REOC-10-935Inspection Number: INSP- 144337 Permit Number: REOC -5 -10 -935
Scheduled Inspection Date: May 26, 2010
Inspector: Bruhn, Norman
Owner: PENDLETON, CARL
Job Address: 9717 NE 1 Avenue
Project: <NONE>
Contractor:
Building Department Comments
re -occ
Passed /�,
Failed
Correction
Needed
Miami Shores, FL
Re- Inspection
Fee
May 25, 2010
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspector Comments
CALL BEFORE GO
GREG WHITE 305.458.9943
Cc
For Inspections please call: (305)762 -4949
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number
Parcel Number 1132060132420
Page 18 of 21
(Rev. F0/02/03)
RE-OCCUPANCY
AP
Date
Contact Name
Buyer Seller - Realtor LO Company Name K ELLOG-G . R459 cry
Property Address 9 7 17 NI E 1 f s v
City Miami Shores
Applicant Name
Signatur
1Y11U.1111 1J11V1 VJ V iiia
Building Department
I MEMED
MAY 2 4 z919 g
BY:
State Fl
•
I hereby certify that I understand that the zoning of the property is for single- family residential use and
that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re-
Occupancy that may be issued by Miami Shores Village certifies only that the referenced property is
being used for single - family purposes and that such Certificate does not constitute any representation,
warranty or certification as to the condition of the dwelling or other structures on the property.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
The foregoing instrument was acknowledged before me this
by
, who is personally known to me or who has
Sign:
Print:
My Commission Expires:
Building Officials Approval:
Loc ID
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Total
1
Phone 19 4- 3
Zip ,33 f 3
day of , 20
produced as identification and who did take an oath.
NOTARY PUBLIC:
Re -Occ. $60.00
Notary $5.00
CCF
6S