ELC-11-608Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 158023 Permit Number: ELC -4 -11 -608
Scheduled Inspection Date: December 06, 2011
Inspector: Devaney, Michael
Owner:
Job Address: 9475 NE 2 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MILLER ELECTRIC CO
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060133760
Phone: 305 -887 -7355
Building Department Comments
A/C REPLACEMENT AND REPAIRS
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comm , ts-
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December 05, 2011
For Inspections please call: (305)762 -4949
Page 4 of 31
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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
Permit No.°3\
BUILDING
PERMIT APPLICATION
FBC 20
APR 06r2O11
Master Permit No.
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): Bank "America Phone#:
Address: 9000 Southside Blvd, Building 300, 1 st Floor
City: Jacksonville
State: FL
Zip: 32256
Tenant/Lessee Name: Phone#:
Email: sherry-anderson @cbre.com
JOB ADDRESS: 9499 NE 2nd Ave.
City: Miami Shores County: Miami Dade
Folio/Parcel #: 11 -3206 -013 -3760
Zip: 33138
Is the Building Historically Designated: Yes
NO x Flood Zone:
CONTRACTOR: Company Name: Miller Electric Company Phone#:
Address: 1881 W. State Road 84 Suite 104
City: Fort Lauderdale State: FL Zip: 33315
Qualifier Name:771DM a 5 b Ld h9 Phone#:
State Certification or Registration #: b CQO b3 / / 2 Certificate of Competency #:
Contact Phone#: 9s-1-`16/- 2 I / eo Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 25,E-00 Square/Linear Footage of Work: 20,067 bldg sf
Type of Work: UAddress DAlteration ONew ®Repair/Replace ODemolition
Description of Work: A/C Replacement and repairs
***+ 14111:******k+ R+ iBs*+k+t***IkW** **** *********F ****+ Y************* ****riale+k************ **#4***
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
ZINN
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 Ls issued. In the absence of such posted notice, the
inspection will not be approved and a re yi'ection fee will be charged.
Signature
Owner or Agent
Signature/
// Con
The foregoing instrument was acknowledged before me this d The foregoing instrument was ackno !edged before me this a`;
day of $g-re-h, 20 by dej C , day of m a mks , 20 a, bX he �y
who is person known to me or who has produced who is personally known to me or who has produced •J
As identification and who did take an oath.
NOTARY PUBLIC: NOTARY P
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Print: Ail
My Commission Expires: li✓57224
APPROVED BY
Sign:
Print
ib �r�, s�• cih Dina Who didtake an oath.
4• JOANN W RANGE
Notary Peat's • State of Florida
?, My Comm. Wilms Sep 2.2013
Commtselon • 00 922478
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My Commission Expires: City / J 3
Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10/07XRevised 06/102009)(Revised 3/15/09)