ELC-11-943r
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
A-121A
Inspection Number: INSP - 160121
Scheduled Inspection Date: October 11, 2011
Inspector: Devaney, Michael
Owner: SCHOOL INC, MIAMI COUNTRY DAY
Job Address: 107 ST AND 6 AVE STREET
Project:
1AADDA\ /CAACAIT CE -ww4
Miami Shores, FL 33138 -0000
<NONE>
Contractor: STRYKER ELECTRICAL CONTRACTOR INC
Permit Number: ELC -5 -11 -943
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: New
Phone Number (305)759 -2843
Parcel NtiMItOVEMENT PROJECT
Phone: (772)219 -3389
Building Department Comments
RELOCATE OVERHEAD ELECTRIC FEED TO
UNDERGOURND
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
October 07, 2011
For Inspections please call: (305)762 -4949
Page 4 of 22
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 No.
OP
Master Permit No. 1/. L{ a D d - Look
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): M 1 007° CathlvOrck-f1/4 1' Phone#:
Address: (00I 4t€ % O1 Ts 54.
City: ' i t 5c4 State: Zip: lip
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: jA, t kfK.A CA5 U.
City: Miami Shores County: Miami Dade Zip: 33112 1
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:Q..::x. ` L
Address: � 2y l sip C h Q,JS C1149
City: I rn state: fl Q f C
Qualifier Name: f� /
State Certification or Registration #: Gi.1'r .� 3"16
Contact Phone #: Email Address:3.' , C6C.4
DESIGNER: Architect/Engineer: JJ
NO Flood Zone:
e#:--712 2I4J c i
zip: (31-pao
Certificate Competency #:
o \i y\et-elerFriC .CcfY)
Phone #:
Value of Work for this Permit: $ 5b® Square/Linear Footage of Work:
Type of Work: Address DAlteration New DRepair/Replace ODemolition
Description of Work: cRelo bvf..cb A._ e�o� pie —ate ,
* ** x°: x**+ x***** **x°********** **+ xa:****** Feesa: ** **° x************ ****** *x: **+x****°x**m**°x****
Submittal Fee $ rY7 Permit Fee $ s°, ®'017
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable) /A-
Bonding Company's Address
City
State Zip
Mortgage Lender's Name (if applicable) ik.1 )/4-
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 RT.F.CTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S ANNIDAVIT: 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 reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this of
day of , 20 11_, by C,',g4.17 d p-
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
oY PUBLIC -STATE OF FLORL.A
Shellie L. Fulford
Commission #DD850330
.,,,;;,,;' Expires: FEB. 28, 2013
BONDED TERU ATLANTIC BONDING CO., INC.
Signature
Contractor
The foregoing instrument was acknowledged before me this ='✓ "j
day of M V
, 20 11, by �UhY) fJ, 010,1 71
who is personally known to e or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: �--
) It
r -4 wi r
My Commission Exp
TIFFANY ROLLER
MY COMMISSION H DD 852886
EXPIRES: January 20.2013
Bonded Thru Notary Public Underwriters
k************************ , iY ***************** ******************************I ************************** ***
APPROVED BY
//
. .i. 6- Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
Miami
COUNTRY DAY SCHOOL
May 23, 2011
Miami Shores Village
Building Department
RE: 601 NE 107th Street, Miami, FL 33161
To Whom It May Concern:
Mr. Gary Butts, Chief Operations Officer, is an authorized signer on behalf of the
corporation, Miami Country Day School, Inc., owner of the above addressed
property.
Sincerely,
Anne Paulk, President
Board of Trustees
Miami Country Day School, Inc.
MOTIF PV LIC.8TA" tYP IMORWA
• °" Shellie L. Fulford
Commission #DD850330
• „ ,;,••° Expires: FEB. 28, 2013
BONDED TURD ATLANTIC BONDING CO., INC.
601 Northeast 107 Street I Miami, Florida 33161 1 305.759.2843 I Fax 305.759.4871 I www.miamicountryday.org Every Student. Every Day.