PL-14-2551 Inspection Worksheet p��_ 25s
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795.2204 Fax: (305)756.8972
Inspectlon Number. INSP-223648 Permit Number. PL-11-14-2551
Scheduled Inspection Date: March 28,2016 Permit Type: Plumbing -Residential
Inspector. Hernandez,Rafael
Inspection Type: Final
Owner. GUGUEN,ALICE Work Classification: Addition/Alteration
Job Address:10601 NE 6 Avenue
Miami Shores,FL 33138- Phone Number
Parcel Number 1122310120020
Project <NONE>
Contractor. MANNY'S PLUMBING SERVICE INC Phone:(305)219-5625
Building Department Comments
Infractio, Passed mems
PLUMBING WORK FOR MASTER SUITE INSPECTOR COMMENTS False
Inspector comments
Passed
Failed
Correction ❑
Needed
Re-inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
Miami Shores Village
10050 N.E.2nd Avenue NE
• Miami Shores,FL 33138-0000 ,
rY : �
Phone: (305)795-2204
Expiration: 02/2412016
Project Address Parcel Number Applicant
10601 NE 6 Avenue 1122310120020
ALICE GUGUEN
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
ALICE GUGUEN 10601 NE 6 Avenue
MIAMI SHORES FL 33138-
10601 NE 6 Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 3,500.00
MANNrS PLUMBING SERVICE INC (305)219-5625 Total Sq Feet: 571
Type of Work:PLUMBING WORK FOR MASTER SUITE Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Top Out
Bond Retum: Final
Classification:Residential Scanning:3 Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40 Invoice# PL-11-14-53656
DBPR Fee $3.38 08/28/2015 Credit Card $247.16 $0.00
DCA Fee $3.38
Education Surcharge $0.80
Permit Fee $225.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $247.16
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 AFF DA : 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 ng. Futhermore,I authorize the above-named contractor to do the work stated.
August 28,2015
A ed Signature:Owner / Applicant / Contractor / Agent uste
Building Department Copy
August 28,2015 1
Miami Shores Village ,
Building Department AUG 252015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY.
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.
PERMIT APPLICATION sub Permit No. Ce
/
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
QPLUMBING [:] MECHANICAL ❑PUBLICWORKS ,CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Itknol KLO
City Miami Shores County: Miami Dade Zip: 331W
Folio/Parcel#: 0 'L231 612 W-2-0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): RiC — Phone#:
Address: %0&oM Nt L fw-.
City: Mimi Shcst*�' State: T__L Zip: 3�;j 3S
Tenant/Lessee Name: Phone#:
Email: �1
CONTRACTOR:Company Name: r\ Dn Phone#:
Address:_> 1
City: Vt�q`P_ Gt1n State:FL Zip: 3-702
Qualifier Name: tkadl P1 ��t[�MO Phone#:
State Certification or Registration#: (NZ& Ilo Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: & Addition ❑ Alteration — New ❑ Repair/Replace ❑ Demolition
Description of Work:P� �RNCr anc
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$ T
(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 ap oved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONT OR
The foregoing instrument was acknowledged before me this The foregoing instr, ment was acknowledged before me this
( W day of AU06 ,t 20 11 by �day of flU!RUU* .20 tS by
I-tk1Cwho is personally known tot1�+?\ :i,:) 'J
,who is personally known to
me or who has produced \r- `1.e as me or who has produced )�'L 4 on -R\-E- as
Identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: �_ NOTARY PUBLIC:
Sign Sign -
Print: Print:
Seal: REBECA M.PASTRANA Seal:
REBECA M.PASTRANA
` MY COMMISSION @ I3Ii8nM MY COMMISSION&EE872624
eov 'I :F }U7.X17 EXPIRES.F,&n2ry 07,2017
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)