PW-16-51 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone:(305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-250605 Permit Number PW-1-16-51
Scheduled Inspection Date:January 26,2016 Permit Type: Public Works
Inspector: Diaz,Osvaldo Inspection Type: Final
Owner: SEGAL,ILAN Work Classification: Public Works
Job Address:500 NE 96 Street
Miami Shores,FL 33138
Phone Number
Parcel Number 1132060140700
Project: <NONE>
Contractor. TECO PEOPLES GAS SYSTEM Phone:(305)957-3857
Building Department Comments
INSTALLING A NEW GAS SERVICE LINE Infractlo sed meats
INSPECTOR COMMENTS False
TO CLOSE PERMIT#PW14-1683
Inspector Comments
Passed1]], 6
[;t
Failed a f
, 2
Correction
Needed
Re-inspection
Fee
No Additional Inspections can be scheduled until
re-Inspection fee is paid
January 25,2016 For Inspections please call:(305)762-4949 Page 19 of 41
Permit NO. PW-1-16-51
Miami Shores Village Permit Type:Public Works
nn,..,. �M 10050 N.E.2nd Avenue NE Per m i Work Classification:Public Works
Miami Shores,FL 33138-0000 Permit Status:APPROVED
Phone: (305)795-2204
�lORIssue Date: Expiration:tion: 04/13/2016
Project Address Parcel Number Applicant
500 NE 96 Street 1132060140700
Miami Shores, FL 33138 Block: Lot: ILAN SEGAL
Owner Information Address Phone Cell
ILAN SEGAL 500 NE 96 Street
mlami shores FL 33138-
500 NE 96 Street
miami shores FL 33138-
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 Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# PW-1-16-58274
DBPR Fee $2.00 01/14/2016 Check*6069 $116.20 $0.00
DCA Fee $2.00
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 ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the ore g ng information is acc to and that all work will be done in compliance with all applicable laws regulating
constctio a z ing. Futhermore,I aut the a e- am con or to do the work stated.
January 14,2016
orized Signature:Owner X
Ap licant / Contracto / Agent Date
Building Department C�py
January 14,2016 1
i
Miami Shores Village
J N II
0'16
Building Department r
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
BUILDING Master Permit No 10-51
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
�
w { CONTRACTOR DRAWINGS
JOB ADDRESS: -�• qk'V`5-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 u 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:$2000 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration Q New ❑ Repair/Replace ❑ Demolition
Description of Work: E2 .,,I ` • — 'R�
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ f
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 CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,20 by --day,of S CL-Lle— .20 / ,by
who is personally known to �FS/e S 1�Eq f� S who' onally wn to
me or who has produced as me or who has produced as
identification and who did take an oath. identificati nd who did take an oath.
NOTARY PUBLIC: NOTAR PUB
HUBERT NUNEZ
Notary Public-State of Florida
Sign: n: i U,
•_My Comm. Expires Sep 11,2017
Print: Print: "'` Bnnded Through National Notary Assn.
Seal: Seal:
APPROVED BY tj�1 lans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)