ELC-11-1878Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 165425 Permit Number: ELC -10 -11 -1878
Scheduled Inspection Date: January 11, 2012 Permit Type: Electrical - Commercial
Inspection Type: Final
Owner: , SHORES SQUARE INVESTMENTS Work Classification: Sign
Job Address: 9005 BISCAYNE Boulevard
Miami Shores, FL 33138-
Inspector: Devaney, Michael
Project: <NONE>
Contractor: ATLAS SIGNS OF LAKE WORTH INC
Phone Number
Parcel Number 1132060110060
Phone: (561)863 -6659
Building Department Comments
FINAL CONNECTION FOR MONUMENT SIGN
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
5-)t-
1 J'B' J�' 2ZJ'/2
January 10, 2012
For Inspections please call: (305)762 -4949
Page 13 of 37
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
FFC2O
Permit No.
Master Permit No
RECEIVED
OCT 12 2011
BY:___ =•
eLC)�-�1 b
sclt,3 (
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): , / "tJ,t' f at u/Mt ji/yff%/Yd "7l Z-16 Phone#:
Address:
City:
30-0 MO Rd VI' Bab
/Afl State: FL
Tenant/Lessee Name:
-r (aa -nk) 1J, A •
Zip: 73176'
Phone#: PI Sy - Ss - SI q
Email:
JOB ADDRESS: ?GUS 811 fLVi9
City: Miami Shores County: Miami Dade
Folio/Parcel#: 1 1- 3aP(o 011 - Op (00
Is the Building Historically Designated: Yes NO Flood Zone:
Zip: ,A'.?
CONTRACTOR: Company Name: ,41L, -S MA/ / 11 - Phone#: CO- / 717' itel
Address: / 07 7 k677 gait Wt7 M' TEYt
City: id ET p4Cftt two/ State: Zip: .7 2Y07
Qualifier Name: U c rF fly // IJ f4Ol P F
State Certification or Registration #: opbo 2G y
Contact Phone #: sd 1- 62 - G Kr y Email Address: de/V/4 n a ,47t4f J dit/ /Ndti17f1 /1 -l. UJ
DESIGNER: Architect/Engineer. 774-0 0012 F /4 t 4NGIJ Phone#: /' 712 my
Phone#: 3'6/ - d6)° 10
Certificate of Competency #:
Value of Work for this Permit: $ , / Square/Linear Footage of Work: 2 `i
Type of Work: OAddress , CJAIteration New
Description of Work: -{- 1 Iv A-L
ORepair/Replace UDemolition
Submittal Fee $ J� • LO—
d
Permit Fee $ /mod 14W CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 FLRCTRICAL 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 properly 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
The fore
day of
who is pe
Contractor
e foregoing instrument was acknowledged before me this
by �'�� � ��', day of ,20 ,by
e or who has produced who is personally known to me or who has produced "? '
As identification and who did take an oath.
Sig
Print:
My ommission Exp'
NOTARY P
Sign:
as
• a1 cating ydrog jTIviake an oath.
a NOTARY PUBLIC
-• STATE OF FLORIDA
'-i'' Comm# EE63019
, irm2.'` ;015
Print L,'�
My Commission Expires:
L
********* ******* * **** * * * * **** ** *** ** * *** **** ** ** * ** ***a *** **** * * ** ******* * ********** * *** a*+ *** * * ** *ears * *** **
APPROVED BY Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk