REOC-10-194 f
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- 135052 Permit Number: REOC -2 -10 -194
Scheduled Inspection Date: February 09, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: OSTROWSKI, JOHN Work Classification: Re- Occupancy
Job Address: 1130 NE 100 Street
Miami Shores, FL 33138 -
Phone Number
Parcel Number 113205019044
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passed, ��--
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 08, 2010 For Inspections please call: (305)762 -4949 Page 20 of 25
M iami Shores Villag FEB 0 8 2010
Building ]Department D ......
. 10050 N E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
RE — OCCUPANCY Fax: (305) 756 -8972
PLICATION : Permit No. 9 1 P— ®G to —1 q4
Date Loc ID
Contact Name Phone # 3 i
Buyer Seller Realtor SCI Company Name W
Property Addres +� 7
City Miami Shores State Fl Zip '�3
I hereby certify that I understand that the zoning of the property is for single- family residential use and
s
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 AIf+MAVIT: I certify that all the foregoing information is accurate.
Applicant Name 0/_ -
Signature
The foregoing instrument was acknowledged before me this � day of FO -> , 20
who is personally known to me or who has
produced a_ , as identification and who did take an oath.
NOTARY PUBLIC: ,\01...eni
..... s
. S
� p3Ex0i�A��G�' -;
Sign:
Re -Occ. $60.00
Print: o� oo ®! /C. Notary $5.00
O
My Comm' �� CCF $0.60 ission Expires: �'��.,;� FC O �
///111111111111 \\ Total
Building Officials Approval:
ay.10/02103)