ELC-12-62Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
06:u,
Inspection Number: INSP- 168759 Permit Number: ELC- 1 -12 -62
Scheduled Inspection Date: April 24, 2012
Inspector: Devaney, Michael
Owner: , BARRY UNIVERSITY
Job Address: 11300 NE 2 Avenue Gamer Building
Miami Shores, FL 33138 -0000
Project: BARRY UNIVERSITY
Contractor: ELECTROCOM INC
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360010160 -22
Phone: (954)632 -1091
Building Department Comments
replace can lights @ breezeway
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
,rJ
April 23, 2012
For Inspections please call: (305)762 -4949
Page 4 of 17
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
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder)] 1Ly
Owner's Address (130o /toe' 2 ova
Permit No.
Master Permit No.
N,✓eir- r y
Phone #
City yil , ,) Sha✓Ci State pt Zip t 3 / fir
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES NO
gAh-`l OA) to , 'ry— /f 0-41/41
County Miami -Dade Zip
Contractor's Company Name
Contractor's Address §(5 3,) 4/40 e
City r,"/16e--71,71/41( State
Qualifier Name 6 ‘ett e-t , 2
State Certificate or Registration No. ±- /3e
Flood Zone
Zip J
Phone #
Certificate of Competency No.,/WC d c
Contact Phone ; E -mail Z- I e
a
Architect/Engineer's Name (if applicable)
Voyrg htaa
Phone# aj,n(• Y2Z. • 4o61.3
Value of Work For this Permit $ %/ 000 Square / Linear Footage Of Work:
Type of Work: ['Addition EAlteration ['New g Repair/Replace ❑ Demolition
Describe Work: IP(A ce. G4" t:51 +S iv 171cGi y
* * * *** * * * * * * * *, * * * * * * * * ** , * * * * * * * * * ** Fees * * ** * * * * ** * * * *, * * * * * * * * * * * ** * * ** * * **** * * ***
Submittal Fee $ Permit Fee $ / C61 o ‘, CCF $ CO /CC $
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date: (Al c. • oC)
Structural Review. $ Total Fee Now Due $ (� V
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 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 -- inspection fee will be charged.
Signature
Owner or Agent ! Contractor
II e
The foregoing instrument was acknowledged before me this l 6 The foregoing instrument was acknowledged before me this ,/®
day of, Nuf , 2017 , by Wlt(f eioVIVAP
who is personally known to me or who has produced
, dayo
w
20 /A byee.ovag
o is perso
or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission E
APPROVED BY
ou Notary Pubiic State of lori •a
9.14 1 itesjos ph V Muter Jr
r My Cemmiasron EE071488
if Expir ®A 04,10/2015
Plans Examiner Zoning
Engineer Clerk checked
(Revised 07 /10 /07)(Revised 06/10/2009)