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ELC-11-84Inspection Number: INSP - 155016 Scheduled Inspection Date: January 28, 2011 Inspector: Devaney, Michael Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Job Address: 415 NE 105 Street Project: <NONE> Contractor: MOODY ELECTRIC INC Building Department Comments Miami Shores, FL TEMP. HOOK UP OF ELECTRICAL FOR 16 CARNIVAL TENTS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments - F Y January 27, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Number: ELC- 1 -11 -84 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)758 -0539 Parcel Number 1122310430010 Phone: (305)758 -2000 Page 6 of 9 City: Miami Shores Is the Building Historically Designated: Yes Value of Work for this Permit: $ Type of Work: °Address °Alteration Description of Work: TL rri t O QA e`T / L /j—an t t v }C.. e-7ol7 —S Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. E\& PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): ST • 2 © S rr Qt= z_irn A Phone #: Address: "i1 S' hl f: 1 0 5 S �r City: ryi 1 i+rv1 I ! 1 s State: L. o R--, 0 A Zip: 3 3 1 .3 & Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 4- 1 1 /.! E 9 0 S S 2 C r County: Miami Dade Folio/Parcel #: Flood Zone: Square/Linear Footage of Work: °New DRepair/Replace /4 € / U r-w EVEETIS% JAN1 4 2011 137 .................... 3o— 0S-3/ Zip: 33i 3 8 Phone#: 3 7S - Z 0 0 CONTRACTOR: Company Name: Y \ c'3 (5 LTC i e_ Address: (/ Ai Cl.) 9 U S T�Ls City: NI 1 •n + t State: Ft-0 /L 4 A Zip: 3 3 i S 0 Qualifier Name: -' 3 t-4- t'4 S. M. , D Phone #: 3 o5 - 7 $ - zo o 0 State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: °Demolition ahsk***** *og% aok$:M eI: okti: sRpk*%k****ekok*skksaSskxskr$>;e**** F s( eikaa: k* x' FekxksBa ;:ekASOka.<* *.** * *** ** r : kta *ra>; *** Submittal Fee $ Permit Fee $ 4 't eP C CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such poste notice, the inspection will not a ?, #proved an4 a reinspection fee will be charged. Signature Sign: Print: Owner or Ajent ThL The fore JAN �e going -Y`', /�9 instrument was acknowledged before me this 7 day of 20 A, by � NG }� eAss who is pgrsonally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: * ** * * * ** * * * * *** * * * ** APPROVED BY dv.49-,rte R. I9 VE I 4 RONALD R LAND •' MY COMMISSION'S DD973720 EXPIRES Mardi 22, 2014 COM ��— Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zip Signature Contractor The foregoing instrument was acknowledged before me this 74 day of .....GZ.°-• , 20 , by V`L. Ql , who is `sonally kn to me or who has produced i • identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Co Clerk