EL-11-2093Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 168537 Permit Number: EL -11 -11 -2093
Scheduled Inspection Date: January 10, 2012
Inspector: Devaney, Michael
Owner: KERSCH, PAUL
Job Address: 665 NE 97 Street
Miami Shores, FL
Project: <NONE>
Contractor: ADT SECURITY SERVICES, INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number 305/758 -9375
Parcel Number 1132060171910
Phone: (786)331 -3967
Building Department Comments
BURGLAR ALARM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
January 09, 2012
For Inspections please call: (305)762 -4949
Page 23 of 25
9MS P
B ING
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 APPLICATION
FBC 20
Permit Type: ELECTRICAL
Permit No. rl _ [ ( -70g S
Master Permit No.
Owner's Name (Fee Simple Titleholder) Jr f4/)1 r t� Ws jfd/i) Phone #
Owner's Address C /VC- 9 7' S
City /L(( State Zip 3 3 / 3
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done) 905-.- 2,2C4:7- /
City Miami Shores Village County Miami -Dade
FOLIO /PARCEL# f t 3P-0 Z 0/7 g'%
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
Zip 3'�) 3�
Flood Zone
/ kill Phone #
/ ki /� z,7' °
Ci ✓/� �.,.s State J' Zip f3 3, r
Qualifier Na J 4 e / 1 f Phone # 415/./. 6 —5-e9
State Certificate or Registra on No. / cJc ( 1 -A—I C - rtificate of Competency No.
Contact Phone E -ma
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ❑Ad . ition 4Alteration
Describe Work:
Phone #
Square / Linear Footage Of Work:
:New ❑ Repair/Replace ❑ Demolition
* * ** * * * * * ** * * ** ** * ** ** * * *, * * * * ** * * * * *, Fees* ** * * ** ** ***** *** * * **** * * * * * * ******* * * *****
e
Submittal Fee $ Permit Fee $ e CCF $ CO /CC $
Notary $ Training/Education Fee $
Scanning $ Radon $ DPBR $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ v y;�
'LO
Technology Fee $
Bond $
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 pro ed and a re- inspection fee will be charged.
Signature
ir "rir
• dent
The foregoing ins ' « en was acknowledged before me this a
day of etto ti'Mr{a1sc0 � � , by
who is personally known to me or who has producedd ,-
i4 5:n'f 3o bl fg identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires;
.**************************** * ***** ** * ** * * **** ***** * * ******* *err **** *** * **
J 1 I
t17+.'r. GERRY BRIERRE
144 MY COMMISSION # EE 100904
?(FIRES: June 7,2015
Banded Thru Notary PubAC Undenvdters
Contractor
The foregoing instrument was acknowledged before me this
day of ,20_,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commi
APPROVED BY
,0vdv7, Plans Examiner
Engineer
(Revised 07/10/07X Revised 06 /10/2009)
ALBA H. AGUILA
Notary Public - State of Florida
My Comm. Expires Jul 26, 2015
Commission # EE 106656
* * * * * * * * ** *- * *"*
if
* **
Zoning
Clerk checked