PL-14-1979 I
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number. INSP-219343 Permit Number: PL-9-14-1979
Scheduled Inspection Date:April 16,2015 Permit Type: Plumbing- Residential
Inspector: Diaz,Osvaldo
Inspection Type: Final
Owner: RICE,CORRIE Work Classification: Addition/Alteration
Job Address:41 NW 105 Street
Miami Shores,FL 33150- Phone Number
Project: <NONE> Parcel Number 1121360050290
Contractor: PSG PLUMBING SERVICES,INC Phone: (305)796-7304
Building Department Comments
ADD NEW BATHROOM TO THE HOUSE WITH ONE Infractio Passed Comments
TOILET AND TWO LAVATORIES INSPECTOR COMMENTS False
nspector Comments
Passed
Failed
Correction ❑ ��j�,IS
Needed t�
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
April 15,2015 For Inspections please call: (305)762-4949
Page 2 of 32
Miami Shores Village C-EIVED
Building Department SEP 10 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972 - °= - -- -
INSPECTION'S PRONE NUMBER:(305)762.4949
FBC 20 k--")
BUILDING Permit No. '?(,I Ll
PERMIT APPLICATION Master Permit No., �I � Z:)
Permit Type: PLUMBING
JOB ADDRESS:
City: Miami Shores County:_^Miami Dade Zip: J l�
Folio/Parcel#-
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple iceTitleholder): CO iZ�1 E PA Phone#: �, �I�•�J�"�CJ
Address: 4� ) ,
"OL
-.
City: 1(`�e O�Yri� <-e State• -*-DoZip: 3�
Ten=4.essee Name: Phone#: 3 0--J- --T-">1f) J-b5
Email:
CONTRACTOR,Company Name: 16 6GG�W4 e e d S d G Phone#• 4.d W-.-'
Address: 1oZ /C.J(.V / y S1-
City-
(?
"-City (?/fid—L oG&O ,7'G- State:_ J157-2— Zip:
Qualifier Name: 40 6 sc.tpc� _ Phone#: 3eZj—
State Certification or Registration#:<' F C / Y 2 6 2 57 Certificate of Competency#• F
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer. Phone#:
Value of Work for this Permit:$ �`�!� f Square/Linear Footage of Work:
Type of Work: OAddress PAlteration ONew ORepair/Replace ODemolition
Descripttii�on of Work. d A
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Educadon Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
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 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. fn the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature &kA1l,_ (QASignature
Owner or Agent - #or actor"
The foregoing instrument was acknowledged before me this, 4 I!' The foregoing instrument•was ckno ged before me this
day of 3 '' ;20 � day df 20 by
�by CCA9_4/�- fLtc1Z.
who is personally known to me or who has produced t who' ' y known to or who has produced
As identification and who did take an oath. as 1 entification and who did take an oath.
NOTARY PUBLIC: e+e+ttt,�un�ii�ri� NOTARY PUBLIC: �9` ptYttti�o���
lir y 1 �9�
Sign: - _ Sign: l `'o : O
Print: °� �.® Dy - Print: -_ 11fr •®°°y:
My Commission Expires: y , .� :
�� ,�,••., � � M Commission fres: l nTE OF F
yy��. .�
RIDA � � nntnnt++ �
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised3/1=012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
1