EL-12-260Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 171317
11,-111-
Permit Number: EL -2 -12 -260
Scheduled Inspection Date: March 21, 2012
Inspector: Devaney, Michael
Owner: ROGERS, SHAUN D & NADINE M DAVE
Job Address: 121 NE 100 Street
Miami Shores, FL
Project: <NONE>
Contractor: AABAA ELECTRICAL SERVICES CORP
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)756 -7345
Parcel Number 1132060132040
Phone: 305 -620 -7864
Building Department Comments
SMOKE DETECTORS AND NEW LIGHT IN BATHROOM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector °Comments
March 20, 2012
For Inspections please call: (305)762 -4949
Page 20 of 23
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
Permit No. �L (n2_
Master Permit No. (20 L t 0
BUILDING
PE ' APPLICATION
FB
FEB
Permit ype: Electrical /%/� 44;.7,4
OWNER: Name (Fee Simple Titleholder): i€ ' r Phone #:
Address: J2% 11.16r--
.4f /61965/—
a --
City: /01/601--, • ,iar State: � Zip:
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: /2/ / e / Z /,l / a
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: /1/1.14141 Phone #: 3 71#9 52
Address:
City: /Ae/
Qualifier Name: f Phone #:344 7XLI 9A9Z-
State Certification or Registration #: .5/273i2/0., 20 Certificate of Competency #:
Contact Phone #: 3065-1i& ® ,64 Email Address:
DESIGNER: Architect/Engineer: Phone #:
State: /7
Zip: ®f
Value of Work for this Permit: $ 5Z'o
Type of Work: DAddress ❑Alteration
Description of Work: �?
Square/Linear Footage of Work:
e
DRepair/Replace
r - �
❑Demolition
*** *: x*****+ x**** ********** * *** ****** ** ** Fees* *********************a:** ****** * *** * ****** **
Submittal Fee $ <</ Permit Fee $ /S !G' e'ecZi CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 1 59 . 140
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
o attach
which oc
whose property is subje
for the first inspect
inspection wil of
Also, a certified copy of the recorded notice of commencement must be posted at the job site
(7) days after the building permit is issued. In the absence of such posted notice, the
ectio fee will be charged.
The foregoing instrume' wa cknowledged before me this
day of F"eLO , 20 1 a ; by 1)knc(- .\'r1 -Q Y2-:395z fs.S
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print cT v1 c''-_ vPr) 0. r")(------> Print: E l.c-r, O
Contractor
The foregoing instrument was acknowledged before me this
day of re 5 , 20 Va- ; by ;Q-c .Mvi g\ve r'
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
14/
My Commission Expires:
otr ELENA MARK
otN�� .u�c ELETIA MARK My Commission Expires: t_} * MYCOMM # EE 163031
• �_.
* MY COMMISSION 9 EE 163931 EXPIRES: February 25, 2016
Banded Rey Budget Natty Services
W I , EXPIRES: February 25, 2016
APPROVED BY
Plans Examiner Zoning
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk