RC-07-255Inspection Date: 02/14/2007
Inspector: Inspector, Default
Owner: OSSMAN, LANCE
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Job Address: 970 94 Street NE
Project:
Contractor:
Miami Shores Village, FL
<NONE>
Permit Type: Residential Construction
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Block:
Phone Number (786)423 -8188
Parcel Number 1132060350030
Lot:
Building Department Comments
Tuesday, February 13, 2007
Page 1 of 1
FEB 1 5 2007
Passed
Inspector Comments
11 -12
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Tuesday, February 13, 2007
Page 1 of 1
Miami Shores Village
Building Department
RE- OCCUPANCY
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Date 2,--/a-i7 M=
Contact Name a C/ N4:2 4/ ' Phone # 305 473 fr2 eV*
Buyer Seller Realtor I — Company Name r`�i% iV iL (i<
Loc ID
, ,"155
Property Address 5'(,)
City Miami Shores State Fl Zip 33/ 3 if
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 G Lv ®G�� ''L
Signatur2
The foregoing instrument was acknowledged before me this day of 66 , 20 0 ,
by Al Fed 3J'4 , who is personally known to me or who has
produced F ] IVe /j Llc `6z0
NOTARY PUBLIC:
Sign:
Print:
as identification and who did take an oath.
My Commission Expires:
Building Officials Approval:
(Rev. 10/02/03)
Re -Occ. $60.00 7-
Notary $5.00
CCF $0.60 / Total O. 60