REOC-10-1162O
Inspection Number: INSP- 146855 Permit Number: REOC -6 -10 -1162
Scheduled Inspection Date: June 28, 2010
Inspector: Bruhn, Norman
Owner: NIELSON, ANGELA
Job Address: 9302 NW 2 Court
Miami Shores, FL 33138-
Project: <NONE>
Contractor:
Building Department Comments
REOCC
Passed
Failed
Correction
Needed
June 25, 2010
Re- Inspection
Fee
6-
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
RICARDO CASTRO 786.838.1595
(16-
For Inspections please call: (305)762 -4949
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number
Parcel Number 1131010150090
Page 16 of 27
RE- OCCUPANCY
APPLICATION
Contact Name: K/ c,'91qtYo ` //ST/e0 Phone#: ?-6
Buyer: IVi'C /A/Vt T /iV6 Z -C, Seller: G1
Realtor: /O/'-e X/? & Company Name: / 7;iz:2r/ / ` 3 C �
Property Address: 92 (92 ,V mV c26/
City: Miami Shores State: Florida Zip:
I hereby certify that I understand that the zoning for this 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.
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name: A / DC cI' c✓1C
Signature:
The fi
day o
who is
(�"�,}�
NOT
Sign:
Print:
going instrument W ;,. a� V W 1\ UE,VU ,....,.. �.....•
2010, by '.
to me or who has produced ^ —%L,
identificat'on and who did take an oath
01
'715 14 .
C 2 5)11
U`
0" rAiik;
ersonally
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
P
My Commission Expires:
Building Officials Approval:
REV 4 -10
Miami Shores Village o gVgIId3n
Building Department JUN z 4 MC y
BY:
Permit No. R'E O L -- t o- I I Z
Re-Occ $60.00
Notary $5.00
Total $ • O b