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PW-16-57 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-250632 Permit Number: PW-1-16-57 Scheduled Inspection Date:January 26,2016 Permit Type: Public Works Inspector: Diaz,Osvaldo Inspection Type: Final Owner: BOQUIN,BELINDA Work Classification: Public Works Job Address:2 NE 109 Street Miami Shores,FL Phone Number Parcel Number 1121360110400 Project: <NONE> Contractor. TECO PEOPLES GAS SYSTEM Phone: (305)957-3857 Building Department Comments hdrac REPLACING THE EXITING GAS SERVICE DUE TOA ° Comments INSPECTOR COMMENTS paw LEAK AND BAD CONDITION, BY DIRECTIONAL DRILLING TO CLOSE PERMIT#PW15-1914 Inspector Comments Passed D/ Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until reinspection fee is paid January 25,2016 For Inspections please call:(305)7624949 Page 22 of 41 Permit NO. PW-1-16-57 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 F`OR1DA Expiration: 04/13/2016 Issue Date: 1/14/2016 Project Address Parcel Number Applicant 2 NE 109 Street 1121360110400 BELINDA BOQUIN Miami Shores, FL Block: Lot: Owner Information Address Phone Cell BELINDA BOQUIN 2 NE 109 ST MIAMI FL 33161-7040 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-1-16-58280 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 AFF VIT: I certify that all the regoing informati is accurate and that all work will be done in compliance with all applicable laws regulating construction adznijlg. Futhermore,I a orize a abov a d contractor to do the work stated. January 14,2016 A riz ture:Ownerpplicant / Contractor / Agent ate Building Departme opy January 14,2016 1 Miami Shores Village 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 S FBC 20 I H BUILDING Master Permit No. Pw � G PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL FNIPLIBLIC WORKS [:] CHANGE OF ❑CANCELLATION [:] SHOP CONTRACTOR DRAWINGS JOBADDRESS: lW l®oln .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 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:$2000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration Q New ❑ Repair/Replace ❑ Demolition Description of Work: ��2 �-� �� f k5;7l` Specify color of color thru tile: Submittal Fee$(7 Permit Fee$ CCF$ CO/CC$ 17)Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ ") Structural Reviews$ Bond$ P TOTAL FEE NOW DUE$ �kc) (Revisedo2/24/2014) I , 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 C OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument s acknowledged before me this day of ,20 ,by day of G by who is personally known to c�.-��S�cs 1 E4 A::� ,who' personally kno n to me or who has produced as me or who has produced as identification and who did take an oath. identification an ho did take an oath. NOTARY PUBLIC: NOTARY PUB C: 4FRy pV� FIUBERT NUNEZ �r ear°w ,`�= Notary Public-State of Florida Sign Sig - e _ Print: Print Commission 003679 a Ana f t 1 g ary ssn.lt Seal: Seal: l (® APPROVED BY I Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014)