EL-09-814Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NS P- 114215
Permit Number: EL -5 -09 -814
Scheduled Inspection Date: June 08, 2009
Inspector: Devaney, Michael
Owner: SPRINGER, LAWRENCE
Job Address: 358 NE 101 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MOODY ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060135280
Phone: (305)758 -2000
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
yt
e ep
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
REC NE
MA . 1 .2009
Permit No. Etoct r T a 4i
aster Permit No.
Permit Tyi)e: Electrical
Owner's Name (Fee Simple Titleholder) D eu, �f%j,/ NG� /u Phone #
Owner's Ad/dress3j ' /J (6/ Sr
City �/ 4 y� �) 40 "55 tate 7" t
O %58 -c 3
Tenant/Lessee Name Phone # ge5 58, -825,63
E -MAIL:
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building I- istorically Designated YES
Contractor's Company N me __ _
Contractor's Address bq lulu
City
Qualifier Nanie
County Miami -Dade Zip
NO
05f 2 j�
Zip 141 C!
Phone #
State
State Certificate or Registration No.
E -MAIL:
Architect /Engineer's Name (if applicable)
Phone #
ll9q Certificate of Competency No.
J'.
Value of Wok For this Permit $
50 .06
Phone #
Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration New Repair /Replace ❑ Demolition
Describe Work:
EPA
wWWWWWWW:WW * &xxxxWWWWXWWWWWW tWWWWWW txx FeesW .WWWWx WWWWWWWWW CWWW CWWWWXWWWW****WWWWWWWWWW
Submittal Fee $ Permit Fee $ "`A®fe4/ CCF $ a(C CO /CC
Notary $ Training /Education Fee $ . 0 Technolo • Technology Fee $ 4
Scanning $ .. Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ IIQ) .
See Reverse side -->
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
tate
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. 1 understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: 1 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
Own.. r Agent
The foregoing instrument was acknowledged before me this /`
The foregoing instrument was acknowledged before me this
//. ry -
day of __fit , by � LL ��:, -��s� day of 1 i , 2�, by �1 ®h
who is ersonally kn who is person ly known to me or who has produced
As identification and who did take an oath. as identification and who did to
n to me or who has produced
NOTARY PUBLIC:
Sign.
Print:
My Co
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
xY. W Y.WW*W* x x WW x x*WWWW,rw XXxXY.XY.Y.xY.Y.xxXY.'x xx Y.xWY.xW . WW W WW x WW WY.x x xx xxxx*Wx xx x xx Y.x Y.x
APPLICATION APPROVED BY:
(Revised 02/08/06)
i Plans Examiner
Engineer
Zoning