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REOC-10-923
1 Inspection Number: INSP - 144181 Permit Number: REOC -5 -10 -923 Scheduled Inspection Date: May 26, 2010 Inspector: Bruhn, Norman Owner: WILLIAMS, MELBA JEAN Job Address: 17 NW 107 Street Miami Shores, FL 33168 -4306 Project: <NONE> Contractor: Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Type: Re- Occupancy Inspection Type: Re Occupancy Work Classification: Re- Occupancy Phone Number Parcel Number 1121360070470 RE -OCC Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments PLEASE CALL PATRIC DUFFY 305 - 904 -4803 May 25, 2010 For Inspections please call: (305)762 - 4949 Page 13 of 21 Rev. 10/02/03) RE- OCCUPANCY APPLICATION Date q / 0 Loc ID 1-.. p�r ) Contact Name - ��i � .. T' / Phone # MI- i4®) Buyer Seller ealto Company Name Property Address I'7 /p W 10 - 7 .7 City Miami Shores State Fl Zip Z7/ 5" 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 Pftl Signature Sign: Print: by produced The foregoing instrument was acknowledged before me this 671 / - day of tY) who is personally known to me or who has " as identification and who did take an oath. NOTARY PUBLIC: Miami Shores Village Building Department 5 13 arglIWEIM Alt MAY 7:4 2010 gli $.41:Y. 0NA J R�iYCQMMISSION#DD716391 Re-Occ. $60.00 giit %, EXPIRES: ° FOF FLOR�� BondedThm Budget Notary 3 Notary $5.00 19; a. O) - CCF $0.60 Total 04 e' My Commission Expires: Building Officials Approval: .10050 N E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795 -2204 Fax: (305) 756 -8972 Permit No. 1 923 ,20! Ai Ai._ DUFFY �REA Y com PATRICK L. DUFFY BROKER 9718 N.E. 2ND AVENUE / MIAMI SHORES, FL 33138 OFFICE: 305.758.5600 / FAX: 305.758.6276 / DIRECT: 305.904.4803 patduffy ©usa.net 4 ,