PL-07-620 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-190128 Permit Number: PL-3-07-620
Scheduled Inspection Date: April 29, 2013 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner:Owne PEREZ-CONTRERAS YENI E
Work Classification: New
Job Address:54 NE 106 Street
Miami Shores, FL 33138-2035 Phone Number
Parcel Number 1121360060040
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
BATHROOM REMODEL Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP44574.
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
April 26,2013 For Inspections please call: (305)762-4949 Page 44 of 50
Permit No. hL-3-07-620
.R °ter Miami Shores Village M Permit Type:Plumbing-Residential
10Shores,FL 33138-0000 N.E.2nd Avenue
Miami Per
1NorfcCtassi�rcafion:New
S
a� Phone: (305)795-2204 Permit Status:APPROVED
�ZORYD�"
Issue Date:3/30/2007 Expiration: 09/26/2007
Project Address Parcel Number Applicant
. .......... ... .............. .................. ......_............... .. ........... ...... .................. ....... ...... ............. ... ............. ..
541106 Street 1121360060040 MARIA DEL ORTIZ
Miami Shores Village, FL Block: Lot:
Owner_Information _._Address..__ ......_...... _. Phone
. ........ Cell
MARIA DEL ORTIZ 54 N.E.106 ST.
Contractor(s) Phone Cell Phone Valuation: $ 700.00
HOME OWNER
Total Sq Feet: 0
Type of Work:BATHROOM Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Lavatory
Bond Retum: Top our
Classification:Residential Re Pipe
Water Main
Underground Rough
Water Service
Final
Main Drain
Heater
Fees Due Amount Total Amt Paid Amt Due
CCF $0.60
Education Surcharge $0.20 $0.00 $0.00 $ 0.00
Notary Fee $5.00
Permit Fee-Additions/Alterations $160.55 Payment Type:
Scanning Fee $3.00
Technology Fee $4.01
Total: $173.36
G �o
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated.
March 30,2007
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
Friday,March 30,2007 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972
BUILDING N I�° Permit No.
PERMIT APPLICATION MAS zoo? Master Permit No.
FBC 2004
Permit Type: Plumbing
Owner's Name(Fee Simple Titleholder),G?&K/ A 012-71- Z . Phone# 30S-742-676Z
h76Z
Owner's Address :5- x/(F 10 (0 S7
CiState P L Zip �j�
Tenant/Lessee Name Phone#
E-MAIL: (�
Job Address(wherethe worlds being done) a (,� ---
City Miami Shores Villaee County . Miami-Dade Zip
FOLIO/PARCEL#
Is Building Historically Designated YES NO
Contractor's Company Name ®�it//U�� Phone#
Contractor's Address
City State Zip
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
E-MAIL:
Arch itect/Engineer's Name(if applicable) Phone#
Value of Work For this Permit$—77 V Square/Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration E]New Repair/Replace
l El Demolition
Describe Work: 4A J(:/
9r+kxxeF�Y at�lr#4exaY e4 d:oY oY�:9e de dextkaY oYxdr de$rear&u� d¢tY k of Feesx�Yxst•ko:�d:ek okxdcxxxeF�irx9cxx&xxxsir'xxxxxd:xxxxxx4cx�a:�e
Submittal Fee$ Permit Fee$ CCF$ CO/CC
Notary$ Training/Education Fee$ Technology Fee$ 0 '
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$ 1 1�
See Reverse side-+
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's blame- if -
( a.pplicable}-- - ---
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. l certify that no work or installation has
commenced prior to the issuance of a permit,and that all work will be performed to- t the -standards of all laws regulating
construction in this jurisdiction- d-,unde-rstand#ht-a separate permit-must be secured or CTRTCAL—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.
Signatu- Signature
Owner r
Ta _
Contractor
The foregoing instrument was ack wledged before me this C__%_-J The foregoing instrument was acknowledged before me this
day of ar ,20aby n f�2- , day of ,20_,by
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. as identification and who did take an oath.
NOTARY P LIC NOTARY PUBLIC:
ryl �l
Sign: Yp�'� 1 e1 Sign:
Print: y: _Commis n , _.ilk
Print:
M Com fission Expires: porde Thrc Y
Y p titieel RC . Itic My Commission Expires:
xxdcxxde�it aY dexueent e4xde dr oexnF it aY scxxx�xxxxak eYxxde�cxxxxde tY i:xxde Y Bex aYr'e eexxae er nY�'xxxxxxaYxx�aC sexYlexsYuYxYaexx�e aY 4e�aYxxeY a't eY nY eY4e or eY oY t 4rxxxxx
APPLICATION APPROVED BY: �� r2 Plans Examiner
Engineer
Zoning
(Revised 02/08/06)