EL-11-165Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 160718
Scheduled Inspection Date: June 08, 2011
Inspector: Devaney, Michael
Owner: PEREZ, DIANE
Job Address: 9405 NW 2 Avenue
Miami Shores, FL 33150-
Project: <NONE>
Contractor: ADT SECURITY SERVICES, INC
Permit Number: EL -2 -11 -165
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number
Parcel Number 1131010330670
Phone: (786)331 -3967
Building Department Comments
INSTALL 3 CAMERAS AND 1 DVR
Inspector Comments
Passed
v
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
June 07, 2011
For Inspections please call: (305)762 -4949
Page 19 of 24
BUILDING
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
Permit No. '�,.1 11 1 (0&-
PERMIT APPLICATION
FBC 20
gagg
Master Permit No.
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) II 0411 (Y1 , Pert, Phone # 7 Wes - 8 5 3- 51 g t/
Owner's Address Q '/ ®S AJ (,c1 42 Aloe
City ail eLyn I State FL, Zip 33/5 -6
Tenant/Lessee Name
Phone #
Email
Job Address (where the work is being done) 9 4 o /L ! L J Ave.
City Miami (Shores Village County
FOLIO / PARCEL # ► /' 3/0i— 033-010 7
Miami -Dade Zip 33 /5-0
Is Building Historically Designated YES NO a/
Contractor's Company Name A i 5- c -/y 5ve s
Contractor's Address /Ls `78's' (k, -KS LU4,y /
City ill 1 e--a.. sk-pe7. ° State F L Zip '3 0 s
Qualifier Name Ge.„0r f )a.,,, g f n e`/ t Phone # 954 -.2 (®f® -S-7/ 9
State Certificate or Registration No. Ef 0 00 /Al/
Phone #
Flood Zone
iMa' --- x'3O F�LI
— aCo 4_5t /%
Contact Phone E -mail
Architect/Engineer's Name (if applicable)
Certificate of Competency No.
Phone #
Value of Work For this Permit $ 0/b 0
Square / Linear Footage Of Work:
Type of Work: ❑Addition [ZAlteration ❑New
n.54"41 I 3 ca was -b 1. Dye__
Describe Work:
❑ Repair/Replace
❑ Demolition
******** * * ** * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* ** * * * * * * * * * * * * * * * * * ** * ** * * * * * **
Permit Fee $ / - ere 40'e, CCF $ CO /CC $
Submittal Fee $
Notary $ Training/Education Fee $
Scanning $ Radon $
Double Fee $
DPBR $
Violation date:
Technology Fee $
Bond $
Structural Review. $ Total Fee Now Due $ \ l 2 . 30
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 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 .: _ ubject to attachment. , ;" >: : + i ed copy of the recorded notice of commencement must be posted at the job site
for the first i n which occurs s en (7) days % per the building permit is issued. In the absence of such posted notice, the
inspection wil of b • appfpved nd a r - 'nspection fee w 11 be charged.
Owner or Agent
The foregoing instrument was acknowled ed before me this
day of 20 I ,by D■One.Rre2
who is personally known to me or who has produced
1
As identification and who did take an oath.
NOTARY PUBLIC:
P
t:
My Commission Expires:
oar °tist, Notary Public Mate of Florida
r r o Barbara Corso
a My Commission ��, _ �'17
b• Expir s 0410 012012
Signature
Contractor
The foregoing instrument was acknowledged before me this t
day of s , 20 1! , by (ea(ye ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Si
Pri
My Commission Expires:
ails Notary Public Slate of Florida
4 e„ Barbara Corzo
My Commission+
•`a Expires
1• 1,
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74,f/
K'9 Plans Examiner Zoning
APPROVED BY
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
Clerk checked