REOC-10-662 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
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i
nspection Number: INSP- 140973 Permit Number: REOC -4 -10 -662
Inspection Date: April 20, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman
Inspection Type: Re Occupancy
Owner: ROJAS, FERNANDO Work Classification: Re- Occupancy
Job Address: 803 NE 91 Terrace
Miami Shores, FL 33138-
, Phone Number (305)751 -0714
Parcel Number 113206005023
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
P ass` r
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
April 20, 2010 Page 1 of 1
M i ami Shores Village APR 2 0 2ogl
B uilding Department
.10050 NR2nd Avenue
Miami Shares, Florida 33138
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Tel: (305) 795 -2204
RE-O Fax: (305) 756 -8972
. PLIC`ATIOT T : Permit lea. - c
IOG -
Date � � � Lac ID
Contact Name cJ � � �� Phone.#
Buyer Seller Realtor' V Company Name �VV
Property Address lZ--
City M1ami Shores 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.
Applie e V
Signature---
The foregoin ment was acknowledged before me this -Z day of �l , 20
by , who is personally known to me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC: 0 "u ilv 11 r 1
S
N S , e
��` . �i a s'
Sign: _ �, \c = Re -Occ. $60.00
Print: ��SS` ; Q` Notary $5.00
My Commission Expires: ' sT,glEii ®F 4\�\\ • \ CCF $0.60
Building Officials Approval: Total
v. 10/02/03)