REOC-10-916 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- 144106 Permit Number: REOC -5 -10 -916
Scheduled Inspection Date: May 24, 2010 Permit Type Re- Occupancy.
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: MATEO, RAYMOND Work Classification: Re- Occupancy
Job Address: 1140 NE 100 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132050190430
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.
May 21, 2010 For Inspections please call: (305)762 -4949 Page 32 of 39
Miami S Village MAY g 1 2010
Building Department
. 10050 NR2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
RE -OCC U P AN CY Fax: (305) 756 -8972
]PLICATION : Permit N'o. (0--C1 p
Date
9 b Lac ED
Contact Name J V1,
P E 12�; Phone # _ 3LE :Jc2_44
Buyer Seller Realtor ' Company Name
i
Property Address _ _ 4D Nl � l O - D S
City Miami Shores State Fl 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.
Appi'cant Name
S , L ✓�'� 7
ignatur 3 e
/ Z-S
The foregoing instrument was acknowledged before me this day of , 20 6 6,
by , who is personally known to me or who has
produced as identificati on and who did take an oath.
NOT Y PUBLIC:
Sign: � Re -Occ. $60.00
Print: -` = Notary $5.00
My Commissian Expires: a, _ CCF $0.60
h • a :: Total
Building Officials Approval: ✓,� .,
v 10102/03)