EL-12-240Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 170895 Permit Number: EL -2 -12 -240
Scheduled Inspection Date: March 08, 2012
Inspector: Bruhn, Norman
Owner: PHILIPPEAUX, BENCHY
Job Address: 11028 NW 2 Avenue
Miami Shores, FL 33168 -4304
Project: <NONE>
Contractor: ADT SECURITY SERVICES, INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number
Parcel Number 1121360020260
Phone: (786)331 -3967
Building Department Comments
BURGLAR ALARM
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
z FA--
March 07, 2012
For Inspections please call: (305)762 -4949
Page 32 of 33
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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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder):
Address: 1 NU
\1aC„ cy �� pR ec v
FEB 0 9.2812
Permit No. 1E
Master Permit No.
7a y94/d4f
Phone #: 7!' Jd I : y� j
City: tk, , w r•.. SV" " tate: Zip: 3 31 b(6
Tenant/Lessee Name: 4040 4C4"/ /1T1, 7 Phone #: 7% /t{.i y"/5"
Email:
JOB ADDRESS: MI- k At elj 2'''' ,fl(
City: Miami Shores County: Miami Dade Zip: 77a y
Folio/Parcel #: it 0 00-4 ('iA_Ch o
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
State Certification or Registration #:
Phone #:
Zip
Phone #:
Certificate of Com etency #:
Contact Phone #: Email Address: CQU;jL ir'. L AT
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit:
Type of Work: ❑Address
Desc • on of Work:
aA 01)n
eilfilteration
Square/Linear Footage of'Work:.
ONew ❑Repair/Replace
❑Demolition
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* *** * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee ` OD Permit Fee $ /e"6'roY' CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $' 64--)
RP
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
er or Agent
The foregoing instrument was acknowledged before this 2- The foregoing Q^
day of , 20 , by c�, +�'1 roo , day of � �/
who is personally known to me or who has produced who epersonally knov
Contractor
ent was acknowledged before me this 60
, 20 by w
My Commission Expires:
APPROVED BY
p/`�`'✓�
Plans Examiner Zoning
to me or who has produced
as identification and who did take an oath.
NOTARY PUBL
Sign:
Print:
My Commission Expires:
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009XRevised 3/15/09)