EL-11-975Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 161580 Permit Number: EL -5 -11 -975
Scheduled Inspection Date: July 06, 2011
Inspector: Devaney, Michael
Owner: HUNDERVADT, ROBIN
Job Address: 9100 N BAYSHORE Drive
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ADT SECURITY SERVICES, INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number (305)751 -7624
Parcel Number 1132050010560
Phone: (786)331 -3967
Building Department Comments
ALARM
Inspector Comments
Passed
•
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
July 05, 2011
For Inspections please call: (305)762 -4949
Page 18 of 21
Miami Shores Village
Building Departmen
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305). 762.4949 0,gy 2
Permit No. EL I I `I
�ly9/f�
BUILDING 05 -25 -201 ■ A07:34
PERMIT APPLICATION
FBC 20
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) J�'` (�l( 'Z! l� Phone 526- DiO1
P ) �� ne #—
Owner's Address 0 b ,,(1 ST k j :-t 7 f w -
City Ca.//v14_ ! �S State [� Ft- Zip .
Master Permit No.
Tenant/Lessee Name
Email
Phone #
Job Address (where the work is being done) 9/00 o &IIS i r
City Miami Shores Village County Miami -Dade Zip ` '3 i 3 8
FOLIO / PARCEL # 1 3 2-o_s 001 054.0
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
NO
Flood Zone
• 4ne # (9150- —J% /s'
/a9 Xi- (- 1/J t
City L.r'U./_�,'..,1 State (= Zip
Qualifier Name "'� T .� �� / . Phone # 9.Sy »»n �..S�l,j'
State Certificate or Registration Th6. ei4o 2/ Certificate of Competency No.
P Y
Contact Phone
/A% E -mail Qa e„,e,
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ Q (
Square ./ Linear Footage Of
Type of Work: ❑Addition ❑Alteration ❑New . ❑ Repair+ ' ..lace ❑ Demolition
Describe Work:
* * ** * ** * * * ** * * * * * * * * ** * * * * * ** * ** * * ** *Fees * * * * * * ** * ** **
Submittal Fee $
Notary $
Scanning $
Double Fee $
Permit Fee $ /-1 e'vt.06?
CCF $
Training/Education Fee $
Radon $
DPBR $
Violation date:
* * * * * * * * * * * * * * * * * * * * * **
CO /CC $
Technology Fee $
Bond $
Structural Review. $ Total Fee Now Due $
See Reverse side -->
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if ap cable)
Mortgage Lender's Address
City State Zip
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 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 re- inspection fee will be charged.
Owner or Agent j Con u ctor
The foregoing instrument was acknowledged before me this g The fore• instrument was acknowled
day of d—� —, 20 11_, by r"-A'h CA k(vi tV 14— day of u , 20 1/, by
who is perso
lly known to me or who has produced
identification and who did take an oath.
Print:
My Commission Expires:
who is personal 'y known to me or who has produced
as identification and who did takeath.
c.
• Notary Public State of Fiotil
13rnara -o2G
My Commission 0D775417
i cnifss0410612012
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * ** *************************************** * *** * ** ** * **** * * * *** * * ** * * * * * ** *,ter * * ***
APPROVED BY
Plans Examiner
Zoning
Engineer Clerk checked
(Revised 07 /10 /07)(Revised 06/10/2009)