RC-08-1404Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 07/31/2008
Inspector: Rodriguez, Jorge
Owner: BLACK, BRIAN
Job Address: 1294 96 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor:
Permit Type: Residential Construction
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Block:
Phone Number (678)986 -2032
Parcel Number 1132060143840
Lot:
Building Department Comments
486
D
Passed of
Inspector Comments
PLEASE CALL BEFORE GO
JIM PETERS 305.302.4795
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Wednesday, July 30, 2008
Page 2 of 2
RE-OCCUPANCY
APPLICATION
Date 6
Contact Naii,e
Buyer
Property Address
1ami Shores Village
Building Department
L
. 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Phone # 36S— sez- 4 5'
Seller Realtor XQ Company Name
al 4 140, z3Kr:
City Miami Shores State Fl
Zip 33 i .J'S
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 Na �': BRA --
1R
Signature
The foregoing instrument was acknowledged before me this t day of()
by , who is personally known to me or who has
as identification and who did take an oath.
produced
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Building Officials Approval:
Rev. 10 /02/03)
ap e
wG,s 4,,,,e,
'''D f..,?" \
Re -Occ. $60.00
Notary $5.00
CCF $0.60
Total 25