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PL-10-1043Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 145638 Permit Number: PL -6 -10 -1043 Scheduled Inspection Date: April 11, 2012 Inspector: Hernandez, Rafael Owner: POLANCO, DEYSI Job Address: 1183 NE 91 Terrace Miami Shores, FL 33138- Project: <NONE> Contractor: ACER PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number Parcel Number 1132050010200 Phone: 305 - 935 -4103 Building Department Comments NEW GAS LINE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 10, 2012 For Inspections please call: (305)762 -4949 Page 4 of 25 BUILDING PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type: thumbin YP � 4 Owner's Name (Fee Simple Titleholder) /'t'11 fhon) Fermin C6Zhone # 724, -374 - Owner's Address %5.054I 1OyQ f ©Qks L,v t goof City /4 . 1 Q 1n f State !ROY! c Zip 181 Tenant/Lessee Name k! 14 Phone # 4,4 E -MAIL: (delta. m polo n co a as . ,.)•7 Job Address (where he work is being done) 1 1F,3 Ale 91sr TC,r'/"{, Ce Miami Shores Village Buildin g Department artment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 .Fax: (305) 756.8972 IVEVERVill 31.114 0 842010 Permit No. 171 � 1 h City Miam Shores Village County Miami -Dade FOLIO / PARCEL # 11 -,329 ' ®©1 -02.00 Zip a.312/2 Is Building Historically Designated YES NO Contractor's Company Name AContractor'ss Address i 5 . N\-E a p(p. C-t • City �-�,tpil(yv,, State Zip 33 1 -19 Qualifier Name 23o i)a r Phone # Phone # (P -9Dc9- - t"psS( State Certificate or Registration No. cs 3 3k Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ acisco Type of Work:..` Describe Work: Addition: '" P ['Alteration Al$ c.4 Gr pis Lt M e. Square / Linear Footage Of Work: :New [rl' Repair /Replace ❑ Demolition *, * * * *** *** *** ***** * * **** * ** ***** *, *, Fees* *** ** *** * ** *, * *** * ***** * * ******** * *** **** Permit Fee $ /54 CCF $ 1° CO /CC Notary $ Training /Education Fee $ ' (0 Technology Fee $. •40 Submittal Fee $ Scanning $ Bond $ Structural Review. $ Radon $ DPBR $ Zoning $ Code Enforcement $ Double Fee $ Total Fee Now Due $ See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City AIM Zip 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 COMMENCEM ENT." 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 ) days after the building permit is issued. In the absence of such posted notice, the inspection will not . ap rove and a ems ection fee will be charged. Signature The foregoin day of who is Signature . Owner o A_ nt Contractor instrument w... acknowledged before me this l The foregoing instrument was acknowledged before me this 7 200c1, by day of L a e, 20 bti , by 213 o .v 4 `rsonally known to me or who has produced who is personally known to me or who has produced ' as identification and who did take an oath. As identification and who did take an oath. IC: CARMEN IRAN 1"341ESION. DD 891B62 EXPIRE . Print: My Commission Expires: • ******** 4caY& eY4rsY4c ,'e ****,t****4e4e4eaYsh****w w it **xxx APPLICATION APPROVED BY: (Revised 02/08/06) NOTARY PUBLIC: Sign: Print: co My Commissionhxpires: Plans Examiner Engineer Zoning