RF-12-54Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 171321
Permit Number: RF- 1 -12 -54
Scheduled Inspection Date: April 03, 2012
Inspector: Bruhn, Norman
Owner: BREMEN, JILL
Job Address: 517 NE 102 Street
Miami Shores, FL
Project: <NONE>
Contractor: MURPHY ROOFS
Permit Type: Roof
Inspection Type: Final Roof
Work Classification: Repair Roof
Phone Number
Parcel Number 1132060170950
Phone: (305) 892 -1700
Building Department Comments
REMOVE OLD SOLAR PANEL AND REPAIR ROOF TILE
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- 168710. Tile must match
&FL_
April 02, 2012
For Inspections please call: (305)762 -4949
Page 19 of 27 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
BUILDING
PERMIT APPLICATION
FBC 20
•
JO 13 nit
BY: •
Permit No.
42-49,-69
Master Permit No.
Permit Type: BUILDING ROOFING
OWNER: Name (Fee Simple Titleholder): 4 � � `/ 4) ' 711l e� Phone #: /S
Address: =J (-7 /v C / O
City: f(a lU �j /M.192 s State:
Tenant/Lessee Name:
Phone #:
Email: 6IZ &MEN f @ aad / p),O1 L ' CO /9/1
Zip:
53/
JOB ADDRESS: '/ 7 /"" Q (
City:
Folio/Parcel #:
Miami Shores
County: Miami Dade
Is the Building Historically Designated: Yes
NO f-km Flood Zone:
CONTRACTOR: Company Name: 1 /'l ' Jn L I,' / a �_ Phone #: �_ � c: ( � �C(9Li
Address: ('� 41 on,J/ i" '- � c 1 �' V
City: a• .5 �1"�d' State: Zip: ? 71 ‘
Qualifier Name: d J,� rJ∎ f al Ldfw Phone #:
State Certification or Registration #: Certificate of Competency #: ' 7 eS 0(..) ( 6-27
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 3 <-2 Square/Linear Footage of Work: - O ql
Type of Work: ❑Addition ❑Alteration p ❑New ❑Repair/Replace { ❑Demolition (%
Description of Work: C7'—C /dc %L Gel4n.,.°¢ SD (R-.. v4 A''q---[
i2 4
Submittal Fee $O • L Permit Fee $ CCF $ CO /CC $
Or I
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)
Morttav 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 reinsyection fee will be charged.
Signature
Omer or Agent
The foregoing instrument was acknowledged before me this
day of C.° , 20 11 , by
.5111-47,00/kiss, reii 1L°
who is personally known to me or who has produced ! ID
As identification and who did take an oath.
o\ \ \ \� i llI1, I / /// /.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
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. dd� /dx�
/ / /�y1 5!U \'a'•.
/ / / / / /11111111j1'tet
Signat
Contractor
'
The foregoing instrument was acknowledged before me this
day of , 20 by .D ?3 olu
who i me or who has produced
as identification and who \cliljltaket a» ath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
03A611012
41111 .on.: -
Commission :•
APPROVED BY Plans Examiner . r`t Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)