REOC-10-404 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- 137809 Permit Number: REOC -3- 10-404
Scheduled Inspection Date: March 15, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: SANDUSKY, VINCENT Work Classification: Re- Occupancy
Job Address: 1025 NE 98 Street
Miami Shores, FL 33138 -2505 Phone Number
Parcel Number 1132050320040
Project: <NONE>
Contractor:
Building Department Comments
re -occ
Inspector Comments
Passed PLEASE CALL BEFORE GO
120V ALICE KELLOGG 305.773.1450
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 12, 2010 For Inspections please call: (305)762.4949 Page 24 of 29
Miami Shore8 Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
RE- OCCUPANCY Fax: (305) 756 -8972
APPLICATION �' 9 Permit No. ' 404
MAR 1 2 2010 Loc ID
Date
I.�-- : -�....
Contact Name / - 1- G ��O'� Phone # �®S" 77 O;< S®
Buyer Seller Realtor Company
Property Address
City Miami Shores State �/ Fl Zip I Q O-
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.
Applicant Name
Signature L�
The f regoing 'nstru nt was acknowledged before me this �� day of 201
by Who is personally known to me or who has
produced Aq- k js identification and who did take an oath.
NOTARY PUBLIC.
Sign:' 711' Re -Occ. $60.00
Print: g ''t� Q Notary $5.00_
My Commission Expires: TR� CCF $0.60
Total ev
Building Officials Approval:
(Rev. 10/02/03)
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