1249 NE 100 St (2).SOB -335 3\
So
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DEC 0 8 2006
6
t
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid.
i nspection Number: INSP -33992
Permit Number: RC -12-06 -2926
Inspection Date: 12/07/2006
Inspector: Grande, Claudio
Owner: NEWBORN, CARYN
Job Address: 1249 100 Street NE
Project: <NONE>
Contractor:
Miami Shores Village, FL
Building Department Comments
Tuesday, December 5, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Block:
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Re- Occupancy
Phone Number
Parcel Number 1132050080060
Lot:
Page 1 of 2
(Rev. 10/02/03)
RE- OCCUPANCY
APP CAT -K
Date I a)-(4 OQ
Contact Name ,yVSIA■
Buyer
Property Address
City Miami Shores
My Commission Expires:
Miami Shores Village
Building Department
Seller Realtor
S a e u3E t ( A -
State Fl
LocLD
Phone #
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 - 2204
Fax: 5) 756-8972
Eermit No
Company Name
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
yy ,, CC .
Applicant Name <►�JJLQ. �w`,
Signature
jS335 - 3 S
Zip 331
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.
The foregoing instrument was acknowledged before me this 5 day of D.,Q.C. - , 20 ,
by � « , who is personally known to me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 0 5C( fie -5 ��—
t, OSCAR RESEK
MY COMMISSION # DD502208
"l'or ytb' EXPIRES: Dec. 27, 2009
(407) 398 Ronda Notary SeMc .00m
Building Officials Approval:
Re -Occ. $60.00
Notary $5.00
CCF Z: 0(fifees
Total.
,1I_ 20548
JOB - -
MIAMI SHORES VILLAGE, FLA.
1W. Vi S
ADDRESS N I b
INSPECTION
TIME READY
REMARKS:
INSPECTOR DATE