EL-11-2272Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 168505 Permit Number: EL -12 -11 -2272
Scheduled Inspection Date: January 17, 2012
Inspector: Devaney, Michael
Owner: MOONS, MICHELE
Job Address: 133 NW 94 Street
Miami Shores, FL
Project: <NONE>
Contractor: SAFE STREETS USA
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number
Parcel Number 1131010330710
Phone: (813)514 -2693
Building Department Comments
LOW VOLTAGE BURGLAR ALARM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 168463.
1//Y r,4-1"
January 13, 2012
For Inspections please call: (305)762 -4949
Page 9 of 18
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
ot
DEC 0 7 2011
BY:
Permit No. EL ....1 1 ^ �
Master Permit No.
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder) Phone # (SOS-) - a iaL\- af-Ick t
Owner's Address \33 Csk
City Nek∎c atao t■c' €C State �L— Zip 33 \5,®
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done) V33 NS4 Ck
City Miami Shores Village County Miami -Dade Zip 33\50
FOLIO / PARCEL # \ \ ?a \O X33 0-1 \0
Is Building Historically Designated YES NO
Contractor's Company Name „age v s GYP Phone # c'SO —CC-135
Contractor's Address \Io \O .C\oc'� a�-
City State L Zip 3-3-S"-
Qualifier Name (Anne S.X 4A c - Phone # (x?
State Certificate or Reeistration \30t)0'- scc0'-1 Certificate of Competency No.
E -MAIL: - �. _ '_S v . = e . ca'n
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ CkCIL . 00
Type of Work: DAddition
Describe Work:
I C1teration
Square / Linear Footage Of Work: \'l®l ®at
DNew
❑ Repair/Replace ❑ Demolition
**** * * * *** * * **** ►, * * * * * **** *** * * * * ** ***Fees* * * **** *w**** * * * ***, air **** * * ****** * * * * ** ** ***
Submittal Fee $:,.:
Notary $
Scanning $
Bond $
Permit Fee $ /c 4 tee' CCF $ CO /CC
ucation Fee $ Technology Fee $
DPBR $ Zoning $
Radon $
Code Enforcement $ Double Fee $
Structural Review. $
Total Fee Now Due $
See Reverse side -4
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 approved and a reinspection fee will be charged.
Signature -
Owner or Agent
The foregoing instrument was acknowledged before me this
day of 72.5.� , 20 IL, by Ceoo
who is personally known to me or who has produced
As tificoimpkvillaididoke an oath.
NOTARY PUBLI `. ` NOTARY PUBLIC
STATE OF FLORIDA F
Comm# EE147031
111162015
Sign:
Print: CiZ"-„ .r- Si.7.
My Commission Expires:
APPLICATION APPROVED BY. Oce- Plans Examiner
Engineer
Zoning
Signature i 4)
/ /
A771 A�f o7
Contractor
The foregoing instrument was acknowledged before me this
day of M. , 20 0.L., by llJ'ok'a a
who is personally known to me or who has produced L.
aS e `,•� i : :[1 .,-. ?heanoath.
C NOTARY PUBLIC
NOTARY P + STATE OF FLORIDA
Comm#EE147031
H6I2015
Print: o
My Commission Expires:
(Revised 07/08/06)