EL-12-989Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 174533 Permit Number: EL -5 -12 -989
Scheduled Inspection Date: June 11, 2012
Inspector: Devaney, Michael
Owner: HUTCHESON, LYDIA
Job Address: 220 NW 112 Terrace
Miami Shores, FL 33168 -3332
Project: <NONE>
Contractor: MOODY ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360010310
Phone: (305)758 -2000
Building Department Comments
fumish three smoke detectors and one carbon monoxide
detector
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 - 174284.
57A_
Vie,,, g, /
June 08, 2012
For Inspections please call: (305)762 -4949
Page 22 of 28
B DING
PE
FBC
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
Permit No..-(
Master Permit No.
ICATION
Permit Type: Electrical
MAY 3 1 2012 �Ilf
BY® ................mao
OWNER: Name (Fee Simple Titleholder): , %C:i. /i&Ch9T) Phone #:
Address: 42iO N �.ad) ) l ,c,r
y: ! 1 )Ti tail State: �-° zip: 33162
Tenant/Lessee Name: /� J Phone#:
Email: /�
JOB ADDRESS: 220 IJ IN ) L 2 ferr
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes ✓ NO Flood Zone:
CONTRACTOR: Company Name: AcoottasG1 /G Phone #:
Address: :/..)a) 96 S%
City: I ^,y' ` I �^
Qualifier Name: i / J �.i -.40,0
State Certification or Registration #: E6
3as ®7 -%••
State: F2.-
Zip: 334C-0
C-i
Phone #: —
1199 Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ to j' ° ®e Square/Linear Footage of Work:
Type of Work: ClAddress OAlteration ONew epair/Replace
cription of Work: CJ°&e
tf-Y— _. c?d-T /41.4410
[f.
ODemolition
***** **** x ******** ********* ****** ***** Fees*** ****** *********** ** *********** ***********
Sub`uittal Fee $ Permit Fee $ 40, r CCF $ CO /CC $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
.wp
Bonding Company's Name (if applicable) f I
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) ( / j✓
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 (J) days-after the building permit is issued. In the absence of such posted notice, the
inspection will not be at y. ved and a r, / ,4n fe will be charged.
orA_e t
The fore oing instrument was acknowledged be ore me this 30
day of , , 201 /.-; by 610 ( )J1)1 i /'l s fl ,
who is personal y known to me or who ha produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: (/l ( til 176:4-
Print:
My Commission Expires:
** ** * * ***** ** * * * **** * ** * **le*
APPROVED BY
MARY PAT BRIGGS
MY COMMISSION # DD 979267
EXPIRES: May 11, 2014
Bonded Thru Nottny Public Underwriters
Signature
The fore
day of
who is personall known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
g instrument was acknowledged before me this ti
, 20 by "� Oh
/ Plans Examiner
Sign:
Print:
My Commis
s: MARY PAT BRIGGS
MY COMMISSION # DD 979267
EXPIRES: May 11, 2014
Bonded Thru Notary Pebdc Underwriters
Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)