PL-10-1776 Inspection Worksheet
Miami Shores Village law,
10050
N.E.2nd Avenue Miami Shores FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-152043 Permit Number: PL-10-10-1776
Scheduled Inspection Date: March 21,2011 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: BUTLER,JACQUELINE Work Classification: Addition/Alteration
Job Address: 1461 NE 102 Street
Miami Shores, FL 33138-2621 Phone Number
Parcel Number 1132050240140
Project: <NONE>
Contractor: THE NEW MIAMI SHORES PLUMBING Phone: (305)751-2446
Building Department Comments
PAINT
Inspector Comments
Passed
-V
Failed
Correction
Needed ❑
Re-Inspection G
Fee
e7
No Additional Inspections can be scheduled until
re-inspection fee is paid.
March 18,2011 For Inspections please call: (305)762-4949 Page 7 of 37
Miami Shores Village T
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 `
Phone: (305)795-2204
r 'y
Expiration: 0412312011
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: $ 1,000.00
THE NEW MIAMI SHORES PLUMBING (305)751-2446 (786)553-5424
Total Sq Feet: p
Type of Work:PLUMBING Available Inspections:
Type of Piping:DEMOLITION Inspection Type:
Additional Info:
Final
Bond Retum:
Classification:Residential Scanning: 1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.00 Invoice# PT-10-10-39090
CCF $0.80 10/26/2010 Check#:3483 $155.60 $0.00
DBPR Fee $2.00
DBPR Surcharge $0.00
DCA Fee $2.00
Education Surcharge $0.00
Education Surcharge $0.20
Permit Fee $0.00
Permit Fee $150.00
Scanning Fee $0.00
Technology Fee $0.00
Technology Fee $0.80
Total: $155.60
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit 1 assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable taws regulating
construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated
October 26,2010
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
October 26,2010 1
Miami Shores Village
Building Department u G
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 OCT 0 6 201,�
Tel:(305)795.2204 Fag:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No. ly
PERMIT APPLICATION Master Permit No. 10 —I b` O
FBC 20
Permit Type: PLUMBING \ ii p� ,�r
Owner's Name(Fee Simple Titleholder) J f1�C_C�V P-1i r1� G uc��IArPhone#
Owner's Address Jq GO( K�� 102,!*- ST
City-CL.M: skores State Vt- Zip Z3 13S
Tenant/Lessee Name Phone#
Email
Job Address(where the work is being done)_I qCp( 2w
City Miami Shores Villaee County Miami-Dade Zip 53(,3$
FOLIO/PARCEL# 1t-laOS-02-4-yl 4 O
Is Building Historically Designated YES NO Flood Zone
Contractor's Company Name 1Aiu-%, 5e%orc-,5 �Rurv%61wy —Phone# 305"'7S—l"2WL((p
Contractor's Address_CL00 1
City 0,%,1 State Zip 33 1 G 16
Qualifier Name Phone#
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E-mail
Architect/Engineer's Name(if applicable) Phone#
Value of Work For this Permit$ Square/Linear Footage Of Work:
Type of Work: []Addition ❑Alteration ❑New ❑ Repair/Replace Demolition
Describe Work: � - �1ytT s AI�b
Submittal Fee$ Permit Fee$ CCF$ COWC$
Notary$ Training/Education Fee$ Technology Fee$
Scanning$ Radon$ DPBR$ Bond$
Double Fee$ Violation date: `cc
Structural Review.$ Total Fee Now D 1%
ue$ d)
See Reverse side-�
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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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
C�
Signature Signa.
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The fore omg instrument was acknowledged before me this/15
day of ,20 by day of ,20�®by J< /I
who is personally known to me or who has produced who is nersonaft known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: N T Y PUBLIC:
Sign: ign:
Print: Print: . A Rid—
My Commission Expires: My c NIMOMMISSION;:'!)®753585
M.�� EXPIRES[tpu`' ,2012
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APPROVED BY /�< < r� Plans Examiner Zoning
Engineer Clerk checked
(Revised 07/10/07XRevised 06/(02009)