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PW-16-56 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-250627 Permit Number: PW-1-16-56 Scheduled Inspection Date:January 27,2016 Permit Type: Public Works Inspector: Diaz,Osvaldo Inspection Type: Final Owner: BUTLER,JACQUELINE Work Classification: Public Works Job Address:1461 NE 102 Street Miami Shores,FL 33138-2621 Phone Number Parcel Number 1132050240140 Project: <NONE> Contractor. TECO PEOPLES GAS SYSTEM Phone:(305)957-3857 Building Department Comments INSTALL A NEW GAS SERVICE LINE BY DIRECTIONAL lnfracuo Passed Comments DRILLING INSPECTOR COMMENTS False TO CLOSE PERMIT#PW15-1149 Inspector Comments Passed EJ Failed Correction � I Needed Re-Inspection Fee No Additional Inspections can be scheduled until re inspection fee Is paid January 26,2016 For Inspections please call: (305)762-4949 Page 27 of 62 Permit NO. PW-1-16-56 y Miami Shores Village Permit Type:Public Works 10050 N.E.2nd Avenue NE e r m Work Classification:Public Works Miami Shores,FL 33138-0000 _ Permit Status:APPROVED Phone: (305)795-2204 R1Dp Expiration: 04/13/2016 Issue Date: 1/14/2016 Project Address Parcel Number Applicant 1461 NE 102 Street 1132050240140 JACQUELINE BUTLER Miami Shores, FL 33138-2621 Block: Lot: Owner Information Address Phone Cell JACQUELINE BUTLER 1461 NE 102 Street MIAMI SHORES FL 33138-2621 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-1-16-58279 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 FFID VIT: Icertify that all th fore oing information is a r to and that all work will be done in compliance with all applicable laws regulating constructio a ning. Futhermore,I a o' the ve-n m co ra or to do the work stated. January 14,2016 uthorized Signature:Owner / A licant / Contractor / Agent Date Building Department Copy January 14,2016 1 t Miami Shores Village ! Building Department JAN 11 2016� 16 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 TA INSPECTION LINE PHONE NUMBER:(305)762-4949 5 '�'FBC 201(-1 _ BUILDING Master Permit No.t"Ilu ® PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL ❑PLUMBING [:] MECHANICAL 0 PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP f� CONTRACTOR DRAWINGS JOB ADDRESS: 1 I •�S' l t)T- City Miami Shores County Miami Dade Zia: 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:$2000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration N New ❑ Repair/Replace ❑ Demolition Description of Work: W iI, ��'0- Specify color of color thru tile: Submittal Fee$ (7) 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$ J (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 s acknowledged before me this day of .20 by -�7 day of 20 by who is personally known to wo t personally known to' me or who has produced as me or who has produced identification and who did take an oath. identification an ho did take an oath. NOTARY PUBLIC: NOTARY PUB C: k HUDERT NUNEZ r •�,,eaiup, ,�I.RY P°jB Notary Public-State of Florida , a'_° „•=My Comm. Expires Sep 11,2017 Sign: Sign =°> ' &rF 04.1r,79 I %°„.t3 Bonded Through National Notary Assn. '' Print: Print: r Seal: Seal: 1� APPROVED BY B I Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)