EL-12-423Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL /� 1
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 170997
Permit Number: EL- 3- 12-423
Scheduled Inspection Date: March 22, 2012
Inspector: Devaney, Michael
Owner: MONTERO, CARLOS
Job Address: 1245 NE 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: LONGMAN ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Rough
Work Classification: Addition /Alteration
Phone Number (786)282 -4809
Parcel Number 1132050270280
Phone: (305)758 -1211
Building Department Comments
EL WORK FOR KITCHEN REMODEL
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
March 21, 2012
For Inspections please call: (305)762 -4949
Page 9 of 13
Miami Shores Village WAR
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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder):
kAddress: \
City: \1°‘..N- 4 f��a�
$(.-4-/sa
Permit No.
Master Permit No.
ciNt «_
State: -, �.
Phone #: - -�
Zip:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS:��
� =s
City: Miami Shores
County:
Miami Dade
Zip: a�
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: L(.7) i-'0' -� I= ��' Phone#: — 7 5 - 1 1 d
Address: '1
City: . `r4�
A/ /, (;) < 1—
State: %"-ls
Zip: $ A / J 57
Qualifier Name: /1-2/ °/
State Certification or Registration #: /<L J S dam �-
Contact Phone #: ? -5 — 7 r 5 --) t /
Phone #: 5 —ls .— ///
_ ,9 d' Certificate of Competency #:
dd
Email Address: a8 ,r d 4•. -ti) ((// i t, /✓� .J� . ,��
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ ,7Cy C
Type of Work: ❑Address DAlteration
Description of Work: k'/
Square/Linear Footage of Work:
❑New
Repair/Replace ❑Demolition
* * * * * * * * * ** * * *** ** **** x*****•x**.x***+r*** Fees********+ x**x:********. x• x******** **•x**+x***+x****
Submittal Fee $ Permit Fee $ / J. efr ,'t-' e' CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
mai
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 approved and a reinspection fee will be charged.
Signature
The foreg
day of
and who did take an oath.
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of /)je ' L , 20 LI, by
o isiersonally known o me or who has produced
as identification and who did take an oath.
NOTARY ' UBLIC: •
My Commission Expires:
OS Ida
1.c State ° 2p15
3.
Nutao01mbExphes EEO Zgty10 • # pssn.
i!? » = MY �ommisslo Nay 031 1c v'
6',n0e6�ytcagn
* * * * * * * * * * * ** ** ** * ** * *** **
APPROVED BY
Sign:
Print:
My Commission Ex
******************************************** * * * * * * * ** * * * * * * * * * * * * * * * * * * ****
#0�j2��f
f ° Plans Examiner Zoning
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk