EL-12-490Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 172698 Permit Number: EL- 3- 12-490
Scheduled Inspection Date: April 24, 2012
Inspector: Devaney, Michael
Owner: PORTNER, TINA
Job Address: 870 NE 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number
Parcel Number 1132060050140
Building Department Comments
BURGLAR ALARM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
,§77t
April 23, 2012
For Inspections please call: (305)762 -4949
Page 16 of 17
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Customer # INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No.
ELt t.-t cmi 0
Master Permit No.
Permit Type: Electrical
iii / � e =l� S� pI OWNER: Name (Fee Simple Titleholder): `.-3`7-61T
Phone #:
Address: F 70 N F L S r
City: M t A-Nl ( Si--(=AES State: L Zip: 3 31'3 S
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 270 A1, 9(9 St-&f--t
City: Miami Shores County: Miami Dade Zip: g3/3e
Folio/Parcel #: d3 3150/e/
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: ADT SECURITY SERVICES Phone #: 954 - 266 -5027
Address: 10785 MARKS WAY
City: MIRAMAR State: FLORIDA zip: 33025
Qualifier Name: GEORGE MANGINELLI Phone #: 954 - 266 -5033
State Certification or Registration #: EF0001121 Certificate of Competency #:
Contact Phone #: 954- 266 -5064 Email Address: LLCARTER @ADT.COM
DESIGNER: Architect /Engineer: Phone #:
Value of Work for this Permit: $ 070/4/. Square/Linear Footage of Work:
Type of Work: CI Address XAlteration ❑New ❑Repair /Replace
❑Demolition
Description of Work:
Burglar Alarm
****** ** e**x*;e************ . • xMM . *,,, A*Fees ' ** . * * ** xr . , .g** ...:: ** <** • * *:;e�ex•;e** ** ** ** ,
Submittal Fee $ V•s Permit Fee $ Jiea� G' O <x CCF $ �T CO /CC $
AMID
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgagg 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 AErIUAVIT: 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 contmencentent 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 o ent
The foregoing instrument was acknowledged before me this' -
Signature
/� ntractor
The foregoing instrument was acknowledged before me this 49
day of M4R .c,1- . 201 V. by P.1rL1 'L' ) a day of ift .10 12, by George Manginelli
who is personally known to me or who has produced who is personally known to me or who has produced
NOTARY PUBLIC
Sign:
Print: n 1 t�Q,
fly Commission E Aires:
th as identification and who did take an oath.
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�
NOTARY PUB e• 0.• Cr 4 i s
re2e/ .,:.
.v o.� O0 pED �to; d ■
Sign:
Print:
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8:
%1\ Commission Expires. '
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Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/091
Zoning
Clerk