EL-09-1267Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
nspection Number: INSP - 120571
Permit Number: EL -7 -09 -1267
Inspection Date: July 29, 2009
Inspector: Devaney, Michael
Owner:
Job Address: 29 NE 98 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
Permit Type: Electrical - Residential
Inspection Type: F' al
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060131120
ELECTRICAL RE CONECTION FROM FPL.
Passed
Inspector Comments
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Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
July 29, 2009
For Inspections please call: (305)762 -4949
Page 1 of 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type; ELECTRICAL
Permit No:
Master Permit No.
BY: ®o ®a ®o®v6moo12•mm.®
Owner's Name (Fee Simple Titleholder) l)As1'1 S, /) SC0 rr "l^ It Phone # yD .S- '31Z_ S'4.3
Owner's Address /v7/ V 4. S Si'
City /112/.1 L.. 1l ,)) (s State .L Zip 2.? de
e
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done) - / Al ' qi f ,r
City Miami Shores Village County Miami -Dade Zip Y 3 1 -2(f‘
FOLIO / PARCEL #
Is Building Historically Designated YES NO ✓ Flood Zone
Contractor's Company Name
6//41044,)
Phone #
Contractor's Address
City State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ Square / Linear Footage Of Work:
Type of Work: ['Addition ['Alteration
Describe Work:
❑New ❑ Repair/Replace
❑ Demolition
***************************************Fees******** **********************************
100.00
Submittal Fee $
Permit Fee $
CCF $ O '60 CO /CC $
Notary $ S • lJyyl •� Training/Education Fee $ Q' d`V Technology Fee $ 2 SO
Scanning $ 3'00 Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ )11 ' 30 AIL 2 9 PA I D
See Reverse side —>�
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for FI.ECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AF'FIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or lnt
The fore o instrument was a Fowled?, m bef. - me this ' e foregoing instrument was acknowledged before me this
day of�,2 �by i ,.: i _�$f . ,20_,by
Imihr AT
who is rsonall}I known to me or who has pro c‘,. `►? :'W1. who is personally known to me or who has produced
Signature
Contractor
4.13 b
ntification an
NOT
oath.
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign:
Print: Print:
0
My Commission Expires: My Commission Expires:
******* * ** * * * *** ** * *** . �**************** ****** *: x************ ****** ****: x****** **** :x*** **:x** ** * *** *:x*******
APPROVED BY
7e,71/1jW Plans Examiner Zoning
Engineer Clerk checked
(Revised 07 /10 /07XRevised 06 /10/2009)