EL-09-563Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: April 15, 2009
Inspector: Devaney, Michael
Owner: AUVERT, DIANA
Job Address: 1223 NE 102 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ADT SECURITY SERVICES, INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
hone Number
Parcel Number 1132050250140
Phone: (786)331 -3967
Building Department Comments
April 14, 2009
Page 1 of 1
Passed
Inspector Comments
//
_
/�
// z e213'
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
April 14, 2009
Page 1 of 1
ic\°\k 444p*- Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33 (38
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder)
Owner's Address
ECEOVED
AP 0 7 2009
-- - - - - - --
ANA AUV6gT
1223 NE 102 v.d . 67^:
Permit No. LO - 543
aster Permit No.
Phone # (5 05
�6.63Pig
City MIA M 1 51-104e5 State FL.
Zip
Tenant/Lessee Name nn
E -MAIL: dC�Ul�.Vetd ``"� � tma l E • Q.0V14
Job Address (where the work is being done) Mkt a.s alowo.
City Miami Shores Village
FOLIO / PARCEL #
County Miami -Dade
'M sg
Phone #
Zip
��►°` ` °'`°�"f/ay
Is Building Historically Designated YES NO
Contractor's Company Name
Phone # C 916 —yo
Contractor's' ddress Q g t / Cird3L14143j 11014,1^"e--
City -gal State Zip --3-3a0
Qualifier Name LO N41✓j iii i Phone # (36s) �(� - 083
State Certificate or Registration No. t--l- a 0 / l 2? [ Certificate of Competency No.
E -MAIL:
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $
Square / Linear Footage Of Work:
Type of Work: ❑Addi 'on ['Alteration New ❑ Repair /Replace w Demolition
Describe Work: l 061'1;&419---
* * * * * * * * * * * * *xxxxxxx * * * * * *xxxxxxx Feesxxxxxx*xxxxxx rxxx *xxxx * ** * * * * * * * * * * * *xxxxxxx
Submittal Fee $ -.CK Ib'O Permit Fee $ /a' e ra CCF $ OZS/ CO /CC
Notary $ Training /Education Fee $ 0 26 Technology Fee $ 2,5D
Scanning $ 401)
Radon $
DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ a .31)
side -�
Bonding Company's Name (if applicable)
Bonding Company's Address
City '\ State
Mortgage Leiler'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 air 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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: 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 approv end a nspection fee will be charged. ®% I r ®(g 2
0/1y��vrrk
signature
Signature
or Agenctor
The foregoing ii trument was acknowledged before me this The forego instru ent was acknowledged before me this "/
day of , 20 , by , day of , 20047, by
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires'! My Commission Expire i90 CommissionDD682830
u .,,,;; Expires: YULE' 26, 2011
xrx xxxxxxxxxxxx **4: sex *BO ** *+x�Y.dSY%' '* "'_kxN(�aa xxxxxxx xaYrxxxxxxx xxx * xx�tx xxxxx x x *, ,� *Wg.**
l3QIVDEDlI_ iUii'�i,aiiICEOivllL�iGCO.,�a�ll
APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning