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PW-16-42 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-6972 Inspection Number: INSP-250587 Permit Number: PW-1-16-42 Scheduled Inspection Date:January 26,2016 Permit Type: Public Works Inspector: Diaz,Osvaldo Inspection Type: Final Owner: DE LA ESPRIELLA,ALEXANDRA Work Classification: Public Works Job Address:1110 NE 100 Street Miami Shores,FL 33138- Phone Number Parcel Number 1132050190460 Project <NONE> Contractor. TECO PEOPLES GAS SYSTEM Phone: (305)957-3857 Building Department Comments GAS LINE TIE IN TO SERIVCE GAS MAIN Inftactlo Passed comments INSPECTOR COMMENTS False TO CLOSE PERMIT#PW13-2447 Inspector Comments Passed EE Failed Correction Needed Re-Inspection ❑ Fee No Addrdonal Inspections can be scheduled until re-inspection fee is paid January 25,2016 For Inspections please call:(305)762-4949 Page 16 of 41 Permit NO. PW-1-1642 X01 y Miami Shores Village Permit Type:Public Works 10050 N.E.2nd Avenue NE Perm 'It Work Classification:Public Works Miami Shores,FL 3313&0000 Permit Status.APPROVED Phone: (305)795-2204 Issue Date: 1/14/2016 Expiration: 04/13/2016 Project Address Parcel Number Applicant 1110 NE 100 Street 1132050190460 Miami Shores, FL 33138- Block: Lot: ALEXANDRA DE LA ESPRIELLA Owner Information Address Phone Cell ALEXANDRA DE LA ESPRIELLA 1110 NE 100 ST MIAMI SHORES FL 33138-2602 Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783 -- --� — ® -- Total Sq Feet: 0 Scanning:3 Available Inspections: Inspection Type: Final Excavation Review Building Fees Due Amount �Date Pay Type Amt Paid Amt Due CCF $1.2o Invoice# PW-1-16-58264 DBPR Fee $2.00 DCA Fee $2.00 01/14/2016 Check#:6069 $ 116.20 $0.00 Education Surcharge $0.40 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $116.20 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 ELE AL,PLUMBING,MECHANIC WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFI AV I certify that all the fo g ' g information is acc rate and that all work will be done in compliance with all applicable laws regulating con on and oni g. Futhermore,I autho he U ed co r ctor to do the work stated. fL�1.L January 14,2016 orized Signature:OwnerAppl nt / Contra / Agent ate Building Departme t C py January 14,2016 1 Miami Shores Village J,�N 0 9 1016 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 201°4 BUILDING Master Permit No. . � (f�— PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL ❑PLUMBING [:] MECHANICAL KPUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP + CONTRACTOR DRAWINGS JOB ADDRESS: `�® {��r 1 I OkN :�)T City Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):RIGHT-OF-WAY Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: TECO PEOPLES GAS Phone#: 954-453-0811 Address: 5101 N.W. 21 AVE., SUITE 460 city. FT. LAUDERDALE State: FL Zip: 33309 Qualifier Name: JESUS VEGA, JR. Phone#: 945-453-0811 State Certification or Registration#: E1608 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$2000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 0 New ❑ Repair/Replace U ❑ Demolition Description of Work: I �!'� Ws¢41 C I Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ 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 not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRA OR The foregoing instrument was acknowledged before me this The foregoing instrumentacknowledged before me this day of ,20 by ::Z day ofw s/ 20 / ,by who is personally known to ��7 o9L S who r rsonally know o me or who has produced as me or who has produced as identification and who did take an oath. identification and o did take an oath. NOTARY PUBLIC: NOTARY PUBLI HUBERT NUNEZ Sign: Sign `'� '�pY`° e o1 Florida Print Print a r.:My Comm.Expires sop 11,2017 3679 Seal: Seal % ` Bonded Through National Notary Assn. 4 APPROVED BY il it Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)