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PL-16-2071 (2) i Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-264020 Permit Number: PL-7-16-2071 Scheduled Inspection Date: August 04,2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: MARVIN R LIST 81 MARIA T MANERBA, Work Classification: Septic IIAAC\/IAI O 1 107 R RRADIA T RRAIUCCQA Job Address:9929 NE 4 Avenue Road Miami Shores, FL 33138- Phone Number (305)858-0204 Parcel Nurrlber 1132060171280 Project: <NONE> Contractor: MR C'S PLUMBING&SEPTIC INC Phone: (305)651-7859 Building Department Comments DRAIN FIELD INSTALL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed HRS IN FILE Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 03,2016 For Inspections please call: (305)762-4949 Page 11 of 31 y N Miami Shores Village PG� ")! 9�, R" �a(\ 10050 N.E.2nd Avenue NE MSsS Miami Shores,FL 33138-000 0 I` �! Phone: (305)795-2204 , . StatUS issuw st64o Expiration: 01/3 /2017 Project Address Parcel Number Applicant 9929 NE 4 Avenue Road 1132060171280 Miami Shores, FL 33138- Block: Lot: MARVIN R LIST&MARIA T MAN Owner Information Address Phone Cell MARVIN R LIST&MARIA T MANERBA 9929 NE 4 AVE Road (305)858-0204 -- - - -- - -- - --- --- MIAMI SHORES FL 33138- 9929 NE 4 AVE Road MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,400.00 MR C'S PLUMBING&SEPTIC INC (305)651-7859 ...__ ....... . _.tt_.:.,... . ...r,n _..... w.. Total Sq Feet: 300 Type of Work:DRAIN FIELD INSTALL Available Inspections: Type of Piping: Inspection Type: Additional Info: op Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee Invoice# PL-7-16-60719 $2.25 07/25/2016 Credit Card $50.00 $ 112.30 DCA Fee $2.P5 Education Surcharge $0.60 08/03/2016 Check#:2494 $ 112.30 $0.00 Notary Fee $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $162.30 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. OWNE FFIDAVIT: certi that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constru ti and zoning. Fut ore,I authorize the above-named contractor to do the work stated. c August 03, 2016 A horized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy August 03,2016 1 Miami Shores Village 400Building Department JUL 2 9 2016 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 �Y'—I ` INSPECTION LINE PHONE NUMBER:(305)762-4949 _ FBC 2011 BUILDING Master Permit No. � PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL OPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: g a q ME, 4 A ue 44 City: Miami Shores ��11 Coun : Miami Dade i : Folio/Parcel#: ( *9;)06 ©V7 oc&-0 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: _Flood Zone: B E: FFE: OWNER:Name(Fee Simple Titleholder): Phone#:I (�. C9,16- Z30 Address: g!7&q &q AJE 47& Amkd . P e City: "i ct U_U S�1'76Q, Q State:— Zip: 3 3 t�d Tenant/Lessee Name: Phone#: Email: IM_GJ i C., I/yA 6,( 'C.� — CONTRACTOR:GCompany Name: o' 'f� -unL' ` J�0172 Phone#: (3) CS> 'o'a et Address: `k3 a- �W O� ,-{ City: State: Ift-- Zip: 33165 Qualifier Name: K"(e- 64-We-k Phone#: State Certification or Registration#: 6 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 2-(E(YO•vO Square/Linear Footage of Work: 30 c Type of Work: ❑ Addition F-1 Alteration ❑ New -Repair/Replace ❑ Demolition Description of Work: gae"ht t Specify color of color thru tile: Submittal Fee$ JZ • (M Permit Fee$ ,/ CCF$ CO/CC$ Scanning Fee$ W Radon Fee$ " DBPR$ Notary$ Technology Fee$ �`� Training/Education Fee$ ® Double Fee$ 9� Structural Reviews$ Bond$ � I TOTAL FEE NOW DUE$ (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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature - ®� Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before m�a this The foregoing instrument was acknowledged before me this day of �`-'(- 20 by day of 5v20 1/, ,by V„� l v- /YI F`' � ,who is personally known to P.�.��t 'Ef+tiGk- who i5_nPrcnnally known to me or who has producedr_'J'a as me or who has produced as identification and who did take an oath. i1�IIIli�U identification and who did take an oath. NOTARY PUBLIC: •MY l �� 9 iiNOTARY PUBLIC: Sign: —•�' "N'T2 Sign. o2.c� Print: -":a X-1 � o�� �� Print: R �o'• �$.•• �T� 4W PIbUC-State of Florida Seal: . �' �RIDA�•� \���a�`� Seal: N. Comm.Epps Oct 23.2018 Commission#►FF 138.5'97 '�011m•�' 8aided'llirouphNWwd NaWy Assn. kye4kkk#k&kkkk$kkkkkkkkkkktkffi#k+kytb�*kk#YkkkkkkR#kk****ffi***4fIt7k7k8tffik7k7kgtktR7kk7k7k$7kkki$k+kytk**i***kekkkkkkkkkkkk$kkkkkk APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r w?% x ' atth , 69 S1Yti, I� r f s isf r `P l f 011, I f OSTDS/'T i ' i i6ii i'eet f, f f f Signatures i I a �