EL-11-1955Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 171313
Scheduled Inspection Date: April 03, 2012
Inspector: Devaney, Michael
Owner: Rengstl, Jack
Job Address: 1496 NE 104 Street
Miami Shores, FL
Permit Number: EL -10 -11 -1955
Project <NONE>
Contractor: ADT SECURITY SERVICES, INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1122320320340
Phone: (786)331 -3967
Building Department Comments
BURGLAR ALARM INSTALLATION
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- 165775. LUIS BARJON -
OWNER APRIL 3
305 - 450 -4316
No one home 4: 10 p. m..
titirA z
April 02, 2012
For Inspections please call: (305)762 -4949
Page 18 of 27
((Pt i 5-D4:4
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.E.i 1 l H
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical �n
OWNER: Name (Fee Si 1e Tiitle�h�older): �� 1 Phone #:
Address: (� 0 va .k,
City: State: Zip: ` 00 l 7
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: lt" CQ ■E,, MLitt
City: Miami Shores County:
Folio/Parce1 #:`t.- v' .7 "' -- O'
Miami Dade
Zip: ' J313
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Com . any Name: ��� Phone #: Q V"C:��iJ.�
Address:
City:
Qualifier Nam
State Certification or Registration #:
Contact Phone #:
DESIGNER: Architect/Engineer: Phone #:
Zip: 32,1)
Phone #:
Certificate of Comp cy #:
Email Address. ,eel, �e • Q Dl
Value of Work for this Permit:
Type of Work: ❑Address
Description of Work:
Iteration
..'000 Square/Linear Footage of Work:
❑New ❑Repair/Replace
❑Demolition
*** * * * * * * * * * * * * *:x:x**+x ****** ** * ******** Fees * * ***** ****** :: ** *: x*: xa :****+x**** *** *+x*** ** * **
Submittal Fee $ Permit Fee $ /t £fe-Peo? 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 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 ' e app ed and a reinspection fee will be charged.
Signature
Owner or Ag
The foregoing instrument was acknowledged before me this
Contractor
The foregoinginstrurpentwas acknowledged before me this Zy
day of , ,;20;_, by , ' day of C% , 20 ii , by ice' �Q. //wall-
who e i ! �/
who is personally known to me or who has pro
who i ersonally known'o me or who has produced
entification and ho s d take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:'._
Print:
My Commission Expires: b1'Rr el%' %, ADAM M. RgMIRQ
!, ,r MY COMMISSION N EE 091724
#I EXPIRES: May 9, 2015
„W:.91' Bonded Thru Notary Public Underwriters
Sign:
Print:
My Commission Ex
Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)