EL-08-1951r
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Scheduled Inspection Date: February 12, 2009
Inspector: Devaney, Michael
Owner: MAIRENA, HENRY
Job Address: 45 NW 96 Street
Miami Shores, FL 33150-
Project: <NONE>
Contractor: ADT SECURITY SERVICES, INC
Permit Type: Electrical - Residential
Inspection Type: Fire Alarm
Work Classification: Alarm
Phone Number
Parcel Number 1131010330420
Phone: (786)331 -3967
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CC
ezfi
February 11, 2009
Page 7 of 13
Miami Shores Village
Buildin g Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33 l38
Tel: (305) 795.2204 Fax: (305) 756.8972 ( i
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder)
Owner's Address
Permit No.
rEsnE
12008
Permit No.
27.4 4>ZELPhone #
L
/1 C
City /:, `';. L �Jf'c� 064 to • Zip %'
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done)
City Miami Shores Village
/is N-,,,)9
Phone #
County Miami -Dade
FOLIO / PARCEL # // 3,'G'/—
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
City
Qualifier Name
NO
Zip
(31_0>Y-4 —yes
Zip -:3C)&,`
Phone # L) d2 L.3
State Certificate or Registration No. ' �''/ /'/Certificate of Competency No.
E -MAIL:
Architect/Engineer's Name (if applicable)
Phone #
�?i
Value of Work For this Permit $ // ��� Square / Linear Footage Of Work:
Type of Work:
Describe Work:
❑Addition
❑Alteration
Nevi
place Demolition
4/
tY. Y. %XY. W W• *Y .Y. %%7[ Y. Fees"' /""Y. Y. KXY. 9C Y. Y. XY.
Submittal Fee $ Permit Fee $ El&e, 'Z., 4
Notary $ Training /Education Fee $
Scanning $ Radon $,
Bond $ ode Enfrcement
Structural Review. $
V 2 12008
DPBR $
CCF$
CO /CC
Technology Fee $
Zoning $
Double Fee $
Total Fee Now Due $
See Reverse side -4,
Bonding'Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
-fliciA:Ackuk.)
Owner or Agent
The foregoing instrument was acknowledged before me this
day ofd, 20 6V , by , day of A As , 20 d , by
who is personally known to me or who has produced who i 'p rsonally known to me or who has produced
As identification and who did take an oath.
Signature
The foregoing instrument was acknowledged before this
NOTARY PUBLIC:
Sign:
Print:
NOTARY PUBLIC -STATE OF FLORIDA
" Alba Aguila
;14 mission #DD682830
s: JULY 26, 2011
My Commission Expires:
:xxx xY.x * WY. x ,cW * xx, xW x xx xxx xxx x** c
APPLICATION APPROVED BY:
(Revised 02/08/06)
as identificlba
NOTARY PUBLIC: e °,..It,
Sign:
Print:
C-STTiIDA
. Alba Aguil
.Alba #DD2830
MIMING 2662011
1C IMING'CO.,INc.
My Commission Expires:
• ac acrr • • • x x xx Y.WW W W x xxx xxx x Y.xx x WY.x x W xx
Plans Examiner
Engineer
Zoning