RC-08-475Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (30 Fax: (305)756 -8972
Inspection Date: 03/20/2008
Inspector: Grande, Claudio
Owner:
GOURMELON, ARMAND
Job Address: 460 95 Street NE
Miami Shores, FL 33138 -2730
Project: <NONE>
Contractor:
Permit Type: Residential Construction
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Block:
Phone Number (305)757 -5398
Parcel Number 1132060140450
Lot:
Building Department Comments
RE -OCC
Passed
Inspector Comments
PLEASE CALL 305.3024795
JIM PETERS
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Wednesday, March 19, 2008
Page 2 of 2
Miami Shores Village
uilding Department
RE- OCCUPANCY ' MAR 1 9 2908 zl
APPLICATION
Date
)'
Contact Name 1 ��-�J1 ��- Phone #
Buyer Seller Realtor Company Name
Property Address 17(2D M C%--
City Miami Shores State Fl Zip '1. B
B Y:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. PO(') 413
Loc ID
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.
The foregoing instrument was acknowledged before me this )C1 day of ufiya, , 20( ,
by tl 1��, ��,feK S , who is personally known to me or who has
produced as identification and who did take an oath.
Sign:
Print:
My Commission Expires:
NOTARY PUBLIC:
3`'_
Building Officials Approval:
Rev. 10/02/03)
Re -Occ. $60.00
Notary $5.00 \
CCF $0.60
Total j Ze--(-)