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PW-15-2975 Inspection Worksheet Miami Shores Village 90050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax:(305)756-8972 Inspection Number: INSP-248459 Permit Number. PW-'11-15-2975 Scheduled Inspection Date: February 23,2016 Permit Type: Public Works inspector: Hernandez,Rafael Inspection Type: Final Owner: ROJAS,MIRYAM Work Classification: Public Works Job Address:534 NE 95 Street Miami Shores,FL Phone Number (305)4981227 Parcel Number 1132060140820 Project <NONE> Contractor. TECO PEOPLES GAS SYSTEM Phone: (305)957-3857 Building Department Comments ctio Passed comments Infra INSTALL A NEW GAS SERVICE LINE BY LINE BY INSPECTOR COMMENTS False DIRECTIONAL DRILLING inspector Comments r Passed J� Failed Correction ❑ Needed Re-inspection Fee No Additional Inspections can be scheduled until reinspection fee is paid OM*NO. PW-1,1-15-2973:,,,'""'r s�!o Gt Miami Shores Village® g Permit 7`ypf 'Fulblic woms 10050 N.E.2nd Avenue NE 0*Cfassfflcafioq'P,Ublic Work Miami Shores,FL 33138 0000 rml Phone: (305)795-2204 FtORtDA �. issue i a �12101201 "; Expiration: 3106/2016 Project Address Parcel NumberApplicant 9306 NE 9 Avenue _.�... 1132060020070 Miami Shores, FL Block: Lot: R W HOLDINGS GROUP LLC Owner Information Address Phone Cell R W HOLDINGS GROUP LLC 216 N MIAMI Avenue MIAMI FL 33128 ...,,-.,..-, Contractor(s) Phone _ Cell Phone Y_ � $ 1 µrvm�m Valuation: ,00® 00 TECO PEOPLES GAS SYSTEM (305)957-3857 (30F;-70-1'3.' Total Sq Feet: 00 Scanning:3 - Available Inspections: Inspection Type: Final Excavation Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 InVOICe# PW-11-15-57880 DBPR Fee $2.00 11/25/2015 Check#:5959 a 510C $64.60 DCA Fee $2.00 Education Surcharge $0.20 12/09/2015 Check#:6022 $64.6C $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 In consideration of the issuance to me of this perrr t, I agree to perform the work covered hereunder in compl, ince with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the prol ar authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work dcnc: "_, c::.".=: -. se:`, r.:; I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICA .,WINDOWS,DOORS,ROOFIRIG and SWIMMING POOL wor(. OWNERS AFFIDAVIT: I c rtify that II the foregoing info atien is accurate and that all work will be done in corn)liance with all applicable laws regulating construction and zo Ing. Fu I a thorize th �bov - amed contractor to do the work stated. Deter ober 09, 2015 Authorized Signature:Owner / Applica it / Contractor / Agent Date Building Department Copy December 09,2015 1 t C�D Miami Shores Village RID 7BY: OV 2 2015 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 20/1/ BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. F-1 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL OPUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 534 NE 95 ST. 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#: 954-453-0806 Address: 5101 NW 21 AVE. STE. 460 City. FT. LAUDERDALE State: FL Zip: 33309 Qualifier Name: JESUS VEGA Phone#: 954-453-0806 State Certification or Registration#: E1608 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition Description of Work: INSTALL A NEW GAS SERVICE LINE LINE BY DIRECTIONAL DRILLING 3/4" PLASTIC 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 Signatureslxa OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 by 29 day of 'uo O /�^ by who is personally known to t r&C—S VF-a A 4 CZ ,who is rsonally know to me or who has produced as me or who has produced as identification and who did take an oath. identific on and w o did take an oath. NOTARY PUBLIC: NOTA Y PUBLIC: HU6E�T NUNEZ public State of FIOtt 017 FFY P 9 Notary fres Sep Comm•ExP FF p43679 Sign: _ 4, y mmission otaNA N Assn.' 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