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PL-16-1938 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-263068 Permit Number: PL-7-16-1938 Scheduled Inspection Date: July 19,2016 Permit Type: Plumbing - Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: BARCLAY GRAEBNER,RICHARD EFFS Work Classification: Septic Job Address:912 NE 95 Street Miami Shores, FL Phone Number (305)490-3299 Parcel Number 1132060010010 Project: <NONE> Contractor. PULLES PLUMBING COMPANY Phone: (786)251-1234 Building Department Comments SEPTIC TANK AND DRAIN FIELD INSTALLATION Inbactio Passed Comments INSPECTOR COMMENTS False TO CANCEL PERMIT#PL-5-15-1249 Inspector Comments Passed HRS APPROVAL IN FILE. Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid ° c i Sho771 res Village 'r 9 10050 N.E.2nd Avenue NE Work sffic � Miami Shores,FL 33138-0000 N i'_J P: t A�lJS 'e „:•.3 '. Phone: ( ) 95-2204 Expiration: 1/11/2017 ,. ISS to: p�ration: 75C2i18 Project Address Parcel Number Applicant 912 NE 95 Street 1132060010010 RICHARD EFFS BARCLAY GRAI Miami Shores, FL Block: Lot: Owner Information Address Phone Cell RICHARD EFFS BARCLAY GRAEBNER 912 NE 95 Street (305)490-3299 MIAMI SHORES FL 3338- 912 NE 95 Street MIAMI SHORES FL 3338- Contractor(s) Phone Cell Phone Valuation: $ 13,500.00 PULLES PLUMBING COMPANY (786)251-1234 .• Total Sq Feet: 0 Type of Work:SEPTIC TANK AND DRAIN FIELD INSTALL Available Inspections: Type of Piping: Inspection Type: Additional Info: HRS Approval Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $8.40 DBPR Fee Invoice# PL-7-16-60566 $4.50 07/15/2016 Check#: 18004 $290.40 $50.00 DCA Fee $4.50 Education Surcharge $2.80 07/12/2016 Check#:8121 $50.00 $0.00 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $11.20 Total: $340.40 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is a6c—ur2e and that all work will be done in comp)ance with all applicable laws regulating construction and zoning. Futhermore,I authorize the ' tractor to do the work stated. July i 15, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 15,2016 1 I� CFTVED Miami Shores Village jL 12 2016 Building Department BY: nku, 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 —1H FBC 20f(4 BUILDING Master Permit No. PUG- R'__zj PERMIT APPLICATION Sub Permit No. F-1 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP , / \ �r— CONTRACTOR DRAWINGS JOB ADDRESS:��4 /6/ C�� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE� FFE: OWNER:Name(Fee Simple Titlgholder): g/-P_-C/ Phone#: Address: 2— City: City: lozgg.re._ State: ` Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: /✓��s �� Phone#: Address: s '-evl City: ��--�, tate: �"� Zip: Qualifier Name: C ®S t� PS Phone#: Gt State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address City: —State: Zip: Value of Work for this Permit:$_ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New En—Repair/Replace ❑ Demolition Desc 'pt(on of Work: Specify color �o{f\color thru tile: Submittal Fee$ 01 3 Permit Fee$ 31,4 C) CCF Scanning Fee$ r_ L� 1 Radon Fee$ DBPR$ Notary$ Technology Fee$ //° �r Training/Education Fee$ �� Double Fe�$ o � Structural Reviews$ Bond$ TOTAL FEE NOW DUE (RevisedOZ/24JZ014) 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 whos-e-property-is subject-to attachment:Also,-a-certified copy of the-recorded7ratice of cammerrcemEwt-mvs't-b`e posted-our he 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 approved and a reinspection fee will be charged. L— Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of -- 20 by L3 day of---�f r20 li�D by ,C isaL� �/ �'�✓,who is personally known toa,:F4 flS �0�L Lo��s ,who is personally known to me or who has produced as me or who has producedP--09-1 y�-L(K�XN% as identification and who did take an oath. identification and who did take an oath. m NOTARY PUBLIC: NOTARY PU IC: rotor Pis^ Notary Pobiic State of Florida Sir.dia Aiva'-z �_ c¢ My Commission FF 156750 $I n: 9j�oFc�o�� Expires09tt)3/2018 g Sign: �n,PP -°+gig r Print: Print:�,NTA� PK Seal: ?� No"public.State of JFIorida Seal: • `• My Comm.Expires Dec 1Cmnmiesion N EE 88Bonded Throgh N91snal ttel �*�x��* ) x�e*�*�**��a��t�r��+ss��*�atux+��s*�****�*.rr•ex*e�+u�*��a�ss� APPROVED BY �3s/ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �, DIVISION a F �Jm � � E»Yin3nmnl+�lennt,�tt H+Eatth �.O Florida Health ®��► Miami-Dade County Q� OSTDS/Well Division ®� 11305 SW 26i°Street•Miami,FL 331?5 O Inspector �'�C ' C ,n 1f� -s Date r' Address ��+ j J 1 OSTDS# Comments: �c ,a- t�,�l C t Signature