PL-15-2526 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)796-2204 Fax: (305)7 -8972 G
Inspection Number. IWSP-256853 Permit Number. PL-10-15-2526
Scheduled Inspection Date:April 14,2016 Permit Type: Plumbing -Residential
Inspector Hernandez,Rafael
Inspection Type: Final
Owner: CARLA GRISONI,CANOR PATO Work Classification:Addidon/Aiteration
Job Address:162 NW 109 Stmt
Miami Shores,FL 33168-4317 Phone Number
Parcel Number 1121360100220
Project <NONE>
Contractor. MANNY'S PLUMBING SERVICE INC Phone:(305)219-5625
Building Department Comments
PLUMBING WORK FOR GARAGE CONVERSION TO commwft
INCLUDE 1 TOILET,1 TUB AND 1 SINK INSPECTOR COMMENTS Fate
Inspector Comments
Passed CREATED AS REINSPEC ON FOR INSP 244919 Need to close gas
permit
Failed
Correction
Weeded
Re-Inspection
Fee
No Add3tiona(Inspections can be sctusiuled urdn
re inspection fee Is paid.
Miami Shores Village
10050 N.E.2nd Avenue NWS'
Miami Shores,FL 33138-0000
Phone: (305)795-2204 "
` Expiration:0411312016
Project Address Parcel Number Applicant
162 NW 109 Street 1121360100220
CANOR PATO CARLA GRISONI
Miami Shores, FL 33168-4317 Block: Lot:
Owner Information Address Phone Cell
CANOR PATO CARLA GRISONI 162 NW 109 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $4,700.00
MANNrS PLUMBING SERVICE INC (305)219-5625 Total Sq Feet: 0
Type of Work:PLUMBING WORK FOR GARAGE CONVERSION Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Top Out
Bond Retum: Final
Classification:Residential Scanning:1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00 Invoice# PL-10-15-57318
DBPR Fee $3.38 10/05/2015 Credit Card $50.00 $192.76
DCA Fee $3.38
Education Surcharge $1.00 10/16/2015 Credit Card $192.76 $0.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $4.00
Total: $242.76
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 th t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Fu the I authorize the above-named contractor to do the work stated.
October 16,2015
Authorized Sign .Owner / Applicant / Contractor / Agent Date
Building Department Copy
October 16,2015 1
Miami Shores Village
Building Department ! OcT ® 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 - -
FBC201 �
BUILDING Master Permit No�t�ff - I d
PERMIT APPLICATION Sub Permit NoL, _
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
�LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION .❑ SHOP
1 - CONTRACTOR DRAWINGS
JOB ADDRESS: IL02 KIW 1 D 9 skree _
City: Miami Shores County: Miami Dade zip: 331
Folio/Parcel#: JX 9-ISLa Old 022.0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): C Qt1[r! 19 An. Phone#: 325 M1 Toa-4
Address: 110?_ cL"Lo lcsc r SNQRek
City: 103&& � 12s' State: T-,L Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 11"I A N N 1/lS �.u 1,N L%N 6," tk Q-,V iCgPhone#: 3O 5-Z Iq
Address: M.1 \kj 3� _ (>L- IS&u tso2- A
1
City �' 16� a, 330
g
State: � Zip: 2.
Qualifier Name: 4 b Al afaL ?-S n90 nA b Phone#
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address City: State: Zip:
Value of Work for this Permit:$4.11000'. Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New 1:1Repair/Replace ❑ Demolition
Description of Work: jAlG GaR`ll j,40-A- 6-19� J t1 VM-
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ At ZZJ. CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ . 46
(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 ed and a reinspection fee will be charged.
Si ature Signature
OWNERo AGENT CON CTOR
The foregoing instrument was acknowle g e me this The foregoing instrument was acknowledged b ore me this
r1 day of ®cAt)oe� '20 1S by _ I day of �C�C� .20_¢ ,by
�=N w csc- YOU. .who is personally known to tJ\A"J`f who is personally known to
me or who has produced ��, C�1 �t�-e-- as me or who has produced �t-- O N !—t LF as
Identification and who did take an o h. identification and who did take a th.
NOTA BUC: NOT PUB
, .
Sign Sig
Print: Print:
Seal: Seal: =REBE�C�A AREBECA M.PASTRANA 4MY CO111NIISSION EE72624 7wEXPIRES:February 07,2017
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APPROVED BY P® Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)