REOC-09-1196Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 119666
Scheduled Inspection Date: July 20, 2009
Inspector: Bruhn, Norman
Owner:
Permit Number: REOC -7 -09 -1196
Job Address: 1055 NE 96 Street
Miami Shores, FL
Project: <NONE>
Contractor:
Permit Type: Re- Occupancy
Inspection Type: Re Occupancy
Work Classification: Re- Occupancy
Phone Number
Parcel Number 1132060143710
Building Department Comments
RE -OCC
Passed i(72'77.4.9.csji
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
PLEASE CALL BEFORE GO
JIM PETERS 305.302.4795
July 17, 2009
For Inspections please call: (305)762 -4949
Page 28 of 32
RE— OCCUPANCY
APPLICATION
Date e7 7/C1
Contact Name '1-Z5rS. Phone # a302.-
Buyer Seller Realtor Company Name
Miami Shores Village
Building Department
SCVII
JUL 1 I :1"
.10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. R &X) 09-15(4
ato � � �° � Loc
Property Address
/(6 N6
City Miami Shores State Fl
Zip 5'3/36
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: Y certify that all the foregoing information is accurate.
The for ein
by
produced
fore me this )1 day of _; 2009
me or who has
as identification and who did take an oath.
Sign:
Print:
My Commission Expires:
NOTARY PUBLIC:
p :.
0, \>ti ` \� ��
` -
'.
2:�i
Building Officials Approval:
Rev. 10/02/03)
Re -Occ. $60.00
Notary $5.00 \
CCF $0.60
Total
IsTic
JuL 17 PIT