EL-11-1165Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
k -10
Inspection Number: INSP- 161417 Permit Number: EL -6 -11 -1165
Scheduled Inspection Date: February 23, 2012
Inspector: Devaney, Michael
Owner: BORUCHOW, IRWIN
Job Address: 950.NE 95 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ATLANTIS ELECTRICAL CORP
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132050070120
Phone: (305) 551 -4043
Building Department Comments
ELECTRICAL WORK FOR INTERIOR REMODEL
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
February 22, 2012
For Inspections please call: (305)762 -4949
Page 2 of 34
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.
Master Permit No
JUN 27'7011
Permit Type: Electrical s�
Owner's Name (Fee Simple Titleholder) v \€E Pf Phone # &S) C� U 2
Owner's Address ()NO toe l c sr-
City NIA \A-AA t State Zip 3 "?13.5
Tenant/Lessee Name 1\-S j Phone #
E- MAIL:
Job Address (where the work is being done) c':6"
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # (C .3jZc>S . 616-+ JO re-0
Is Building Historically Designated YES
Zip 33138
NO
Contractor's Company Name -1, izS j( 1 C_ Phone # Cam) 3g5 ?% 0
Contractor's Address 1 Zg®-s Sax 4
City WA. t State rti Zip > h(1-5—
Qualifier Name 6,_.,!1/4c4. c CO (3612-E.--- Phone #
State Certificate or Registration No. c- i'3oO19iL - O `6C ertificate of Competency No.
E -MAIL:
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ OW
Type of Work: ['Addition
Describe Work:
Square / Linear Footage Of Work: ‘r.-Ig19 0 i
Alteration ['New ❑ Repair/Replace ❑ Demolition
Submittal Fee $ Permit Fee $ ->
CCF$
CO /CC
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side -�
Bonding Company's Name (if applicably)
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 taws 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approv and a reinSpection fee will be charged
Signatur$® Signature
r Agent Contractor
The foregoing i strument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20 , by , day of , 20 , by
who is personally known to me or who has produced who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: /, T Sign -
L5 !42
Print: r r � Q �. 2d: Print: 04.0 pV)
R p F,S
rItatt My Commission Expires My Commissi� `'1�'�'u
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APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning