EL-12-1721- Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 1 V
/,u
Inspection Number: INSP-180947 Permit Number: EL-9-12-1721
Scheduled Inspection Date: October 30, 2012
Inspector: Devaney, Michael
Owner: CORTES, MARIA
Job Address: 1562 NE 105 Street
Miami Shores, FL 33138-0000
Project: <NONE>
Contractor:
PINAR ELECTRIC MD INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)458-9935
Parcel Number 1122300530130
rsuuamg uepartment comments
ELECTRICAL WORK FOR INTERIOR REMODEL Infractio PaSSI
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed G� 2�y 7i
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Phone: (786)256-0812
October 29, 2012 For Inspections please call: (305)762-4949 Page 16 of 16
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
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
FBC 20
SE 1 � 201�
Permit No.
Master Permit No. P_C�1 ; ) —I
JOB ADDRESS: L z
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City: Miami Shores
County: ' Miami Dade
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Zip: I ?4
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple. Titleholder): f 10 wl 0. CQ(,YlQ C'O ttCC Phone#:
Address: I BS CA_?.0L V1 C 0 r) 6 i JJ - �dr -2O6
City: 4-1 6LS C CC V n e State: lam- zip: 3 3 I y
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 9"Wh'-;t- Z1 G � ZAAZ Phone#: Z
Address: % %a X/D(J / d 2 /�'1/ C- X %p Z
City:
Qualifier Name: /7"�/�/C�� C//�df9 p
State Certification or Registration #: Q�� �Y6 Certificate of Co
Contact Phone#: % � ��% �i Email Address: "VAX-f49
#:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: Square/Linear Footage of Work:
Type of Work: ❑Address 03Alteration ❑Ngw , �Repair/Replace
Description of Work:
Zip:
Submittal Fee $ Permit Fee $ ` "dam' 3L CC $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $.
Technology Fee $
❑Demolition
OCP TOTAL FEE NOW DUE $ 1 i
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
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- 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 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
J
rst inspection which occurs seven(7) days after the building permit is issued. In the absence of such posted notice, the
n will not be approved and a reinspection fee will be charged.
r
Signature
rn rn 2! % Owner or Agent Contractor
w or oing instrument was acknowledged before me this D The foregoin instrument was acknowledged before me this
cc CL.
a4ai )019 201 Z, by G►V i�{ (/1' S day of L14Z 20 /4 , bymoo
wvv is rsonally known tome or who has produced O'i(Jei who is personally known to me or who has produced���
little 'o 1 As identification and who did take an oath. o%zGy Z719 _ as identification and who did take an oath.
C:
Sign:
Print:
My Commission Expires: 3"ZS_ _Z-b1`f
APPROVED
1&/Z
Plans Examiner
NOTARY PUBLIC:
Sign:
Pri
V1 Mona
ra
My Commission Expi �68ion # DD 91340
BondW Through A Sond
Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)