EL-11-794Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 165563 Permit Number: EL -5 -11 -794
Scheduled Inspection Date: October 20, 2011
Inspector: Devaney, Michael
Owner: CRUZ, ISAIAS
Job Address: 9817 N MIAMI Avenue
Miami Shores, FL 33150-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060131100
Building Department Comments
BATHROOM ELECTRICAL SWITHES AND OUTLETS
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
ze--67--- 7/
October 19, 2011
For Inspections please call: (305)762 -4949
Page 13 of 16
BUILDING
PERMIT A
FBC 20
Permit T
Owner's Name (Fee Simple Titlehol
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
l
No. E(_:L '' 9.9
Master Permit No.,,
Owner's Address
City
Tenant/Lessee Name
Email
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historical) Designated YES NO
140 7
/tif
e 77
Zip
Phone #
County
Miami -Dade Zip
Contractor's Company Name
Contractor's Address
City
Qualifier Name
Phone #
Mood Zone
State
Zip
Phone #
State Certificate or Registration No. Certificate of Competency No.
Contact Phone
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work:
Describe Work:
❑Pjddition
E -mail
Phone #
Square / Linear Footage Of Work:
:New ❑ Repair/Replace ❑ Demolition
.2(7‘''
�uJ
* * * * * ** * * * * * * * * * * * * * *** * *** * *** ** *** Fees* * *** * * ** ** * * * * * * * * * * *** * **** * * * * * * * *** **
Permit Fee $ /,4 e € 6' CCF $ CO /CC $
Submittal Fee $
Notary $
Scanning $
Double Fee $
Training/Education Fee $ Technology Fee $
DPBR $ Bond $
Violation date:
Radon $
Structural Review. $ Total Fee Now Due $
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 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 a re- inspection fee will be charged.
Sign
The fore o'�g' II
Af
day • A -.
Owner or Agent
Signature
Contractor
ent was acknowledged before me thi The foregoing instrument was acknowledged before me this
, 2 O / B , by-- ./ 'o J 1412 day of , 20 , by
who is perso -fly known to me or who has produced who is personally known to me or who has produced
M identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: e v��````14 � v e`�� /�,;, NOTARY PUBLIC:
�;;Qres
_yFA = V2 ::::
Si
▪ • (2� • Cappi 6S90A . ;1_, My Commission Expires:
/////, 'E�®F�F \•, \ \
Zce-- //
APPROVED BY ' /� ✓f't��lans Examiner Zoning
My Commission Expires:
Engineer Clerk checked
(Revised 07 /10 /07XRevised 06/10/2009)