REOC-10-609 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 140422 Permit Number: REOC -4 -10 -609
Scheduled Inspection Date: April 13, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: PITTS, BUFORD Work Classification: Re- Occupancy
Job Address: 142 NW 95 Street
Miami Shores, FL Phone Number
Parcel Number 113101033062
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
PassedGy %CJ 7 please call before
.� Carolyn Fischer 754.4.
281.7578
Failed
Correction ❑
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 12, 2010 For Inspections please call: (305)762 -4949 Page 16 of 17
Miami Shores Village 3(gMET3
Building D g l A pk p 2 2010
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 F_Y ,.,.....
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE- OCCUPANCY Permit No. 1Gi � 10 "_�J"I
APPLICATION
Contact Name: t c3 �C�A I rl C C y- Phone#: 16 y -
Buyer: JP—V% c h i {' 6 20 Seller: 16 v-) 4 tS Wry!„ ► J j
Realtor: Ca +ry 1 i r1 - e Company Name: K a n t7 U DOtiU.t G/1 lLQ ( vc
Property Address: 1 y'Z (N ►n1 GS Sir �N► I i yam
City: Miami Shores State: Florida Zip: JS , S�
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: ? v % l - -a s
Signature:
The for goin instru n was agimowledged before ie thil
day of , 20110, b
/ who is ersonally known to me or who has producei
identification and who did take an oath
NOT Y LIC: r] 9 �
Print: CLEM-
�r11!►
M Commission Ex ' '� �" o
Y RP� .°r���`�t;��.��'��'. tae„
Building Officials Approval: sorm
Re -Occ $60.00
Notary $5.00
Total $ �S�
REV 4 -10
APR 12 1010