RC-11-1890Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 167999 Permit Number: RC -10 -11 -1890
Scheduled Inspection Date: December 20, 2011
Inspector: Bruhn, Norman
Owner: AYUSO, AGUSTIN & NORMA
Job Address: 10619 NE 10 Place
Miami Shores, FL 33138 -2103
Project: <NONE>
Contractor: ADVANCE SOLAR & SPA INC
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Solar
Phone Number ()_
Parcel Number 1122320280580
Phone: (954)938 -8507
Building Department Comments
PV PANEL ATTACHMENT
Failed
/42 e
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 167109. CREATED AS
REINSPECTION FOR INSP- 165456. Plans and permit are required for
inspection. NBsame comments NB
December 19, 2011
For Inspections please call: (305)762 -4949
Page 20 of 27
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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 //�� j / f�
BUILDING Permit No. /26 / /'6 7v
PERMIT APPLICATION Master Permit No. LPL. / / /.8V
FBC 20
Permit Type: BUILDING
ROOFING
`
OWNER: Name (Fee Simple Titleholder): 4.4 �' �le� ��h,���� Phone#: 91— 75
Zip: j V5D
Address: 1004 %% IV F- [� 112 f �r'L=
City: 41.41/ 7i[Ore State:
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 1 6/61 A/ i— 104 �le9C�
City:
Miami Shores County:
Fo1io/Parcel #.
Miami Dade
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name: ,f C1�<'�/C 6
Address: 9n6,7 r 4,114/
City: CAVE" t i lik,'Id le State:
t9vidri
State Certification or Registration #: C116 C15 6 V
Contact Phone#: 1.9/ ''/ t — 01 5'6 Email
DESIGNER: Architect/Engineer:
Qualifier Name:
Zip: �27/
NO Flood Zone:
4,7 fi
Value of Work for this Permit: $
Type of Work: ❑Addition
Description of Work:
edos
Phone #:
Zip:
Phone #:
Certificate of Competency #:
Address: 9ke e , dii",„Ge ,d Cow/
Phone #:
Square/Linear Footage of Work:
ClAlteration ONew
(e'/'
ORepair/Replace ODemolition
p1�� . -r °c pi/ -575/697
*** ***s. **************** ** *** ** *Fees * **** x**** ** ** * ** *** *****x• ****** *.x*****x * **
Submittal Fee $ (� �� Permit Fee $ ) U d dJ
CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $�
,.A
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before Re this % 3
day of 0 (+ , 20 i J , by NV.1 -n I'k uk So ,
who is personally known to me or who has produced N1t
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 'SPSC ► ea \ ,t62,
My Commission Expires:
NOTARY PUBLICSTATE OF FLORIDA
,"" "\ Jessica Vadeboncoeur
Commission #DD765465
Expires: MAY 16, 2012
Signature f, 4A.a., 1st
Contractor
The foregoing instrument was acknowledged before me this' 3
day of t�c ,20 AL by Br ac b d
who is personally known to me or who has produced h
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: i Cez,
My Commission Expires:
e� r'1 GUS
OTARY PUBLIC.STATE OF (1 FLORIDA
•""."'•-$ Jessica Vadeboncoeur
Commission #DD765465
%.,,,,,,.F Expires: MAY 16, 2012
BONDED &
* nxx****** * *a*xaxxx**** a ~ 64*** x**** x**** x****xxxx*** *****x *ax**** • **** +vu�c
APPROVED BY G /b4+`( Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk