PL-16-1311 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-258887 Permit Number: PL-5-16-1311
Scheduled Inspection Date:June 09,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: LEVER, DANIEL&KATIE Work Classification: Drainfield
Job Address:501 NE 96 Street
Miami Shores, FL 33138-2735 Phone Number (305)632-9829
Parcel Number 1132060171550
Project: <NONE>
Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859
Building Department Comments
TO INSTALL DRAINFIELD Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed lyl HRS APPROVAL IN FILE
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
June 08,2016 For Inspections please call: (305)762-4949 Page 19 of 45
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NO
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Miami Shores Village u
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204
Expiration: 11/1 5f2016
INN
Project Address Parcel Number Applicant
501 NE 96 Street 1132060171550 DANIEL 8 KATIE LEVER
Miami Shores, FL 33138-2735 Block: Lot:
Owner Information Address Phone Cell
DANIEL&KATIE LEVER 501 NE 96 Street (305)632-9829
MIAMI SHORES FL 33138-2735
501 NE 96 Street
MIAMI SHORES FL 33138-2735
Contractor(s) Phone Cell Phone Valuation: $ 2,500.00
MR C'S PLUMBING&SEPTIC INC (305)651-7859
Total Sq Feet: 300
Type of Work:TO INSTALL DRAINFIELD Available Inspections:
Type of Piping:
Additional Info: Inspection Type:
HRS Approval
Bond Retum: Final
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Owners Bond $500.00 Invoice# PL-5-16-59777
CCF $1.80 05/19/2016 Credit Card $272.80 $550.00
DBPR Fee $4.50
DCA Fee $4.50 05/18/2016 Check#:328 $500.00 $50.00
Education Surcharge $0.80 05/16/2016 Check#:1092 $50.00 $0.00
Permit Fee $300.00 Bond#:3092
Scanning Fee $9.00
Technology Fee $2.40
Total: $822.80
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is acc ate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named actor to do the work stated.
May 19,2016
Authorized Signature:Owner / Applicant / ontractor / Agent Date
Building Department Copy
May 19,2016 1
Miami Shores Village G '.'V I `.-
Building Department M Y 16 2096
100380 N.E.Zssd Avesssse,Miami Shores,Florida 33135 BY�
Tots(303)7952=Fans(305)736.5972
INSPECTION'S PHONE NUMBERS(306)762A949
BUILDING Permit No.
PERMIT APPLICATION mnaw Peru No-RU( 1-311
FBC 20
Permit Type: PLUMBING
OWNERS Name(Fee Simple Titleholder): Phom*: SGS -C?.,2-
Address: 6-61
�-
City: F P�a.� �L,.,✓r� State: �(_ Zip: ��1 �S
Tenant/Lessee Name: Phoneli:. NIA
Email: je-JGIC +G�FIa�.Car�
JOB ADDRESS: Sok
City: Miami Shores County: Miami Dade Zip: 3313�
Folio/PamIt I( ` Lo(e—GI-.1- —I sso
Is the Building Historically Mods Yes NO�� Flood Zone:
0
CONTRACTOR:Company Name: �' P� neo:
Address: l ?7 N j&)
City: u tV-� state• zip; � 611
Qualifier Name: �'i� � �t`'h't�. Phoneli• 30
State Certification or Registration arocate of Competency t
Contact Monet: P.mal Address:
DESIGNER:Awhitect/Engineer; Phone#:
Value of Work for this Permits$ �` ��' —SquamUnew Footage of Work: 30-Z r�
Type of Work: OAftess OAlteradon' ONew air/Replace Memolition
Description of Work: -/72) 11v2;7x-te-
stttssttstttttstsssstsssstsssssssssss*sF�sss**ts**suss*setts**ts***********tt*ssstss
Submittal Fee Permit Fee$ CCF$ CO/CC$
Scanning Fee$ 16 Radon Fee$ DBPR$Bond$
Notary$ Traiuing/Educatlon Fee$ 0.60 Techs 1W Fee$
Double Fee$ Aftudwa Review$
TOTAL FEE NOW DUE$ 0-7Z• ''
Rmadim Company's Name()f 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
constnwdon in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BODS,HEATERS,TANKS and AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVTP: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating const;wdm and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COM [ENCEMENT 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 COM ZNCEMENT."
Notice to Applicant: As a condition to she 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 lion law brochure will be delivered to the person
whose property is subject to attachment. Also, a cenVed copy of the recorded notice of commencement must be posted at the,fob site
for the,Rrst Inspection which occurs seven (7) days Acer the building permit is issued In the absence of such posted notice, the
Inspection will not be approved and a reinimcdon fee will be charged
Signature f Signature
—( t�
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me&4—L?—
day of 20 16.by day of 20 lit,by Y&M tAe &Vcir�c
who personally known to me who is personally known to me or who has produced Ilk
As identification and who did take an oath. t as identification and who did take an oath.
NOTARY C: NOTARY PUBLIC:
Sigry/.--I d h sign:
Print: Re l Print:
My Commission Expires: ,T,,...,, LWAu.MWM My Commission Expires:
MY COIdMISSION @ FF 0174 ••••u�,,,.,, .
.. . EXPIRES:ootobsr 24,2017 ,•.o�Y p�
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'••,;;�o����:•° Commission#EE 868595
APPROVED BY t/�r Plans Examiner
StnicWd Review Clerk
(Revised 07/10WXRevised 05/1W2009 3/15109)
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� 13-SC-1 678752
AePLICATION #:AP1237281
amor rLORMA DATE PAID:
DBPART oM OF
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TRZAMMM MM DISPOSAL SYST M FSB PA=*
#:PRIM 6994
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