REOC-10-485 w
t
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 138780 Permit Number: REOC -3- 10-485
Scheduled Inspection Date: March 25, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: PICHARDO, PABLO AND LUZ Work Classification: Re- Occupancy
Job Address: 101 NW 101 Street
Miami Shores, FL Phone Number (786)251 -0641
Parcel Number 1131010220140
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passed PLEASE CALL BEFORE GO
ALAN BEARDSLEE 305.218.7200
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 24, 2010 For Inspections please call: (305)762.4949 Page 11 of 21
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
nn Tel: (305) 795 -2204
E -0 CCUPANCY Fax: (305) 756 -8972
cr.
--
�� Loc ID
Date �- z f -- BY:........
Contact Name �� �� Phone '#
Buyer Seller >/ Realtor 1__ Company Nam e1� C L
Property Address / b Z lv
City Miami Shores State Fl Zip 33 .. 1 � �
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.
Applicant Name ,— ' � � ,� j �. v ? 64 r C.
Signature
The foregoing instru.m nt was acknowledged before me this a4 day 01- 201
by Q , who is personally known to me or who has
produced as i entification and who did take an oath.
NOTARY PUBLIC:
Sign: �'� �'1�p� Re -Occ. $60.00
Print: �,���}��.��. ����,.
Notary $5.00N_
My Commission Expires: P� CCF $0.60
°sans °° V
�
Building Officials Approval: Total
(Rev. 10/02/03)
Jj?i {}✓ 1 iELI i r- _
"HE r; ,r