ELC-13-1828 WX
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-197104 Permit Number: ELC-8-13-1828
Scheduled Inspection Date: March 20, 2014 Permit Type: Electrical - Commercial
Inspector: Devaney, Michael
Inspection Type: Final
Owner: , Work Classification: Addition/Alteration
Job Address:201 NE 95 Street
Miami Shores, FL 33138-0000 Phone Number (305)756-3711
Parcel Number 1132060133920
Project: <NONE>
Contractor: SOUTH DOM ELECTRIC INC Phone: (305)626-5904
Building Department Comments
RENOVATION OF HALF BATHROOM Infractio Passed CommentsINSPECTOR COMMENTS
False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
March 19,2014 For Inspections please call: (305)762-4949 Page 5 of 28
Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit N(
PERMIT APPLICATION Master Permit No.
Permit Type: Electrical
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Foho/Parcel#:
Is the Building Historically Designated:Yes Flood Zone:
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OWNER:Name(Fee Simple Titleholder): 1G "LL. Phone#: d 737
Address: L'• ✓5' ' q
City: AAW State: [ Zip: ✓?�l
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: S2(I W &1 j(/1 C`ECTet iC, 1 IL Phone#: ;60 .M 9/,?�L
Address:596® AZO Ig 2 57
City:}/q 1 State: lt: f Zip: 3E50/&;7
Qualifier Name: M A, T 6—S Phone#:
State Certification or Registration#: JER®®/!24,q / Certificate 9f Competency,#:
Contact Phone#:,3P5,5mM 2q Email Address: `
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ {�0• Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: �1 � hO����
Submittal Fee$ Permit Fee$ 2 G�d`Q'f> CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ '
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 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
RECORDINWVOUR 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 rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not roved and a rel ection fee will be charged.
Signa a Signature
W�b_
Owner , Ag Contractor
The regoing ' ent was acknowledged before me this The for oing ins ent was ac wledged b o this
day of ,20 ,by c rr e, day of ,20 ,b ��
whoe-' onally kno to me or who has produced who iso_Aersnally known to me or who has produced
As identification and who did take an oath. -�CJ' entification and who did take an oath.
NOTARY PUBLIC: �_OTAgX PUBLIC:
ign Sign:
public S a 015
Print: �/L/+- y1Zc-ei i�Ll Print: Nota�Y ices SeD 23 Z
y EE
M Commission Expires: °`: rwee% LAURA my Assn.
My p My Commis ` ,. commiss�h Na ionai Notary
*
My " Bondedwou9
* COMMISSION#DD 85MI
EXPIRES:June 9,2013
A.01"�o�`O� Bonded Thru Budget Notary�Se
APPROVED BY Plans Examiner Zoning
,. Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009XRevised 3/15/09)