REOC-10-781 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 142367 Permit Number: REOC -5 -10 -781
Scheduled Inspection Date: May 06, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: CANARY, JAMES Work Classification: Re- Occupancy
Job Address: 9835 NE 4 Avenue Road
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060170180
Project: <NONE>
Contractor:
Building Department Comments
re -occ
Inspector Comments
Passed please call before go
James Canary 786.473.2105
305.606.6126
Failed
Correction ❑
Needed
Re- inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
May 05, 2010 For Inspections please call: (305)762 -4949 Page 16 of 17
Miami Shores village G ZjWZi '
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wilding Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 p
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE- OCCUPANCY Permit N O. `I/VC S i 10
APPLICATION
Contact Name: r�`. t4iq P_ �A �, T1 r' )0
Buyer: 0�. � ( 0X150 0 , ` 0 �1 `� %n .
�e.� 5eller: I_a_Q, iv ter' J ► m mar
Realtor: 4ePA° P– 'Z0)Q4 L7 i Company Name:
Property Address - 3 5 lu c A v4— ® Ld
City: Miami Shores State: Florida Zip: 3 3 ) 3�
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:
Signature:
The foreg ' nstrument was ac o edged befor me is
day of , 20 n by
who is person known to me or who has produced
As identification and who did take an oat
t,1
Sign: .�,ai
Print:
R
My Commission Expires: n0
�e
Building Officials Approval:
Re -Occ $60.00
Notary $5.00
Total $t0 AS -()D
REV 4 -10