPhone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �Uv o�� quare/Linear Footage of Work:
Type of Work: El Addition El Alteration ZNew ❑ Repair/Replace ❑ Demolition
Descriptioof Workk . 1 N`'
Specify color
•-of�eol pt*rw tile:
Submittal Fee$ `� Permit Fee$ Z 26, CCF$ CO/CC$
Scanning Fee$ G Radon Fee$ t - DBPR$ ! �J Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ CA 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 no4,beap oved and a reinspection fee will be charged.
Signat '��!' Signature
OWNER or AGENT �ONTRACAR
Th oregoing instruct was acknowledged b fore this Th f egoing instry�? nt waCknowledged before a this
day of
`� 204 by day of C 20 by
tg�►yfC��( o is personally knowrf to wh is personally know
me or who has produced 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: Sign:
Print: Notary Public-State of Florida print: roVP`tip°: Notary Public-State of Florida
• • . . y�. .
�:F Commission#EE 173842 ^ :r Commission#EE 1!'942
Seal: %F <<,�P.` Seal: . ,�°`�,
8onded Through National Notary Assn. 8onded Through National n Assn
APPROVED BY ( �/ U"/`7' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)