REOC-10-913 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 144102 Permit Number: REOC -5 -10 -913
Scheduled Inspection Date: May 24, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: , CAV HOLDINGS, LLC Work Classification: Re- Occupancy
Job Address: 58 NW 104 Street
Miami Shores, FL 33150- Phone Number
Parcel Number 1121360131060
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passed
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 30 of 39
Miami Sh r ° �C�IIb�
o es Village MAY 2 12010
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY '
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE- OCCUPANCY Permit No. g�,70C�y — ( q
APPLICATION
Contact Name: CXA_ L_ - Phone #: — !q4- tea ®
Buyer: K to (2u k &w j Seller: C-4V-
Realtor: _ RATXt e 44 [— P Company Name:
Property Address: 541 nt Vj i
City: Miami Shores State: Florida Zip:
I hereby certify that I understand that the zoning for this 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.
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant Name: A4 C >d A
Signature:
The foregoing instrument was acknowledg efore me this
day of _ZD , 20 ,� , by . Cj
who is person ly kn t o me or who has produced
As identification and who did take an oath
NOTARY PUBLIC:
Sign: Y 'u'� ONA E. AMY
* *E
Y COMty 910N t DD 718397
Print: XPIRES: January 19, 2012
FoF R °P NO TfIN B4981 Semi= My Commission Expires: �� Y
i
Building Officials Approval:
Re - Occ $60.00
r y
Total $ &_cL_,
REV 4 -10