1205 NE 95 St (12)ADD 3 CAR GARAGE
30 1 01
Passed
l �
Inspector Comments
5 Is4,
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Number (
umber.°1
=06 -232
Inspection Date: 01/18/2007
Inspector: Grande, Claudio
Owner: NOELL, JAQULYN
Job Address: 1205 95 Street NE
Project: <NONE>
Miami Shores Village, FL 33138-
Contractor: HOME OWNER
Building Department Comments
Wednesday, January 17, 2007
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 - 8972
Block:
Permit Type: Residential Construction
Inspection Type: Footing
Work Classification: Addition
Phone Number
Parcel Number 1132060143970
Lot:
Page 1 of 1
•
New Construction Subterranean Termite 1 OMB Approval No. 2502 -0525
(exp. 10/31/2005)
This form is completed by the licensed Pest Control Company p &- 3 i-- . (D o - 2 ,'2
Public reporting burden for this collection of information is estimated to average 15 mir�utias, per le se,-ieeluding-the'time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This information is mandatory and is
required to obtain benefits. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control
number.
Soil Treatment Record 1 JAN 1 8 2001 L
Section 24 CFR 200.926d(b)(3) requires that the sites for HUD insured structures must be free of termite hazards. This information collection requires the builder to
certify that an authorized Pest Control company performed all required treatment for termites, and that the builder guarantees the treated area against infestation for
one year. Builders, pest control companies, mortgage lenders, homebuyers, and HUD as a record of treatment for specific homes will use the information collected.
The information is not considered confidential.
This report is submitted for informational purposes to the builder on proposed (new) construction cases when soil treatment for prevention of subterranean
termite infestation is specified by the builder, architect, or required by the lender, architect, FHA, or VA.
All contracts for services are between the Pest Control Operator and builder, unless stated otherwise.
Section 1: General Information (Treating Company Information)
Company Name: Sharp Shot, Inc.
Company Address 6963 SW 151 St.
Company Business License No. JB3118 Company Phone No. 305-251-4890
FHANA Case No. (if any)
Section 2: Builder information
Owner/ Noell Myers
Company Name Phone No.
Section 3: Property Information
1205 NE 95 Street Miami, Fla. 33138
Location of Structure (s) Treated (Street Address or Legal Description, City, State and Zip)
Type of Construction (More than one box may be checked) Slab
Approximate Depth of Footing: Outside 21/2 ft Inside
Section 4: Treatment Information
Date(s)ofTreatment(s) Friday, January 12, 2007
Brand Name of Product(s) Used Demon
EPA Registration No. DMS4G14006
Approximate Final Mix Solution %
Approximate Size of Treatment Area: Sq. ft. 600 Linear ft. -0 Linear ft. of Masonry Voids -0-
Approximate Total Gallons of Solution Applied
Was treatment completed on exterior?
Service Agreement Available?
N/A
0.25%
Yes
Name of Applicator(s) Alberto Nunes
60
Yes )17 No
No
Note: Some state laws require service agreements to be issued. This form does not preempt state law.
Attachments (List)
Comments
Certification No. (if required by State law) j E 1 1 1 14 6 2 2
Authorized Signature
Forms VA 26 -8375 and HUD -92052 are obsolete.
City /Miami
Basement
22 ft
State Fl Zip 33158
Crawl Other
Type of Fill rock /sand
The applicator has used a r • ct in accordance with the product label and state requirem nts. All treatment riaterials and methods used comply with
state and federal regulati
Date 1 -12 -07
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalti •s. (18 U.S.C. 1001, 1010. 1012; 31 U.S.C. 3729, 3802)
form HUD - NPCA -99 -B (09/2002)