PL-12-800 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL '
Phone: (305)795-2204 Fax: (305)756-8972
2
Inspection Number: INSP-173127 Permit Number: PL-5-12-800
Scheduled Inspection Date: August 21, 2013 Permit Type: Plumbing - Residential
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: LLERENA, MARK Work Classification: Pool - Private
Job Address: 1550 NE 103 Street
Miami Shores, FL 33138- Phone Number (786)981-1301
Parcel Number 1132050310110
Project: <NONE>
Contractor: AQUARAMA POOL INC Phone: (954)529-4552
Building Department Comments
POOL PIPING
Inspector Comments
Passed ^
Failed
Correction
Needed ❑ 1
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 20,2013 For Inspections please call: (305)762-4949 Page 1 of 39
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Miami Shores Village up,Iv a
Building Department artment , ��
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10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972 fflY:7� -, -
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No. Pk't 2-, a:-,.D
PERMIT APPLICATION Master Permit No: 2 — I
FBC 20 tO
Permit Type: PLUMBING 1
OWNER:Name(Fee Simple Titleholder): '1� � �, � Phone#:
Address:
City:
State: —1� -
Tenant/Lessee Nam : Phone#:
Email: Vq\1?Nam
JOB ADDRESS: 1c)a 3
City: Miami Shores County: Miami Dade Zip: 1'3?n
Folio/Parcel#: L 1— 3 Zc�s — 0--- i — 0 1 1 C)
Is the Building Historically Designated:Yes NO Flood Zone: V�-
CONTRACTOR:Company Name: �,ra� aZ�c�t� "�5 ��� 3)-Ac-- Phone#: CjS-F -15�Z-Cl-14SSZ
Address: 30^4- -ItArA 16 t& '4- '7�,U
City: VIC5 State:
Qualifier Name: A(3 � v i Phone#: �SA_ zSy�
State Certification or Registration#: C..QC— 1 QS(,,F i 1 Certificate of Competency#:
Contact Phone#: Z-'j 4SS Z- Email Address: a j 1 " 'ar'. r—c�
DESIGNER:Architect/Engineer: �1 �, `�" G tk L-,�3 a Phone#:
Value of Work for this Permit:$ 500 ` Square/Linear Footage of Work:
Type of Work: DAddress <77) ❑Alterations lew ORepair/Replace ODemolition
Description of Work: 1co
Submittal Fee$ �� Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training(Education Feet Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ °
e r
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 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 properly 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 o5pdrs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will�ot be approv and a reinspection fee will be charged.
F;r
Signature Signature— '
Owner or Agent Contractor
The foregoing instrument was acknowledged befor me this
The foregoing instrument was ac wledged before me this g g g
day of ,20 Com,by ' --t4 day of -L 20!1,- 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 PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print: �
NOTARY PLTEL IC-STATE OF FLORIDA
�
My Commission Expires: ,.•�""�,, Zelda Andrea My Commis�i�tTi �i���:
c Commission#BE091055 r Zelda Andreu
Cemnlission#EE0910SS
TMTJATL6MCBONDaiGCO.,INC
MAY 05,2015 °�,,,,.•°''Expires: �.IAY05,2U15
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10R009)(Revised 3/15/09)