PL-16-1259 r2,e�/ — 9
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-258581 Permit Number: PL-5-16-1259
Scheduled Inspection Date:June 07,2016 Permit Type: Plumbing-Residential
Inspector: Hernandez, Rafael
Inspection Type: Final
Owner: JIDY,ALFREDO Work Classification: Addition/Alteration
Job Address:8745 NE 4 Avenue Road
Miami Shores, FL Phone Number
Parcel Number 1132060460880
Project <NONE>
Contractor: ELPIDIO MOREJON INC Phone: (786)2954004
Building Department Comments
CHANGE EXISTING SINK Infractlo Passed Comments
INSPECTOR COMMENTS False
TO REPLACE PERMIT#PL15-2405
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
t 41, o PLS-16-1259
°R s , Miami Shores Village -Type Pittt7l lnw�=Ko
10050 N.E.2nd Avenue NE Work Pas,srtatfon: raticA
771,77
Miami Shores,FL 33138-0000 �.:
Phone: (305)795 2204
tllPR }VED
Expiration: 11/19/2016
Project Address Parcel Number Applicant
8745 NE 4 Avenue Road 1132060460880
Miami Shores, FL Block: Lot: ALFREDO JIDY
Owner Information Address Phone Cell
ALFREDO JIDY 1312 15 Terrace
MIAMI BEACH FL 33139-
1312 15 Terrace
MIAMI BEACH FL 33139-
Contractor(s) Phone Cell Phone Valuation: $ 250.00
ELPIDIO MOREJON INC (786)295-4004
Total Sq Feet: 0
Type of Work:CHANGE EXISTING SINK Available Inspections:
Type of Piping:
Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning:1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid .Amt Due
CCF $0.60 Invoice# PL-5-16-59725
DBPR Fee $2.00 05/23/2016 Credit Card $58.60 $50.00
DCA Fee $2.00
Education Surcharge $0.20 05/10/2016 Credit Card $50.00 $0.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $108.60
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 rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
g.
construction and zoninuthermore,I authorize the abov9lo&med contractor to do the work stated.
ii �r/L—� May 23, 2016
Authorized Signature:Owner / Applicant / Contractor Date
Building Department Copy
May 23,2016 1
,. Miami Shores Village RECET I 1
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972 ('�j
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 N
BUILDING Master Permit No. /-2C 6 -k?-G:318
PERMIT APPLICATION Sub Permit No. jt 6'1 2—gl
❑BUILDING ]iLECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 9SRENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
y, �1CONTRACTOR DRAWINGS
JOB ADDRESS: qS � `/
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: 11-32 OC-6,466 is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: �Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Phone#:
Address: /'• /2 1 C_—
City:
City: 0'�t-tq`41 State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: r- D -c Phone#:7 �s `f ,�
Address: '? .3 /c,e'
City: /V'- State: Zip?- ��-
Qualifier Name: - / e.e \A 6 Phone#:
State Certification or Registration# D S Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address City: State Zip:
Value of Work for this Permit:$ � Square/LineaYRepair/Replace
ta a of Work:
Type of Work: El Addition El Alteration El New ❑ Demolition
Description of Work:
�—
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ 0 G 0 CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ - to Training/Education Fee$ b • %® Double Fee$
Structural Reviews$ P Bond$
TOTAL FEE NOW DUE$y �nll
(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 me this The foregoing instrument was acknowledged before me this
5— day of 20 AC ,by day of °'� 120 by
ho is personally nown to �Z��aiD �lo�z o� who is personall r nown to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take a
NOTARY PUBLIC: j;c, NOTARY PUBLIC: ��dQ °i10a
+'n 1� - QQ• °� X10 19
�PG'�to 91 y0
Sign: L a6o �o0� '•,.�„ Sign:
Print: Print: PU LIC
Seal: Se
6 �`6�,o ddb _�•* o�c 0
2
APPROVED BY `� ` Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
1'11 -W, it
Date: May 05, 2015
State of Florida.
County of Miami
Before me this day personally appeared Elpidio Morejon who,being duly sworn deposes and says:
That he or she will be the only person working on the project located at 8745 SW 4 Ave Miami Shores,
FL 33138
Sworn to(or affirmed)and subscribed before me this 05 day of May. 2016 by Elpidio Morejon.
Personally Know Z
OR produced identification
Type of Identification Produce
�c
Print,Type or Stamp Name of Notary
d••ry,P•4/ JULIAN A CARDONA
=2°»a `e`c�'•: Notary Public-State of Florida
"'! •= Commission#FF 191910
= My Comm. Expires Jan 21,2019
'"%���`• Bonded thro tign National Notary Assn.