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PL-15-3045 Inspection Worksheet Miami Shores Village TC is 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-248984 PermitNumber: PL-12-15-3045 Scheduled Inspection Date: April 19,2016 Permit Type: Plumbing - Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: ROY,WILLIAM Work Classification: Gas Job Address:1280 NE 101 Street Miami Shores, FL Phone Number Parcel Number 1132050210010 Project: <NONE> Contractor: PULLES PLUMBING COMPANY Phone: (786)251-1234 Building Department Comments RELOCATE GAS PIPE TO WATER HEATER, DRYER AND Infractio Passed Comments RANGE. INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. April 18,2016 For Inspections please call: (305)762-4949 Page 5 of 25 PULLES PLUMBING CO. Invoice 8541 S.W. 133 PL. MIAMI,FL 33183 Date Invoice# LISCENCE#CFC056693 305-5580410 4/19/2016 2886 305-382-8914 FAX Bill To WILLIAM R.ROY 1280 N.E. 101 ST. MIAMI SHORES, FL Description Amount PERFORMED DROP TEST ON NATURAL GAS SYSTEM.TESTED WATER HEATER,GAS DRYER AND OVEN, 150.00 FOUNK NO LEAK,TEST HELD 100%,TEST PERFORMED WITH PROPER 7 TO 11 INCHES OF WATER COLUMN ON MANOMETER GAUGE. I NOR you for your usmess. Tota $150.00 s y, Miami Shores Village s man Rt .` 10050 N.E.2nd Avenue NE 3 Miami Shores,FL 33138-0000 r Phone: (305)795-2204AN i F`OR'°A sExpiration: 06/07/2016 no Project Address Parcel Number Applicant 1280 NE 101 Street 1132050210010 WILLIAM ROY Miami Shores, FL Block: Lot: Owner Information Address Phone Cell WILLIAM ROY 1280 NE 101 Street (305)793-5050 MIAMI SHORES FL 33138- 1280 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,400.00 PULLES PLUMBING COMPANY (786)251-1234 Total Sq Feet: 0 Type of Work:RELOCATE GAS PIPE TO WATER HEATER, Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return: Press Test Classification:Residential Scanning:1 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PL-12-15-57987 DBPR Fee $2.25 DCA Fee $2.25 12/10/2015 Check#:16603 $ 115.70 $50.00 Education Surcharge $0.40 12/08/2015 Check#:16594 $50.00 $0.00 Notary FE&, $5.00 Permit FQQ, $150.00 Scannin4Fee $3.00 Technology Fee $1.60 Total:;....:, $165.70 In considgration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS,AFFIDAVIT: I certify all t going information is accurate and that all work will be done in compliance with all applicable laws regulating constructi6h and zoning. Fu a ri the above-named contractor to do the work stated. December 10,2015 Autbef5aid Si tures Owner / Applicant / Contractor / Agent Date Buildibg Department Copy December 10,2015 1 of Miami Shores Village DEC 0 8 2015 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20(0 BUILDING Master Permit Nozz I'' H02— PERMIT APPLICATION Sub Permit No. 1 G' X49 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 24UMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �� _,Z 4�F7 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): /�� d� Phone#: Address: City: //�l a�� 9� State: Zip: 3� Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: U��P� �'"� %�� Phone#: �v a Address: City: � tate: � Zip: Qualifier Name: �A,5e Co _i�_ ms' s Phone#: Z� '"ZP(z—O 2'-s 155; State Certification or Registration#: �'C o�� 3 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 10001 Square/Linear Footage of Work: Type of Work: ❑ Addition ,,��❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Des5n1ption of Work: :. �J G 1�'� Q ��' e-7 gool �• � Specify color of color thru tile: Submittal Fee$5® tlZ) Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ ' Technology Fee$ Training/Education Fee$ 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 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 ®' OWNE.�or AGENT ` CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20 S ,by (3� day of 43C(Z- 20 1 by CJ Jt I/ "'i O�-i ,who is personally known to pS k?J J '5 - J -� rho is personally k""no``wwn�n to me or who has produced _ as me or who has produced F✓ubo\Xt'� Wck iyt]tas identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Si Sig . I� n Print: P ' QNIDA A PSI k2 a Ea Seal: .. ^ Notary Public State of Florida Seal: Joanna M Feliciano ' a My Commission FF 082753 La °syr Notary Public State of Florida Expires o1/12/2018 Q Sindia Alvarez My Commission FF 158750 Ex ire-09/03!2018 * x� �x 0 APPROVED BY l2' '15 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) s pt` JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 11/26/2015 EXPIRATION DATE: 11/25/2017 PERSON: PULLES CARLOS H FEIN: 650502786 BUSINESS NAME AND ADDRESS: PULLES PLUMBING COMPANY 8541 S.W 133 PL. MIAMI FL 33183 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation If,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 y: •• •• • • • •• •• • . . . . . . . ... . . . . .. . .. . • . . •.• •• to REQ Yoe/a-lz cl GttY y'atsA4t0"R. TU` .� j F I I nT., j ZJMING Com: � , EPTI 11()(,OMIT IANGE WITH AI-L LLOf SAL i �'I Al I MJf)(:OUP11 Y RUI FS AND RF GUI Al IONS It lie �:Jdj I SCALE: APPROVED BY: NR WN eye, DATE: �//9 Af ISED �i 9 t G��S /tel�� .� ,►�� , //,4►tr ee #9 c_. `� , 11J�/G4 P jr �`e/�.-r.� / Cry DRAWING NUMBER