RC-08-1707Inspection Date: 09/23/2008
Inspector: Rodriguez, Jorge
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Owner: PEDROSO, TOMAS
Job Address: 510 95 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor:
Permit Type: Residential Construction
Inspection Type: Re Occupancy
u..........
Work Classification: Re- Occupancy
Block:
Phone Number
Parcel Number 1132060140830
Lot:
Building Department Comments
SE?
25"6
Passed
Inspector Comments
CA Lt iku'&C ( -6 fl- --V I t
1 __ .� _ c ,.
3
q, (
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Tuesday, September 23, 2008
Page 1 of 2
Miami Shores Village
Building Department
RE- OCCUPANCY
APPLICATION
Date
SEP 1 9 2003 ;t
lf�
—Itill5rnkrratritrair
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. R ° q -Of' / 707
LocID
Contact Name / J/9y ty b 0 W s o rJ Phone # (3 a ) d % Y- al 6 41
Buyer Seller Realtor Company Name
Property Address j/ 0 "✓E 9 S S i-
City ]Miami Shores State Fl Zip 33/3t
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 /1%/'7
Signature a
UQ �
The foregoing instrument was acknowledged before me this / t day of
by AIa^ .2.Do ,au sa.J
, who is personally kno n wto me or who has
, 20 0 k
produced as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
itz
My Commission Expires:
Building Officials Approval:
(Rev. 10/02/03)
,,,
RUTH PALMIERI
1, �. A MY COMMISSION # DD 419749
EXPIRES: August 18, 2009
4:84,0' Bonded Mini Notary Public Undamtriters
Re -Occ. $60.00
Notary $5.00
CCF $0.60
Total
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