EL-11-1964Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 165817 Permit Number: EL -10 -11 -1964
Scheduled Inspection Date: October 31, 2011
Inspector: Devaney, Michael
Owner: SHEA, SEAN
Job Address: 1053 NE 95 Street
Miami Shores, FL
Project: <NONE>
Contractor: MOODY ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060143600
Phone: (305)758 -2000
Building Department Comments
REPAIR UNDERGROUND PIPING & WIRING
Passed
Ei
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Co
S',__,
3/ a-----e /-/K
October 31, 2011
For Inspections please call: (305)762 -4949
Page 15 of 18
BUIL k G
PERMIT APPLICATION
Fsc 20
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
RECEIVED
OCT 25 Mt
Permit No. M Acl (9
Master Permit No.
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) SeAk s C .4hone # 305' -75-1- ZS /
Owner's Address %05533 A)E qS 97
City 0/1/0141 110i�� State rt.,
eti/A
Tenant/Lessee Name
Email ----
Zip /3 g-
Phone #
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Ain �e_
County Miami -Dade
Zip
Is Building Historically Designated YES NO
Contractor's Company Name wit- c_1721G hue. Phone #
Contractor's Address 6634 AJ ®s r
Flood Zone
3oc- 110 -zoo®
City h1 m r State . FL Zip 3 �j/ Co
Qualifier Name CIO h J _ MOO ( Phone # %j OS--75.? —2° State Certificate or Registration No. e G 0 01,9 q Certificate of Competency No.
Contact Phone E -mail
4
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ 1
Type of Work: ['Addition
Describe Work:
Phone #
['Alteration
Square / Linear Footage Of Work:
['New Repair/Replace
❑ Demolition
r
Submittal Fee $ Permit Fee $ /f Pte' ' CCF $ CO /CC $
Notary $ Training/Education Fee $
Scanning $ Radon $ DPBR $
Double Fee $ Violation date: k Structural Review. $ Total Fee Now Due $ t \C t tD
Technology Fee $
Bond $
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 her ' y made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prli 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.
Signature
Owner or Agent
The fore wing instrument was acknowledged before me thisJb®
day of , 2O 1� , by �OS 11 L S1T ffif ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
"Y °t; •• MARY PAT BRIGGS
My Commission Expires: _ *� MY COMMISSION # DD 979267
. c; EXPIRES: May 11, 2014
'4.0V Bonded Thru Notary Public Underwriters
* * * * * * * * * * * * * * * * * * * **
APPROVED BY,z / /I/ f L
Signature
Contrac
The foregoing instrument was acknowledged before me this091
day of 6ef- , 20 J, by i Jfl g
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissio
Ilet
? y•••• MARY PAT BRIGGS
.x MY COMMISSION # DD 979267
's` .e EXPIRES: May 11, 2014
' irctirg` Bonded Thru Notary Public Underwriters
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *' a * * * * ** * * * * * * * * * * * * * * * * * ** ** * * ** *sir * * * ** * * ** *sir * * **
49"C-7-Plans Examiner
Engineer
(Revised 07/1 0/07)(Revised 06/10/2009)
Zoning
Clerk checked