REOC-10-713 I
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 141686 Permit Number: REOC -4 -10 -713
Scheduled Inspection Date: April 28, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman
Inspection Type: Re Occupancy
Owner: GILBERT, RICHARD Work Classification: Re- Occupancy
Job Address: 1480 NE 102 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132050240260
Project: <NONE>
Contractor:
Building Department Comments
RE -OCC
Inspector Comments
Passed CALL BEFORE GO
HEATER ZIBELLI 305.458.1296
Failed 6 L11
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 27, 2010 For Inspections please call: (305)7624949 Page 16 of 22
Miami Shores Village 3032W �
Building Department APR 7 2010
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ..,.......
Tel: (305) 795.2204 Fax: (305) 756.8972 �' "'����•�•�
INSPECTION'S PHONE NUMBER: (3057 762.4949
RE-OCCUPANCY' Permit No. 0
APPLICATION
Contact Na e. Epr 1 (L LC i Phone# : 3OS ' q5- ° )2 '?4
Buyer: L =1ti S (SiL t, Seller: �Z � 0
Realtor: 1 L C l Company Name: L (a4 - VAS
Property Address: ) Ileo N = /d 2 S
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•
Signature:
\
The foregoin instrument as a owl mibefore e this0:1
day of 1 , 20 by O ,
w is personally known to me or who has produced
As identification d who did take an oath
NOTAR
Sign:
Print:
My Commission Expires:
cp
OP
Building Officials Approval. e
Re -Occ 60.00"4
Notary $5.00
Total $ COS - o
REV 4 -10