PL-15-2512 2C ['5 '/ 2/ 3
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-254311 Permit Number: PL-10-15-2512
Scheduled Inspection Date: March 10,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: TAVARES,TIERES Work Classification: Gas
Job Address: 10050 NE 12 Avenue
Miami Shores, FL Phone Number (305)244-2356
Parcel Number 1132050190370
Project: <NONE>
Contractor: MILLENNIUM PLUMBING LLC Phone: (561)674-7727
Building Department Comments
RELOCATE GAS FOR STOVE ADD GAS FOR A DOOR Infractio Passed Comments
LAMP INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-244784. Pending drop test
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
March 10,2016 For Inspections please call: (305)762-4949 Page 22 of 28
�.. P 10 1 ,- -1 ►-
Miami Shores Village �� _ fe mttType.blurt bi" -R6s)d lt) )
10050 N.E.2nd Avenue NE
Work CIassli�tiom Gas
Miami Shores,FL 33130.0000
,— = : p�ft�
Pht ,APPRCii� �'
one: (305)7952204
�oxtvA
1p Expiration: 04/03/2016
Project Address Parcel Number Applicant
10050 ONE 12 Avenue 1132050190370
Miami Shores, FL Block: Lot: BEYOND ALL REVOCABLE TRU
Owner Information Address Phone Cell
BEYOND ALL REVOCABLE TRUST 10050 NE 12 Avenue
- --- - --- MIAMI SHORES FL 33138- (305)244-2356 (786)709-3909
10050 NE 12 Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
MILLENNIUM PLUMBING LLC (561)674-7727 Valuation: $ 400.00
Total Sq Feet: 0
Type of Work:RELOCATE GAS FOR STOVE ADD GAS FOR Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Final
Bond Return: Press Test
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# PL-10.15-57298
$2.25 10/02/2015 Credit Card $50.00 $115.10
DCA Fee $2.25
Education Surcharge $0.20 10/06/2015 Credit Card $ 115.10 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $165.10
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 confo ith the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this pe a ume r onsibi ity for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for E TRICAL,PL U ING,M CHANICAL.WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS ,#FFIDAVIT- I certi tha all t e for
information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio6and zoni Futhermo e,I a thorize the above-named contractor to do the work stated.
October 06, 2015
Authori ed Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
October 06,2015 1
Midl I II JI IUI CJ V IIIdr3C
Building Department OCTa� zo
' 15
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 201-0
BUILDING Master Permit No. 1 �• ,S� 1
PERMIT APPLICATION Sub Permit No. 2S 12
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10 n �03 I Z rLy'
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: 2 Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): Phone#:
Address: /00,3 0 AJ /-2—
City:
City: /y/&/t-1 1 State: �'� Zip:
Tenant/Lessee Name: Phone#:
Email: L r
CONTRACTOR: Company Name:_i i /l/em 1 U Yl� Jvsh Or rv� f'c�wne#:
Address. I I 13 3 X4O�4, C/ q 516
City: C a: M A-&!S2z State: 1'l-- Zip:
Qualifier Name:, C'��' dZ�`-� .� cj 1 !/i4-//J` Phone#:
State Certification or Registration#? certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$_4�� —Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 1—O
bZ ti moo IZ
Specify color of color thru tile:
Submittal Fee$ so 66 Permit Fee$ 11-6o � CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE S U ( � s 0
•
Bonding CorTipany's Name(if applicable)
Bondirfg 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 attachme ,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection wht]gh oc rs seven ( ) days after the building permit is issued. in the absence of such posted notice, the
inspection will not be prove and a reinspection fee will be charged.
Signature Signature .Q.
OWNER or AGENT ONT OR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of J C LI (L20 1,:!r by day of A-�V ,20 G 5-' by
personally known to cam! VM-4 personally known to
pr who has produced 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:
Sign: L Sign: �ZL JC-
Print: A 1 R 2X�- Gy#1 Iqa Print: !, v 1 FL C k--O�
Seal: g;;yAIR DACUNHA Seal: �,"'�,, 31LVAR DVACUNMA• Co�r►rarissioComm scion N FF 170061 0 `'o c ,(nmission Expires ,my Commi20, 2016 toOctobe
APPROVED BY f•�) /S Plans Examiner Zoning
Structural Review Clerk
I
1 0.'� +
ANNE M. G A N N O,ti P.O. Box 3353,West Palm Beach, FL 33402.3353 —LOCATED AT**
CONSTITUTIONAL TAX COLLECTOR www.pbctax.com Tel: (561)355-2264
sem-in"',Palm 11vach C01urllr 11133 MODEL CIR E
Serving i/carr. BOCA RATON, FL 33428
TYPE OF BUSINESS OWNER CERTIFICATION aRECEIPT#/DATE PAID AMT PAID BILL a
23.0069 PLUMBING CONTRACTOR SiVALLS JEFFREY L CFC1427397 815.885767-09+16115 $27.50 840182927
This document is valid only when receipted by the Tax Collector's Office.
STATE OF FLORIDA
PALM BEACH COUNTY
B1 - 160 2015/2016 LOCAL BUSINESS TAX RECEIPT
MILLENNIUM PLUMBING LLC LBTR Number: 201469797
MILLENNIUM PLUMBING LLC EXPIRES: SEPTEMBER 30, 2016
11133 MODEL CIR E
BOCA RATON, FL 33428 This receipt grants the privilege of engaging In or
managing any business profession or c ccupation
within its jurisdiction and MUST be con. Dicuously
displayed at the place of business and it such a
manner as to be open to the view of the p Iblic.
Dear Business Owner:
Your new local business tax receipt is on the reverse side. Verify this information and display it conspicuously at your place of business,open
to the view of the public.
This receipt is in addition to and not in lieu of any license or receipt required by law or city ordinance and is subject to regulations of zoning,
health and any other lawful authority(County Ordinance Number 17-17)
• Receipts may be transferred to a new owner when evidence of a sale is provided, the original receipt must be surrendered and a
transfer fee is required.
• Receipts may be transferred to a new location when proof of zoning approval is provided,the original receipt must be surrendered and
a transfer fee is required.
• A business name change requires a new Local Business Tax Receipt. Therefore a new LOCAL BUSINESS TAX APPLICATION,
(PBCTC FORM#65), proof of business name change registration with the state and proper fees would be required.
This receipt expires on September 30, 2016. Renewal notices are sent at the end of June. If you do not receive a notice by the end of July,
please contact our office.
I hope you have a successful year.
a," '�. 1
Constituticnal Tax Collector, Serving Palm Beach County