RC-08-892Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 05/19/2008
Inspector: Grande, Claudio
Owner: FORTIN, JASON
Job Address: 116 97 Street NE
Miami Shores, FL 33138-
Project: <NONE>
Contractor:
Permit Type: Residential Construction
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Block:
Phone Number
Parcel Number 1132060132560
Lot:
Building Department Comments
Thursday, May 15, 2008
Page 1 of 2
Passed
Inspector Comments
PLEASE CALL BEFORE GO
CRAIG JESKE 305.793.9099
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Thursday, May 15, 2008
Page 1 of 2
Parcel Owner Report
Parcel Number: 1132060132560
Owner Information
JASON FORTIN
Phone:
Related Permits
Residential Construction
Windows /Shutters
116 97 Street NE
Miami Shores FL 33138 -
Tax ID: 1132060132560
Current Owner: Yes
it Number A • lication Date Ex • iration Date APPROVED
Perm
05/15/2008 11
RC -5 -08 -892 09105/2006 01/01/2999 DENIED
WS -9 -06 -2265
Miami Shores Village
Building Department
RE- OCCUPANCY
APPLICATION
Date
Contact Name
Buyer (---
Property Address
C Cc. 1'
GY:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. 4'00
Loc ID
e.&.e Phone # 7U->'� 79 - 990 ?
Seller Realtor Company Name
7
City Miami Shores
State Fl Zip ?I/ ?cP
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
Cr 04 Je
The foregoing instrument was acknowledged before me this
by C R A I 6- J ' , who i personally known
Ili{
day of
me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
Sign.
Print: S c) M- 3z /
My Commission Expires:
:o z, p SUSAN MCGRATH
y<1!,'11. Notary Public - State of Florida
Ast6 -, 4, 2008
'" 71, e :� Commission # DD 369378
v'�''' Sao% Bwdisd By Nuiiurrut itutulyAssn.
♦���_�_
Building Officials Approval:
(Rev. 10/02/03)
Re -Occ. $60.00 N
Notary $5.00
CCF $0.60
Total l QO . (0O