REOC-10-693 0 0-1,
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 141312 Permit Number: REOC -4 -10 -693
Scheduled Inspection Date: April 26, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman
Inspection Type: Re Occupancy
Owner: RODRIGUEZ, HUMBERTO Work Classification: Re- Occupancy
Job Address: 189 NW 100 Terrace
Miami Shores, FL Phone Number
Parcel Number 1131010230190
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passed PLEASE CALL JIM PETERS
305 - 302 -4795
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 23, 2010 For Inspections please call: (305)762 -4949 Page 20 of 27
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M iami S hores V
BY.— ... .... a_e .10050N.E.2ndAvenue
Miami Shares, Florida 33138
�.T Tel: (305) 795 -2204
RE — OCCUPA N CY Fax: (305) 756 -8972
APPLICATION : Permit N o.
Date Floc 1D
Contact Name (/UI S 'r L-" Phone w 3 Buyer' Seller Realtor Company Name L
Property Address C 6 C t L C ERL
City Miami Shores State F1 Zip
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 ✓� (rte .
Signature
N
The foregoing instrument was acknowledged before me this day of , 20
by , who is personally known to me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
Sign: Re -Occ. $60.00
Print: -IC Q
Notary $5.00
My ConnR ission Expires: - 0310612092 CCF $0 60
NOTARY PUBLIC - Total
Building Officials Approval: = `•, commission # n
v. 10/02/03) ''� '9f OF .......