REOC-10-123 r
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Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 134226 Permit Number: REOC -1 -10 -123
Scheduled Inspection Date: January 28, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: Work Classification: Re- Occupancy
Job Address: 12 NE 101 Street
Miami Shores, FL
Phone Number
Parcel Number 113206013138
Project: <NONE>
Contractor:
Building Department Comments
Af -6
Inspector Comments
Passed ALBERT VASQUEZ
_ 305 - 801 -2761
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 27, 2010 For Inspections please call: (305)762 -4949 Page 21 of 27
Miami Shores Village
Building Department
10050 NZ2nd Avenue I
Miami Shores, Florida 33138
Tel: (305) 795 -2204 i
RE— OCCUPANCY Fax (305) 7%4972
APPLICATION Permit No � ) 0 -12 ,3
Loc ID
Date
Contact Name Phone # ';0 15 - 80 t a2
Buyer Seller Realtor Co any Name � Sowt c
Property Address s
City Miami Shores State Fl Zip j
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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-
,
f
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. $
F
F
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant
Signature `
i
The foregoing instrument was acknowledged be re me this 13 day of cl . 20 /0
by /1X�,Aen J �n Imnum tame or who has
produced IV • cS X 8 - 1 aaj Zi ca, as i cation and who did take an oath.
NOT Y P LIC:
Sign.
SIGNED AND SWORN ®EF R ME Re -OCC. $60.00
PAUL J. MERMELSTEIN
Print: NOTARY PUBLIG s tate of New York Notary $5.00
My Commission Expires- 2- ) -q1-� \` Qualified in Kings N E es Feb, 28_2!_Q CCF $0.60
Total
Building Officials Approval:
(Rev. 10/02103)
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