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EL-11-2251Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 168991 Scheduled Inspection Date: January 23, 2012 Inspector: Devaney, Michael Owner: JOHNSON, GARY Job Address: 9003 NE 4 Avenue Road Miami Shores, FL Permit Number: EL -12 -11 -2251 Project: <NONE> Contractor: ADT SECURITY SERVICES, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1132060460020 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 20, 2012 For Inspections please call: (305)762 -4949 Page 39 of 47 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 BUILDING PERMIT APPLICATION FBC 20 { 1) DEC 0 5 2011 B Permit NoE ' 1 J 12-2S Master Permit No. Permit Type: Electrical ' " I OWNER: Name (Fee Simple Titleholder): Goa / 14 16 f" Phone #: Address: [O `5 1 [E CrV/f '4h AL City: 44 1i( ((b3 State: f L Zip: 3 3/$ ,)- Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: P.W "e-ib ' City: Folio/Parcel #: Miami Shores County: �!— 3gCto ©L6 00(2-0 Miami Dade J@- Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company N m : Address: //)0 Vc City: Qualifier Name. ezy9 State Certification or Registration #: ' I I'� /1 af Contact Phone #: DESIGNER: Architect/Engineer: Phone #: State: Zip: 3 c- Phone #: Certificate of Competency #: Email Address: Value of Work for this Permit \ :,/ 9�0-43 Square/Linear Footage of Work: Type of Work: ❑Address MAlteration New ❑Repair/Replace ❑Demolition Description of Work ? aQ a Submittal Fee $ Permit Fee $ d ® tv/e' CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ CO /CC $ Bond $ 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 po:r ed notice, the inspection will not be approved and a rei; spection fee will be charged. Signature wne r Agent The foregoing instrument was acknowledged before me this day of "� ,20(( ,by who is personally known to me or who has producedlb : identification and who did take an oath. NOTARY PUBLIC: SO Sign: Print: ?Q,ni (, tr.-L_ My Commission Expires: GERRY BRIERRE MY COMMISSION # EE 100904 EXPIRES: June 7, 2015 1 ndo fire Nohry Pub9e UndenwIDers Signature ontractor The forego in trument was acknow edged before me this day of , 20 t t, by eC(4 Maijlne1a, who me or who has produced 1, as identification and who did take an oath. NOTARY Sign: Print: My Commission Expires: C: ** ****:x******* ********* A:********** �x********** ** **+x***** ****** * ****** **** x************* *** ** ********:ss:****** ** APPROVED BY A 4✓ 5%'LY %( Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk