PL-16-461 f
Inspection Worksheet (�
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-253253 Permit Number: PL-2-16-461
Scheduled Inspection Date: August 23,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez, Rafael Inspection Type: Final
Owner: STANDAERT, NATACHA Work Classification: Pool - Private
Job Address:576 NE 97 Street
Miami Shores,FL 33138- Phone Number (646)460-6061
Parcel Number 1132060171510
Project: <NONE>
Contractor: La Casa de las Piscinas Inc Phone: (305)633-9699
Building Department Comments
POOL PIPING AND HEATER INSTALLATION 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
August 22,2016 For Inspections please call: (305)762-4949 Page 5 of 36
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Miami Shores Village
e 10050 N.E.2nd Avenue NE
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14,
Miami Shores,FL 33138-0000 4E
Phone: (305)795.2204 �Y `..
Expiration: 09/18/2016
Project Address Parcel Number Applicant
576 NE 97 Street 1132060171510
Miami Shores, FL 33138- Block: Lot: NATACHA STANDAERT
Owner Information Address Phone Cell
NATACHA STANDAERT 576 NE 97 Street (646)460-6061
MIAMI SHORES FL 33138-
576 NE 97 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,000.00
La Casa de las Plscinas Inc (305)633-9699 (305)216-3907
Total Sq Feet: 00
Type of Work:POOL PIPING AND HEATER INSTALLATION Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Main Drain
Bond Return: Final
Classification:Residential Scanning: 1 Rough
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee $3.38 Invoice# PL-2-16-58746
DCA Fee $3.38 03/22/2016 Check#:1426 $ 187.96 $50.00
Education Surcharge $0.40 02/19/2016 Check#:2047 $50.00 $0.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $237.96
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the forego ation is a e ur d that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the ab na o do the work stated.
March 22, 2016
Authorized Signature:Owner / Applicant / Cohtra r / Agent Date
Building Department Copy
March 22,2016 1
Miami Shores Village 710 _ xJ �,
Building Department FEB 99 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ��
Tei:(305)795-2204 Fax:(305)756-8972 ---___
INSPECTION LINE PHONE NUMBER:(305)762-4949
a
F B C 20
BUILDING Master Permit
PERMIT APPLICATION sub Permit ft&/
r-JBUILDING ELECTRIC ROOFING REVISION EXTENSION MRENEWAL
19 PLUMBING [:] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CON CTO DRAWINGS
DR 7 �g -E . 7 �-�
City: Miami Shores County: Miami Dade Z4w=,
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): A)CkVCjcj s D Phone#: 6 Lli6 Y 6 ep 6 r) -4
Address: 6S� 9T'-k
City: r)� f A State: -F Zip: -1 / 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �5--�� J ----c—_;e_"'-jFhone#:
Address: '2' `'Op/
City: J Staff: zip: 3
Qualifier Name: 'Ja �- f P Phone#:
State Certification or Registration#: J �� J Certificate of Competency#:
DESIGNER:Architect/Engineer: f Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ "` Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New /el?
❑ Repar/Replace ❑ Demolition
Description of Work• if`i 41Ll recd -�`44z
Specify color of color thru tile:
Submittal Fee$�r r� Permit Fee$ 2 ` CCF$ CO/CC$
Senning Fee$ Radon Fee$ DBcP�R$ Notary$
Technology Fee$ w (0 0 Training/Education Fee$ 6 T Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ �
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lenders Name(if applicable)
Mortgage Lenders 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$25W, 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 n (7) days after the ding permit is issued in the absence of s notice, the
Inspection will not be approved 0cdon fee w charged.
Signature Signature
E GENT CONTRACTOR
The forgoing instrument was acknowledged before me this The foregoing in ent was acknowledged before me this
f >� sYr >4
day of 20 �by day of 20 ,by
,q Ta n Q Q 920jrto is personally known to 1"1- C who is personally known to.
me or who has produced ars me or who has produced as
identification and who did take an oath. Identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC
Sign: Sign:
Print: f��(� ✓ ��- Print:
-,jcpRY PVe`�, Seal.
"RV P''e;� ADRIANA HERNANDEZ
Seal: ADRIANA HERNANDEZ :?.
Notary Public-State of Florida _ Notary Public-State of Florida
.� .c My Comm.Expires Feb 2,2018 =" a� My Comm.Expires Feb 2,2018
Commission B FF 88137 "%�` �,, Commission#FF 88137
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(ReibedD1/24/2014)
Miami
Budding Department
10050 N.UM Avenue
Mud Shoi e%Fbrlde 33138
Tel:(305)795.2M
Fac(305)756.8972
Notice to Owner-Workers' Compensation insurance Exemption
Florida I.aw raguirce Wo&M' Compensation hm=w oamw mdw clmpter 440 of the Flom Fla.•S%t j 44O.OS
snouts corposaba officers is the mon ice►to exempt thentsedves Am this regairem"for a"mon prgeed prior to
obudmag a buildhcgpermit PwnwtD&ej%n&DrvnimofWaimCOWM=tmaWkYWFSM&OcWm
An employee in the camtraction hft*y Who cuplwo we or more part-time or fi n time
=WkW es„inClUft flea owner,mfrs obtain wa*eW comp on coverage. Comae oi&M
or men&ws of a limited Habr7ity,compnoy gl q in the conettuction indway may elect to be
ezemplif!
1. The officer ovens at leans 10 percent of the stock of the cxrpomti�,or in the one of
an LLC,a sulemeat attesmg to the minhumm 20 parcent ownership;
2. 11w cffww is listed as as officm of the oorponatiom in the studs of the Florida
Dqwbnft Of StIle,Divisan QfCmpmlbmg and
3. The corporation is registered and listed as wive with the Florida Dqmuum of
State;nvisio n of
No more Gm throe owporate officers per corporstion or limited liab0ify compamy members an
allowed to be cw mpt Cram options are valid far a pedod of two years or uoffl a
voluatmy revocation is filed Or exemption is revoked by the Division.
Yom contractor is requesting a permit under this woadoirs'compensation mon and has wimmiedgg
da3► ,l��a�oy�or ars foryourprOe M Ile films that he dohr she or not use
be tin:only person avowed to wo&on your project Ia these ' I�'isam;Shores as��no that he or on vu�71
wadim,mon x $nom the c0afte lWs a mq my for day labor,-�� vmi Uctom
m of
BY SIGMG BELOW Y THAT YOU HAVE READ MRS NIOTT�mU[ AND 175
C0NTSIM.
Sim
State
county ofd
The fcaegodag wasacknowle dge befarse me this-day of �-3f- .20J4
By e a 9!-auhapeT' wbispmsomanyiw mmmeorhwp
Nay. .•�" HERt1ANDFx
My Comm.Expues Feb 2.2018
Commission FF 88137