PL-15-1917 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-240242 Permit Number: PL-7-15-1917
Scheduled Inspection Date: November 10,2015 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: LEZAMA, LOUIS Work Classification: Addition/Alteration
Job Address:420 NE 92 Street
Miami Shores,FL Phone Number
Parcel Number 1132060140079
Project: <NONE>
Contractor: SEROTA PLUMBING CO Phone: (305)672-7252
Building Department Comments
REMOVAL OF 2 SET LAVATORIES 1 SHOWER PAN SET Infractio Passed Comments
1 TOILET INSPECTOR COMMENTS False
nspector Comments
Passed 014
Failed
Correction -�
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
November 09,2015 For Inspections please call: (305)762-4949 Page 11 of 43
Miami Shores Village a +
10050 N.E.2nd Avenue NE \
Miami Shores,FL 33138-0000
Phone: (305)795-2204 ` \a yK `,., . .
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�� � w� �`\� ����^ � Expiration: 02/17/2016
Project Address Parcel Number Applicant
420 NE 92 Street 1132060140079
LOUIS LEZAMA
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
LOUIS LEZAMA 420 NE 92 ST
MIAMI SHORES FL 33138-3155
Contractor(s) Phone Cell Phone Valuation: $ 3,250.00
SEROTA PLUMBING CO (305)672-7252 Total Sq Feet: 00
Type of Work:REMOVAL OF 2 SET LAVATORIES 1 SHOWE Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40 Invoice# PL-7-15-56527
DBPR Fee $2.25
DCA Fee $2.25 07/29/2015 Credit Card $50.00 $119.90
Education Surcharge $0.80 08/21/2015 Credit Card $ 119.90 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $169.90
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 conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore,I authorize the abovglnqmed ntractor to do the work stated.
A August 21, 2015
Authorized Signature:Owner / Applicant Cont actor / Agent ate
Building Department Copy
August 21,2015 1
Miami Shores Village ��t 15
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Building Department BYY.
t
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 20141-"'e,/
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No. all-f-_
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
�LLIMBING ❑ MECHANICAL_ ❑PUBLIC WORKS ❑ CHANGE OF f-I CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �A 11f '� Q,�, Z b do,C -
City: Miami Shores County Miami Dade Zip 3 / .3
Folio/Parcel#:_// 3 0�- 0/-'1_ O b 1r9 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: I`l BFE: FFE:
OWNER: Name(Fee Simple Titleholder): -%Z5-1
1�tS 6t4lci, lX44*� Phone#:`3 vS'��.9.4 C .HA2 L.
Address: 7i 7 A3 r R 2 i-&
City: State: 01 Zip:3 1j 9
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address: n s� f t-=- �--, rr ty� j�� `1 l 17 9
City:-=z zt� tcy w( State: Zip: .=
Qualifier Name: „� cZr.�-T'LS Phone#: _ b�S�-(p"1:�.� 25r,�.Ir,
State Certification or Registration#:C F C 1 LP 4)21-2-1 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: 0 City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition Alter�ation� ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:1--, ; c �� A-L)AT-,6 A- S
Specify color of colorh►
Submittal Fee$ ,° Fee$ 6 UCCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ \` qc)
(Revised02/24/2014)
I
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.
Signature � -1 L" 1_ Signature
,/_1 .1
OWN or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before this
c, i `� f 20 . b
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Se,Adr t^ 2 cxt*r-`rN who is personally known tom_ who' own
personally kn
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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: ,L
Print:Ll J)✓iPrint: ��
Seal: smRycKARLE CERA
LYNNE M LIN Seal: NOTARY PUBLIC
Commission#FF 234178 $TATE OF FLORIDA
My Commission Expires FFIZIZ41
Me 25 2019 Camno
APPROVED BY ? Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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ALL MATERIALS,DIMENSIONS AND SIZE
DESIGNATIONS GIVEN ARE SUBJECT TO
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