PL-13-1366 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972 �
Inspection Number: INSP-193808 Permit Number: PL-6-13-1366
Scheduled Inspection Date: September 18,2013 Permit Type: Plumbing - Residential
Inspector: Diaz,Osvaldo
Inspection Type: Final
Owner: SHAHNAZ PARVIN, MUHAMMAD Work Classification: Addition/Alteration
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Job Address:87 NW 100 Street
Miami Shores,FL 33150- Phone Number
Parcel Number 1131010180380
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
INSTALLING 3 NEW TOILET FIXTURES, 3 SINKS Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 17,2013 For Inspections please call: (305)762-4949 Page 6 of 17
Miami Shores Village
Building Department JuN/1 W3
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949'
FBC 20 %:�
BUILDING Permit No. ) l `
PERMIT APPLICATION Master Permit No. 'I�C��-- '
Permit Type: PLUMBING
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JOB ADDRESS: r l wU,� k t)O
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): A(,L. Ch6 LA:)A U r Phone#: -1Z L `l 4 I �1 101
Address: 0,JC- g a ND SjEae!-4
City: AL k State: L zip: 331
Tenant/Lessee Name: Phone#: 7 01
Email:
CONTRACTOR:Company Name: se-1 Phone#•
Address:
City: State: Zip:
Qualifier Name: Phone#.
State Certification or Registration#• Certificate of Competency#•
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ ®�° n° Square/Linear Footage of Work:
Type of Work: UAddress alteration ONew ORepair/Replace ODemolition
Description of Work: .Zn s n i'n(4 3 /U &2 `TO i f -Pxlv_r-5
Submittal Fee$ Permit Fee$ �S d if CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
No Training/Education Fee$ Technology Fee$
e Fee ! Structural Review$
TOTAL FEE NOW DUE$ Z'
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 a reinspection fee will be charged.
Signature Signature
er or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day ofTLNC 20 5 bytUHAr1't'1tl'1 9-') l MAIL Isley of .20_,by
who is personally known tome or who has produced P�( l7 who is personally known to me or who has produced
CAQ !N As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: `o\a►I III fill///,/ NOTARY PUBLIC•
Sign: �O Sign:
Print: _�<.,"lei,l�_ �'b2.,j�_ Print
My Commission Expires: '%.j;%'''d 3pp f�®�: My Commission Expires:
ZZ
4011111111100
APPROVED BY (Q Q-13 Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Rmised 3/15/09)