REOC-10-210 r
r/
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 135366 Permit Number: REOC -2 -10 -210
Scheduled Inspection Date: February 16, 2010 Permit Type: Re- Occupancy
Inspector: Bruhn, Norman Inspection Type: Re Occupancy
Owner: HOLDINGS, LLC CAV Work Classification: Re- Occupancy
Job Address: 74 NE 103 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 113206013158
Project: <NONE>
Contractor:
Building Department Comments
Inspector Comments
Passed � PLEASE CALL
do-z_ PATRIC DUFFY
305-904-4803
Failed
Failed C (/
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 12, 2010 For Inspections please call: (305)762 -4949 Page 19 of 25
o'I Miami Shores Village
,.r Building Department
. 10050 N.E.2nd Avenue
BY. . ......... Miami Shores, Florida 33138
Tel: (305) 795 -2204
RE- OCCUPANCY Fax: (305) 756 -8972
I APPLICATION Permit No.
Loc ID
Date � t
Contact Name _ �i�c1c Phone # 3&5-- 9o-q (+ gq
Buyer Seller ealto Company Name
Property Address g7 L R/ ! 0 3 S"74 - E - r
City Miami Shores State Fl
- zip 37
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 �q- f d- >4 r-t" hz�r-^J-r)
Signature
The foregoing instrument was acknowledged before me this day of T769� , 20
by e ccc L- _ who i erson knot me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
Sign: L 4
y Re -Occ. $60.00
Print: L r> is r i ,' 7 _ Li' Notary
My Commission Expires: LOIS E LINDLEY CCF $9169
MY COMMISSION # OD838034 Total X 6 0 —av
Building Officials Approval: EXPIRES December 15, 2012
(4
Rev. 10/02/03)