EL-11-2187Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 167029 Permit Number: EL -11 -11 -2187
Scheduled Inspection Date: January 19, 2012
Inspector: Devaney, Michael
Owner: NINO, AILEEN V DI
Job Address: 755 NE 91 ST Street 4 -F
Miami Shores, FL
Project: <NONE>
Contractor: VERES ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060440310
Phone: 786- 229 -8294
Building Department Comments
REMOVE LIGHT FIXTURE OUTSIDE OF BACK DOOR.
Passed
E/
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
January 18, 2012
For Inspections please call: (305)762 -4949
Page 10 of 23
A
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
B ING
PERMIT APPLICATION
FBC 20
11 NOV 3 1011
8 i- oaoomvonaoa,ome
Permit No. 111—a)3-7
Master Permit No.
Permit Type: Electrical l
OWNER: Name (Fee Simple Titleholder): UckfleSS0( 't ■\0
Address: 55 otl SV ' 4+
City: Worn n `3 \n'ore s State: F\
Tenant/Lessee Name: Oil O AAn cyc
\hy -Ncsso ■ . G-"fuj \ \o \cvnokk1- Cow\
JOB ADDRESS: 15 5 NE (=A` 4
City: Miami Shores County: Miami Dade
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone: N®
Phone#: ROS Sa(01/ I
Email:
Zip: 33)33.
Phone #:
Zip:
CONTRACTOR: Company Name:
Address: /ono() JfJ SS Y
City: A i'n-��
Vev- r s Ctnr i [.-
State:
nC✓
Phone#: 7' o 2.5 t ' 77 Cj G
Zip:
Qualifier Name: ( c U p .� . " Phone#: (7g05 ;eg %aL? e
State Certification or Registration #: 7t7t 2O/ 7-2 3 0 Certificate of Competency #:
Contact Phone# Email Address: , ,//tJ/ Q A �o C A3 -vim
DESIGNER: Architect/Engineer: Phone#:
°a
Value of Work for this Permit: $ 3 DO - Square/Linear Footage of Work:
Type of Work: °Address °Alteration
Description of Work:�P" (1
C.oti(l\n Q lC(1 (1\1
°New ORepair/Replace Demolition
x�cvre. )-- Cc - hcxC L dco{
*e*ew* ** ** * ****** ********** * * ***,x+x** ***Fees**** ** ** *****a ** era *** ******* **** * ** *** ******
Submittal Fee $ Permit Fee $ % eotei2 CCF $
Scanning Fee $ Radon Fee $ DBPR $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
CO /CC $
Bond $
TOTAL FEE NOW DUE $ 5 64 OLD
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 FI FCTRICAL 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 and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of (, , 20 if , by ./ NC 3S5-
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY P : LIC:
Contractor 1
The foregoing instrument was acknowledged before me this c
day of 4/0 L/ , 20 , by ( A ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
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Sign .. y Sign: O
Print: __ ...` ®y �� °a: , l Print: A
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APPROVED BY frck�Plans Examiner Zoning
My Commission Expires:
kik . APHIEL ALBINA
it COMMISSION # DD
EXPIRES: November 9, 2013
dot°�`O� Bonded Thru Budget Notary Sens
Structural Review Clerk
(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)