RC-07-2515Inspection Date: 12/20/2007
Inspector: Grande, Claudio
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Owner: BUTLER, ELEANOR
Job Address: 123 97 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor:
Permit Type: Residential Construction
Inspection Type: Re Occupancy
u0000 Work Classification: Re- Occupancy
Block:
Phone Number
Parcel Number 1132060132440
Lot:
Building Department Comments
Wednesday, December 19, 2007
Page 2 of 2
DEC 2121
Passed
Inspector Comments
BUTLER 786 -556 -2919
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Wednesday, December 19, 2007
Page 2 of 2
ivii iili 3iiuiCs V iiiage
Building Department
RE- OCCUPANCY
RECEIVED
APP- TC TION DEC 1 9 2007
BY:._S
Date
Contact Name /12. 4 4.7 �z-) 72442
Seller Realtor Company Name
//:2- 3 )tI . 97 s3
Buyer +-
Property Address
City Miami Shores
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 1756 -8972
P rmit No. K.0 2-515
LocID
Phone'# 503-- 7c7-02-la
State
Fl Zip 33/3?
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
Signature
The fore
by
P
1/20/1
4-1 11-91_1---
ng instrument was acknowledged before me this day of
t , who is personally known to me, or who has
NOTARY PUBLIC:
My Commission Expires:
Building Officials Approval:
(Rev. 10/02/03)
LOIS H. WELLS
Notary Public - State of Florida
rra,a 15, 2010
- Commission # DD 584 943
. o ^, 3•"' Bonded By National Notary Assn.
Re -Occ. $60.00
Notary $5.00
CCF $0.60
Total
DEC I 9 2007
cwiet
WWI SI-IVIES VILLAGE