EL-12-221Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
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Inspection Number: INSP - 169761 Permit Number: EL -2 -12 -221
Scheduled Inspection Date: March 22, 2012
Inspector: Devaney, Michael
Owner: SCROGGINS, MATHEW
Job Address: 445 NE 93 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: JACQUES ELECTRIC
Permit Type: Electrical - Residential
Inspection Type: Alarms
Work Classification: Pool - Private
Phone Number (305)757 -2147
Parcel Number 1132060140390
Phone: (954)214 -8711
Building Department Comments
HOOK UP POOL EQUIPMENT
Infractio Passed Comments
No Approved Permit Available or False
Passed
Er
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
'1249'1 Vk- iC440---,11
F //) / S d?/Yr
"1/9-7-2-
March 21, 2012
For Inspections please call: (305)762 -4949
Page 1 of 13
1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit No. E�� 2 29...
Master Permit No. S7I 2-23 SB
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder) Y I '-1-1h e ) co^0 4 b7s Phone # .30S7-60 q
_ i q (
Owner's Address Li U S ,4je q3 5-6
City M I''qill Shoi'eS State YY y Zip ? 3138
Tenant/Lessee Name 4J►a L /105 9/45 429 go/ # c01/41 Phone #
E -MAIL: / 'cc
(5
Job Address (where the work is being done) ($ 1Yl t° 1111S". 1111S". ,Q6 % 3
City h res Village Countty 'ami -D Zip 33/
FOLIO / PARCEL # / a 0Y Li —Dw 9V
Is Building Historically Designated YES NO
Contractor's Company Name .� C CQuP S V [ PC B c Phone # 615f- p� �7 �A
Contract° ' Ad s -711/ SO c/1415
City �i% l�v State li Zip 3 761�8L
Qualifier Name Qi ( M. / 4' dO k) Phone # -iSif -dff d Q
7/
State Certificate or R s on No. 00/ fl 97; Certificate of Competency No.DOOD 17R3a
E -MAIL: r3 aalcl t� 7 az ,'.re)
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ t ,it 7O tOl
Type of Work:
Describe Work:
Square / Linear Footage Of Work:
❑Additi n ❑Al on ew ❑ Repair/Replace ❑ Demolition
Ad< r% �/ epotpdlere
**** *** *** * *** * ***** *eras **** *** **** *F ************* ********** * * **** * **** * * ********
Submittal Fee $ Permit Fee $ PO CCF $ CO /CC
Notary $
Scanning $ Radon $ DPBR $
Training/Education Fee $ Technology Fee $
Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ n(] . 7X)
See Reverse side ->
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 CONDMONERS, 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 mart 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 ;r 1 Al 14, Signature
Owner or Agent 1 % Contractor
The foregoing instrument was ac wled before me this 4 The foregoing instrument was acknowledged before jme_this ,6j
day of , 20 /�, by cl Ili ,/2dr6751tdl $ , day of F 20 L� by Jdhf , th'dbit},
who is personally known to me or who has produced h f'/ue/2 who is rsonally known me or who has produced
/1661 6#9 5 e As id-- m ..won and who did take an oath. as iedentification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
GWENDOLYNB. STEWART
MY Cr 11 SION M DD9615:
Aar 9,
r
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/06/06)
NOTARY P
Sign:
Print:
My Commission Expires:
Plans Examiner
Engineer
Zoning