EL-11-1870Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
_or(oci
Inspection Number: INSP- 165403 Permit Number: EL -10 -11 -1870
Scheduled Inspection Date: November 30, 2011
Inspector: Devaney, Michael
Owner: SEGRERA, VERONICA
Job Address: 314 NE 94 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: JACQUES ELECTRIC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Pool - Private
Phone Number (786)797 -1985
Parcel Number 1132060136190
Phone: (954)214 -8711
Building Department Comments
HOOK UP POOL EQUIPMENT
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
P3/ /'/
November 29, 2011
For Inspections please call: (305)762 -4949
Page 17 of 38
Miami Shores Villag�
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 12Z011
BY. Q S�
BUILDING Permit No. L1 1 '—' 7in
PERMIT APPLICATION Master Permit No. SW) H l 9
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): I/ffl,6eI/O /l (% 01 / ,r o e 2 Phone #: 7g6-79 / a /9 U S
Address: /� 3 Lf E
�� g7 6+ /
City: 1► 1 ; c 1 h Of PS State: rt■ 33 I ,/ 2
g
Tenant/Lessee Name:
Email: e/9 q b ')/ vo7d e f Q , (tfr1
JOB ADDRESS: 3 I/ /l.! % 1/40 U I
City:
Folio/Parcel #:
Phone #:
Zip:
Miami Shores County:
1I� 3206 —o/ -6190
Miami Dade Zip: 3 3/ 7
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: "at/ C (�
711 Sz 1rrS,V
Address:
City:
Qualifier Name:
State Certification or Registration #: 1 Dt/ /D / 72— Certificate of Com
eS c td'c
-free
lr%p tate:
# r�000/ 783a
Phone #:
Zip: 3 7602Y
Phone #: 95'7 'o`[ / —g
Contact Phone #: ",� ��'/-�lisV-S Il / ,� c/ A U" R/
Email Address:
etency
/ /ct�///i
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ U 00 ! c2� Squ
Type of Work: ❑Address ' Alteration
Description of Work: Oki
e/Linear Footage of Work:
❑R- • /Replace ❑Demolition
/ / /�'
******** * *, * * * * * * * * * * ** * * * * * * * * *** * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ 0 Permit Fee $ mod' ' CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 2.(0S •
Bonding Company's Name (if applicaTle)
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 not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this D
day of c ./tb, , 20 Hi , by %'4U 6c a �` /),� � t c, c., e
Signature
/fr/46tte
Contractor
The foregoing instrument was acknowledged before me this
day of � /� �i t' d � , 20 9) , by " l: /w, 'i d/,
who is personally known to me or who has produced '1L. who is personally known to me or who has produced
L166 P "i ( As identification and who did take an oath.
NOTARY PUBLIC:
Sign: ,p�`�Gi ,t
Print`.
My Commission Expires:
` I I � B. ST ART
mv
f.�"'• ■ "r.f - ,1,4 19, 2, 14
y
41 N
{yam C-
as identification and who did take an oath.
NOTARY PUBLIC:
r
Sign: ". j �', c= J tik
Print:
My Commission E
!I l" J(1r 1 B. STE WAR T
N1) J.,1.,■11,11SSION r DDy61586
o-FJkis A1,r-i1 19, 2 14
ua}
'�"V'1Jir vti L�sco,r„
* * * * * * * * * * * * * * * * ****** ******* *k*** ***kk4r4ceY3: kkk *9e*&*ae**oY4r?e4* **It**** **k * ** * *k**kkk******Y9e***k****** *k
APPROVED BY mir� < j / -1 Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09)