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PL-15-772 — /,3p/.?z 77/ Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)796-2204 Fax:(305)756-8972 Inspection Number: INSP-231658 Permit Number: PL-4-15-772 Scheduled Inspection Date: September 15,2015 Permit Type: Plumbing- Residential Inspector. Diaz,Osvaldo Inspection Type: Final Owner: JACKSON,LANCE AND PAULA Work Classification: Pool- Private Job Address:391 NE 103 Street Miami Shores,FL 33138-2432 Phone Number Project <NONE> Parcel Number 1121360130290 Contractor: PARKWOOD POOLS INC Phone:(954)683-3355 Building Department Comments POOL PIPING Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed 6 Failed o(� Correction Needed Re-Inspection a Fee No Additional Inspecdons can be scheduled until re-inspection fee is paid September 14,2015 For Inspections please call:(305)762-4949 Page 14 of 56 x f t Wa Miami Shores Village �* 10050 N.E.2nd Avenue NE s Miami Shores,FL 33138-0000 Phone: (305)795-2204 m i :': �� ., ' Expiration: 1112212015 Project Address Parcel Number Applicant 391 NE 103 Street 1121360130290 LANCE AND PAULA JACKSON Miami Shores, FL 33138-2432 Block: Lot: Owner information Address Phone Cell LANCE AND PAULA JACKSON 391 NE 103 Street MIAMI SHORES FL 33138- 391 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 750.00 PARKWOOD POOLS INC (954)583-3355 Total Sq Feet: 0 Type of Work:POOL PIPING Available Inspections: Type of Piping: Inspection Type: Additional Info: Main Drain Bond Retum: Final Classification:Residential Scanning:1 Rough Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# PL-4-15-55075 DBPR Fee $3.38 04/06/2015 Check#:777 $50.00 $186.36 DCA Fee $3.38 Education Surcharge $0.20 05/26/2015 Check#:1641 $186.36 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $236.36 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 AFFIDAVI . certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoni he I uthorize the above-named contractor to do the work stated. May 26,2015 Authorized ignure:Owner / Applicant / Contractor 4Z Agent Date f ----------- Building Deplaftment Copy May 26,2015 1 Miami Shores Village FIRREECEIVED Building Department 6 201510050 N.E.2nd Avenue,Miami Shores,Florida 33138 Ti*.(305)795-2204 Few(305)75SM72 INSPECTION LINE PHONE NUMBER:(805)M-4949 FBC 20(C) BUILDING Mauer Pern*N0.2a�- 1�—�' I PERMIT APPLICATION sub Permit [-]BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ©PLUMBING ❑MECHANICAL ❑PUBLIC WORKS [-] CHANGE OF ❑CANCELLATION [:]SHOP CONTRACTOR DRAWINGS 1oB ADDRESS: AR i NE 103 %*' City: Miami Shores County: Miami Dade Zia: 33t s8 Foft/Parcero. 11-2,1136-0113- 0250 Is the BuildhM Hilstorkally :res NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ?aLj . &tlaSm Phone#:3OS-3033.-5515 Address: 341 Ns los stre& City: MA.-A, 5hom State: F1 ZIP: 33132 Tenant/Lessee Name: AIA Phone#: Email: p=la j&rk-*ten a asnn'.l.torr► CONTRACTOR:Company Name. t'w4l'uma Pus, ��w. Phmml: ftci-582-3355 Address: UN&I U Su isr� '84✓d. City: 1'. 60kt" . State: F1.. Zip: 3330, Qualifier Name: 1&yu Ajams Phone#:4S4-707-1Ro7 State Certification or Registration#: CPC 1461M Certificate of Competency#: DESIGNER:Architect/Engineer: a lA Phone#: Address: City: state: Zip: Value of Work for"Peraft$ ISO-es. S*we/Unew Footage of Woria Type of Work: ❑ Addition ❑ Alteration L2''Nery d Repair/Replace ❑ Demolition Description of Work: ?Oolio.nQ Specify color of color thm We.- Submittal ile.Submittal Fee$ Permit Fee$ r + ®V CCF$ CD/«$ Scanning fee$ Radon Fee$ DBPR$ Notary$ Tecknology Fee$ Trakring/Edueation Fee$ Doable Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 2'S'' C'�- (Revt /24/2014) 4z Bonding Company's Name(if applicable) 14 rA Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) 01A 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 drat no work or!Installation has commenced prior to the Issuance of a permit and that all work will be performed to meet the staruiards of all laws regulaft 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 AFFIDAW I certify drat 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 Applkont: As a candlNon to tiles Issuance of a br Aft permit with an estimated volue oweeding$25W,the app/kant must promise In good fold►that a copy of the notice of comrnencement and construction Nen law brod►ure wNl he deNvered to the person whose property Is su*d to attachment Also,o cerdfled copy of the recorded notice of commencement must be posted at the Job site for the first Imo► **ick occurs seven (7) days after the bulk ft permit Is issued. M the absence of such pasted notice, the Inspection w1Nnot be approved and o reinspection fee be charged. Signature signaWre OWNE ceAGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of Meek .20 J___,by day of (Yle,[d�► .20 yam,by wic T&cLsbn .who is personally known to Uw;d r-AAm .who D personally known to me or who has produced Aef, tis NwS& as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC NOTARY PUBLIC: /41A�r �: Print: Print: f d,�yyty FV ' �psty P`., Seal: :`'r°-" CHERYL MORGAN Seal: ��:: a��: CHERYL MORGAN "i MY COMMISSION#FF008874 MY COMMISSION#FF008874 ' ''. 'c• m 9C 9 ;QP '•,'eat-ell EXPIRES June 28,2017 ''..'FOR a?••`` EXPIRES June 28,2017 tttt*tst$s$** (407J 398-0153 Florid N t i $$t$ttstt$$f$$$ 40 0t$ _! Ott $00000** APPROVED BY '� f Plans Examiner Zoning Structural Review Clerk (R A4/2K4)