PL-15-3197 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-250118 PermitNumber: PL-12-15-3197
Scheduled Inspection Date: May 23,2016 Permit Type: Plumbing -Residential
Inspector: Hernandez, Rafael inspection Type: Final
Owner: CARVALHO,ANNELI DE Work Classification: Addition/Alteration
Job Address:356 NE 102 Street
Miami Shores,FL 33138-2429 Phone Number
Parcel Number 1132060135120
Project <NONE>
Contractor: REGOSA ENGINEERING SERVICES INC Phone: (786)262-2964
Building Department Comments
ACRYLIC SHOWER BASE,ACRYLIC LINER WALL,VALVE Inftactlo Pwsed Comments
AND FIXTURES. 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 8
10050 N.E.2nd Avenue NE 3 "3
Miami Shores,FL 33138-0000
Phone: (305)795-2204
tORri�p'
3 3 , rlue >a }£ Expiration: 11/0812016
Project Address Parcel Number Applicant
356 NE 102 Street 1132060135120
Miami Shores, FL 33138-2429 Block: Lot: ANNELI DE CARVALHO
Owner Information Address Phone Cell
ANNELI DE CARVALHO 356 NE 102 Street
MIAMI SHORES FL 33138-2429
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
REGOSA ENGINEERING SERVICES M (786)262-2964 (786)344-8720
Total Sq Feet: 0
Type of Work:ACRYLIC SHOWER BASE,ACRYLIC LINER Available Inspections:
Type of Piping: LInspectione:Additional Info:Bond Retum:Classification:Residential Scanning:1 g
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# PL-12-15-58179
DBPR Fee $2.25 12/29/2015 Cash $50.00 $109.10
DCA Fee $2.25
Education Surcharge $0.20 05/12/2016 Credit Card $ 109.10 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $159.10
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFID ,, I certify that I the f e ing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction an g. Fut rtnor aut ri he abov med contractor to do the work stated.
May 12, 2016
uthorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 12,2016 1
Miami Shores Village EC 2 9 2015
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
ZD
FBC 20 V-4
BUILDING Permit No. -
PERMIT APPLICATION Master Permit N6120J -31 clk
Permit Type: PLUMBING
JOB ADDRESS: Ivy IO2, S�i
City: Miami Shores County: Miami Dade Zip:_ 3 13
Folio/Parcel#: 11 3 20(0 0(35 I
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): Anne 1t 0e Ccir 4 a]bo Phone#:
Address:35 p MG- iox bfi
City: 1\Alclf y`1 !Sr"es State: FL Zip: 3,5138-
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Vlfi lk r Z Mao7n Hoo(1 Oenoy. Phone#: --7&0-511 -S(09
Address: i®c5p l) 3wrtoV ,
City: 17ota t State: Zip:
�Z 3 31-1$'
Qualifier Name: V_0 0-_yA ri SQL.A
_ Phone#•
State Certification or Registration#:_C yz 5 48D Certificate of Competency#:
Contact Phone#: Email Address: CSA 31®a b:( F t Wt- LZA.0 e+
DESIGNER:Architect/Engineer: Phone#:1 -51-7'X10`1cl
Value of Work for this Permit:$_ �/ .. Square/Linear Footage of Work: 3X
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: 1IG �0V1LAA pe( UcAs-� ISG 11 �1"'y- �Ul )
-►al�e x
�xxxx�xx��xm�m�x�x�x��x�x�x����x�xxx��Fees'�xxxxuxx�xmx*x�x�xx�*�xxx�xxxx*�x����x�xx�xx
Submittal Fee Permit Fee$ �Z' CCF$0 ' G O CO/CC$
Scanning Fee$ Radon Fee$ DBPR$!p Bond$
Notary$ Training/Education Fee$® 20 Technology Fee$ QJ®
Double Fee$ ® Structural Review$
TOTAL FEE NOW DUE$ (cpi ,
y
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 pp roved and a reinspection fee Will be charged.
d4Signature X Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this oZa
day of�,20115,by Art ne l i fie (61 P JCl� 0 day of� ,2015,by �°�yu h 54
who is personally known to me or who has produced DL- who is personally known to me or who has produced
D 2.O)'fQI 40470As identification and who did take an oath. S520:7(OIL49 4I1C identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
J,
Sign: Sign:
Print: Y1 Cam 21 Print: �(Qt1 r1 2
My Commission Exr : CLEYDE M NENRIQUEZ My Co ;XCEMYDE N MENRIQUEZ
•': MY COMMISSION#FF923860 °'i ••'s MY COMMISSION#FF923860
., EXPIRES Odober 04,2019 EXPIRES October 04,2019
APPROVED BY 'NOW —f E+ Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)