ELC-11-1754Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 164802 Permit Number: ELC -9 -11 -1754
Scheduled Inspection Date: October 11, 2011
Inspector: Devaney, Michael
Owner: EDELMAN, ALEX
Job Address: 9999 NE 2 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ADT SECURITY SERVICES, INC
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number ()-
Parcel Number 1132060134490
Phone: (786)331 -3967
Building Department Comments
BURGLAR ALARM INSTALLATION FOR UNIT 211
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
7,//c-r
October 07, 2011
For Inspections please call: (305)762 -4949
Page 11 of 22
1
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
9999 NE 2 Avenue
Miami Shores, FL 33138-
1132060134490
Block: Lot:
SHOREVIEW CENTER
Owner Information
Address
Phone
Cell
,
SHOREVIEW CENTER
P.O. BOX 476
LAWRENCE NY 11559-
0
(516)551 -3806
Contractor(s)
Phone Cell Phone
ADT SECURITY SERVICES, INC (786)331 -3967
,
Valuation:
Total Sq Feet:
$ 523.00
0
1
Type of Work: ELECTRICAL
Additional Info: ALARM
Classification: Commercial
Scanning: 1
,
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
,
Amount
$0.60
$2.00
$2.00
$0.20
$100.00
$3.00
$0.80
$108.60
,
Pay Date Pay Type Amt Paid Amt Due
Invoice # ELC- 9- 1142110
09/23/2011 Check #: 130108 $ 50.00 $ 58.60
09/27/2011 Check it 130155 $ 58.60 $ 0.00
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Underground
W. W.
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
September 27, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
September 27, 2011
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 ON NUMBER: OS) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder):
Address:
City:
Tenant/Lessee Name:
Email:
State: ".
a'
SEP 2 3 2011
Permit No. V-1& 1 1 ITDff-
13-
Master Permit No.
4fr one #:
Phone #:
Zip: 3.5
JOB ADDRESS:
City:
Folio/Parcel #:
Miami Shores County: Miami Dade Zip: 33J18
ll .301 o60/ 3' '9cv
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name:
�- 47S3t(d/l3f - g 1( s- Phone #: 7sr/ -07 b 'sa42
Address: /4074:93
City: /'///T4f lifAl State:
Qualifier Name: geo/r4' E �j 9 Ya'A' YZ, • Phone #:
State Certification or Registration #: fJ t2 / /pZ / Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone*.
Zip:
35o2.s'
Value of Work for this Permit: $ 5-9-3 Square/Linear Footage of Work:
Type of Work: ❑Address Ariklteration
Description of Work: 772 S
UNew ❑Repair/Replace
❑Demolition
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************x * * * * * * * * * * ** * * * *r * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ /c'' .° `'
Scanning Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Radon Fee $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
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 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 rapt be appj -oved an 7a reinspection fee will be charged.
Signature Signature
Owner or Agent ' ontractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me thisZ 3
day of :.�: , 20 �, by , day of 20 l/ , by L &vim
i : . - . known to m' -, or who has produced who 's personally kno o 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:
My Commission E
Y** Y Y***************
APPROVED BY
ao r out Notary Public State of Florida
Stephen K Loffredo
at My Commission DD800331
00 Expires 06/23/2012
NOTARY PUBIrI "lits ADAM M. RAMIREZ
+: II MY COMMISSION # EE 091724
EXPIRES: May 9, 2015
Bonded ,T otary Public Underwriters
Sign:
Print:
fbaikt vtet . GNU& ire?
My Commission Expires: r/c /l r
****** * ****************************** **** Y ** *******
> 1 /
C.0 (.131. Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)