EL-11-2155Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 167470 Permit Number: EL -11 -11 -2155
Scheduled Inspection Date: December 07, 2011 Permit Type: Electrical - Residential
Inspection Type: Final
Owner: NUGEN, JOHN Work Classification: Alteration
Job Address: 375 NE 99 Street
Miami Shores, FL 33138 -2436
Inspector: Devaney, Michael
Project: <NONE>
Contractor: ALLSITE ELECTRIC LLC
Phone Number
Parcel Number 1132060135530
Phone: (954)632 -6146
Building Department Comments
TRENCH AND BURIAL OF ELECTRIC LINE CHANGE TO
UNDERGROUND SERVICE.
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
December 06, 2011
For Inspections please call: (305)762 -4949
Page 31 of 31
Miami Shores Village l- CEIVED
NOV 2 .2011
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
1.
Permit No. 2
i _ ISS
Master Permit No.
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder):
:5;10,/ % hc_ -"r-)47 phonet
Cj
51)---ee
I F
City: ( i r ; S �c7 1 State: Zip: 3 13 2
Tenant/Lessee Name: Phone #:
Email:
Address: '3 �� 1�
JOB ADDRESS: 7 S
1
City: Miami Shores
County:
Miami Dade
.3a
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
Address: I 42 ;;, )71„,/, fr
City:
Qualifier Name:
State Certification or Registration #: r _
Contact Phone #:
N ^ 1
NO Flood Zone:
Phone #:
State: u Zip: �' e
Phone #:(.--/
Certificate of Competency #:
Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value Of Work for this Permit: $
Type of Work: OAddreSs Alteration
itcik (C)
to
Description of Work:
Square/Linear Footage of Work:
ONew ORepair/Replace ODemolition
G
************* *************** ********a * ** Fees ********* ** ** x****+ x*** **********************
Submittal Fee Permit Fee $ .1 �c;� ePt'' CCF $ CO /CC $
leA
Radon Fee $ DBPR $ Bond $
Training/Education Fee $ Technology Fee $
Structural Review $
Scanning Fee $
Notary $
Double Fee $
TOTAL FEE NOW DUE $ l
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 hot �t;� 'nd a reinspection fee will be charged.
Signature
)� Signature C
wner or Agent Contractor
The fore.'oin y: 'strument was acknowledged before me this / The foregoing instrument was acknowledged before me this %CO'
day .of to ✓ , 20 ! , by 16-1 1‘) t'UC% Ce
who • ersonall me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Pal
N Do ISSion # i
�•••• ODIaS590
day of j to it b , 2011 , by NA-11 C�ovt,�
who is personally known to me or who has produced stl-i-V
Lamps as identification and who did take an oath.
NOTARY PUBLIC?
Sign: t
JACQUELINE PARNELL
0+'� H £ Notary Public • State of Florida
• My CormnssionExpres May 21 2012
Q:= Commuston s DD m0851
Print:1140 Lt ti;
( '�"�� ; t' Banded Through National Notary Assn.
My Commission Expires: MN.`t 2.1 2.IorZ
Ap
> x> k�x> x�xu�x:******** �x= a== ka� +a=x>4+x+x>k�x�x=��:=x=x>k>x+x* A6tpi . e44** is* �x* ***=is�x�:=i=�u ****at�x**** * * ** : x: �xx�> k >>=�x>z=�a *+x�x+x*** *�x�a *�x=a� ***
�� �� /lllllIII N\\`\/
APPROVED BY L M ' Plans Examiner
Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)