REOC-10-1188Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 147172 Permit Number: REOC -6 -10 -1188
Scheduled Inspection Date: July 01, 2010
Inspector: Bruhn, Norman
Owner: SENA, HAZEL
Job Address: 14 NE 108 Street
Miami Shores, FL
Project: <NONE>
Contractor:
Building Department Comments
June 30, 2010
For Inspections please call: (305)762 -4949
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number
Parcel Number 1121360110070
re -occ
Passe
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
please call before go
mike mason 305.527.3088
C_,
C
Page 15 of 26
Sign:
Print:
(Rev. 10/02103)
RE- OCCUPANCY
APPLICATION
Date 61d1l/D
Contact Name /1
Miami Shores Village
Building Department
Buyer Seller Realtor )( Company Name ke I I @ 4. 1) f s A ,1 gad) hi
Property Address e
City Mani Shores State F1 Zip 13/4; C +
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 ofRe-
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 e4/,Pk
Signature P.i.4 Y. 2D
The foregoing instrument was acknowledged before me this 2,(L day of <71":._,„, , , 20 /
by Re,„/ ae: 5, , , a.. who is personally known to me or who has
produced ', �' �. as identification and who did take an oath.
NOTA$ 1T� ' ••�a V -e
• • - •
'% /C CO
My Commission Expires: #•,,,,,,,,,.
Building Officials Approval:
gmazgwmn
Ai JUN 2 8 2010
BY:
• 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756-8972
Permit No. I ®—
Loc ID
Cti 6) hike hAlot,& /4bone# Jo -(-..r.,2 30�'�
liA/29
Re -Occ. $60.00
Notary $5.00
CCF $0.60
Total la ,'; l