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PLC-16-1760 Inspection Worksheet Miami Shores Village c 16 ` 1 -15 9 10050 N.E.2nd Avenue Miami Shores,FL 1. Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-271660 Permit Number: PLC4-164760 Scheduled Inspection Date: November 23,2016 Permit Type: Plumbing -Commercial Inspector: Hernandez, Rafael Inspection Type: Final Owner: CHURCH,ST ROSE OF LIMA CATHOLIC Work Classification: Addition/Alteration Job Address:415 NE 105 Street CHURCH BLDG Miami Shores,FL Phone Number (305)758-0539 Parcel Number 1122310430010 Project <NONE> Contractor: QUINTERO GENERAL CONSTRUCTION Phone:(786)487-5738 Building Department Comments NEW TOILET ADDITION, REPLACE EXISTING FAUCETS. 1 ctiO Comments INSPECTOR COMMENTS False Inspector Comments Passed [,Zf CREATED AS REINSPECTION FOR INSP- 61745. Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid z E S `sa s Miami Shores Village " ye Ply, �+A-3t118rGi 10050 N.E.2nd Avenue NE z CISH Miami Shores,FL 33138-0000 he Phone: 305 MIR ( ) l ; . Expiration: 0110212017 �� 716�t0�� p Project Address Parcel Number Applicant 415 NE 105 Street Number: CHURCH BLDG 1122310430010 ST ROSE OF LIMA CATHOLIC C' Miami Shores, FL Block: Lot: Owner Information Address Phone Cell ST ROSE OF LIMA CATHOLIC CHURCH 9401 BISC BLVD (305)758-0539 MIAMI FL 33138-2970 Contractor(s) Phone Cell Phone Valuation: $ 3,000.00 QUINTERO GENERAL CONSTRUCTIO (786)487-5738 Total Sq Feet: 0 Type of Work:NEW TOILET ADDITION,REPLACE EXISTI Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Classification:Commercial Re Pipe Scanning:1 Main Drain Heater Water Service Final Water Main Lavatory Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# PLC-6-16-60323 DBPR Fee $3.38 06/24/2016 Check#:1177 $50.00 $189.56 DCA Fee $3.38 Education Surcharge $0.60 07/06/2016 Check#:1187 $189.56 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $239.56 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-n on r c to do the work stated. July 06,2016 Authorized Signature:Owner / Applicant / 'Contractor / Agent Date Building Department Copy July 06,2016 1 Miami Shores Village �u 24 016 Building Department Bpi 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 �y BUILDING Master Permit No. CQ PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 'PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP ` CONTRACTOR DRAWINGS JOB ADDRESS: 7 &-4 t 7 City: Miami Shores County: Miami Dade Zip: 2 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): C T w L.U Phone#: Address: �C 2 City: �LUct V1 k: State: Zip: 3 Tenant/Lessee Name: Phone#: Email: } CONTRACTOR:Company Name: aim flewCozi A ou Phone#: Address: 9 D D/,j&a MP- 7e-x,,, City: r� State: /c--D� Zip: -?30,jf Qualifier Name: a r Phone#: State Certification or Registration#: C)cr— IW09`43 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 10rj� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alte4rationI❑ New �tRepair/Replace ❑ Dem(o�lition Description of Work: N e,� �a \J -4A Ai + r it is\a-ee, Specify color of color thru tile: Submittal Fee$ 5-0 - 52:1 Permit Fee$ i � CCF$ �e �• CO/CC$ Scanning Fee$ -?• CO 40 Radon Fee$ - 3 2? DBPR$ �1, ° Notary$ Technology Fee$ 7 /-/d* Training/Education Fee$ 6 i.� Double Fee$ Structural Reviews$ Bond$ _ TOTAL FEE NOW DUE$ ls 'eS (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 - whoseproperty-issrtbkct to attachment.--ANso,-a-certifiedcopy ofthe retarded TM-tcL-of-commencem-entrntist4be pOW-0-t-th-elonite 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. Signatur Signature aero UtE3..✓ ' OWNER or AGEN CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this —day of S&v—(- .20 L l® by .3 l day of PA Ne 20 /40 .by .r. r.A&P,% ,who is personally known to dm&�6149a® a Lf who is personally known to me or who has produced_ .c as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: �1 NOTARY PUBLIC: Sign: � \��\\1111NIIIlllll/j�� Sign: Is `�p Print: wlfau. V¢. � S/p'p��L��i Print: Seal: Seal: 0559gg - °KARLA P. GARCIA Q`` P�Ml"COMWUION#FF140421 ####EXP ARAM APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)