490 NE 101 St (6)CALL ROBERT /LIANA AT 305 - 694 -5358
IR 1
Passed v U
11 /
/
Inspector Comments
L/
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
....:..... ...........................
Inspection Date: 07/27/2006
Inspector: Grande, Claudio
Owner: BLOOM, MARK
Job Address: 490 101 Street NE
Project: <NONE>
Contractor:
Building Department Comments
Wednesday, July 26, 2006
Miami Shores Village, FL
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
�UL 2 8 co Permit Type: Residential Construction
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Block:
Phone Number 786/253 -7552
Parcel Number 1132060170430
Lot:
Page 1 of 2
Sign:
Print:
(Rev. 10/02/03)
RE- OCCUPANCY
AP— P�I-CAT -I-ON--
Applicant Name
Signature
My Commission Expires:
Miami Shores Village
Building Department
RECEIVED
JUL 2 6 2096
y� onleu '7fa(
Loc ID
Date -- t...1., Z 2 *
Contact Name V-6125 AC -- , Cr L .J4 Phone # US C °i'( S3s e2
Buyer Seller hit Company Name e l i � 1 �►�
II �
Property Address LI I 0 ►' v ID I
City Miami Shores State F1 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.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
The foregoing instrument was acknowledged before me this Z.‘ day of c TOty , 20 06 ,
by "Uk11 3{ , who i rsonall known to me or who has
produced as identifi tion and who did take an oath.
oxtC4 1
NOTARY PUBLIC:
MONICAUS EV gg3
MY COMMISSION # OD 839
tai EXPIRES: October 20, 2009
Bonded- Nu NotaNP' 0underaate1e
Building Officials Approval:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
RC, ON -- lq 1S
Re -Occ. $60.00 7
Notary $5.00 !�/
CCF $0.60 l/
Total 65‘
JUL 2 6 PAID
Bill To I
MARK BLOOM
490 NE 101 ST.
MIAMI SHORES, FL 33138
Return to:
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Date Fee Name
07/26/2006 Re- Occupancy Fee
07/26/2006 CCF
07/26/2006 Notary Fee
Wednesday, July 26, 2006
Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Invoice Number: RC -7 -06 -25708
Invoice Date: July 26, 2006
Permit Number: RC -7 -06 -1998
Fee Type
Fixed
Calculated
Fixed
Total Fees Due:
Fee Amount
$60.00
$0.60
$5.00
$65.60
Payments
Date Pay Type Check Number Amount Paid Change
07/26/2006 Check 2235 $65.60 $0.00
Total Paid:
$65.60
Total Due: $0.00 II
IP9AnA 1451 tEtT1 n126
1.
APPLICAT)3N FOR CERTIFICATE OF RE-OCCUPANCY
I, Jdse�' ae,i'ine ye r , hereby apply Tor a certificate
to re- occupy the single family residence.known as : (address)
ci9o/vE /0( .Sf.
Miami Shores, Florida.
Legal Description: (P 3 - 3 Y). P8 /f'(4
Lot: Block To PB & PG: s ��4"• SAo.•es
c „
I hereby certify that I understand that the zoning of the property is for single - family iesidential use •
and that it is for more than one family to reside therein. I also understand that any
Certificate of Re= Occupancy that may be issued by Mani 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 suc , • roperty.
Applicant Date /40A3
Print N. • D.Sc. 4 C/ c ✓
* * * * * r * * * * * * ** * * * * * * * * * * # * * ** **# ** * * * * * * * * * * * * * * ** * * * * * * * **** *4141 # * # * * **
For purposes of conducting the inspection required by Section 902 of the Mlanu Shores Land
Development and Zoning Code, please contact:
Contact Name: lit'd` // 4 / 44e.
Buyer ____ Seller ✓ Realtor Company Name
Application Fee 050) paid: Cash
Inspected by. pproved Denied Date
Comments:
Check No..22.%
PAGE I OF 2
Telephone: o —) 75 - 3 3 ?
-1
On behalf of Miar i Shores Pillage, Florida, the undersigned certifies that the property
described in the above application has been inspected for purposes of re- occupancy pursuant to
Sections 901.and 902 of the Miami Shores Land Development. and Zoning Code and that such _
property may be re- occupied by the above applicant for single -famfy residential purposes, •
CERTIFICATE OF RE OCCUPANCY
THIS CER I U ICATE VERIFIES THAT THE REFERENCED
PROPERTY HAS BEEN INSPECTED BY IvIIAAVII SHORES
VILLAGE AND HAS BEEN DETERMINED TO PRESENTLY
COMPLY WITH THE SCHEDULE OF REGULATIONS OF THE
MIAMI SHORES LAND AND DEVELOPMENT CODE ..
PERTAINING SOLELY TO THE REQUIREMENT THAT EACH
ONE-FAMILY DWELLING IS USED AND INTENDED TO BE
USED FOR A ONE - FAMILY DWELLING PURPOSE ONLY;
HOWEVER, THIS CERTIFICATE DOES NOT CONSTITUTE ANY
REPRESENTATION OR WARRANTY AS TO THE CONDITION
OF THE DWELLING OR OTHER STRUCTURES ON TEE
PREMISES DESCRIBED HEREIN, OR ANY ASPECT OF SUCH
CONDITION ;AND INTERES ihll PERSONS ARE ADVISED AND
ENCOURAGED TO MAKE THEIR OWN INSPECTION OF THE
PREMISES IN ORDER TO D 1 F RMENE THE CONDITION,
"THEREOF.
PAGE 2 OF 2
MIAMI SHORES " GE, FLORIDA
By: —�� I
Date of Certification: c =- 3