EL-11-611Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
c(c9'
Inspection Number: INSP- 158040 Permit Number: EL -4 -11 -611
Scheduled Inspection Date: October 05, 2011
Inspector: Devaney, Michael
Owner: DURU, CLEMENT
Job Address: 139 NW 102 Street
Miami Shores, FL 33150-
Project: <NONE>
Contractor: CREST ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Temp for Test
Phone Number
Parcel Number 1131010220080
Phone: (954)520 -2748
Building Department Comments
TEMP FOR TEST
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
___re/s-- /7
October 04, 2011
For Inspections please call: (305)762 -4949
Page 8 of 49
9112\ _34ck_
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: Name (Fee Simple Titleholder): —Pc L)
Address:
City: State:
Tenant/Lessee Name: Phone #:
Email:
k -C(
Permit No.
Master Permit No.
APR 0 6 at
BY :. -.
Phone #:
Zip:
JOB ADDRESS:
City: Miami Shores County: Miami Dade
Zip: '
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company
Address:
NO Flood Zone:
e: CYW6Jr Et e C-4 (/' I L I 10\C_ Ju) b�
City: IP0 V - LIM `v- State:
Phone #: `� &j Sao 2 72%6
Zip/
Qualifier Name: CJO- (�Q C4-v1 61--,& �j Phone #: of 92 7`7' 6
State Certification or Registration #: Et L J L4 / ' ! Certificate of Competency #:
Contact Phone #: 2 'L 2J 2746 Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: Address °Alteration New DRepair/Replace °Demolition
Description of Work: '7 t-t t t-c t)—
* * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * ** Fees * * * * ** * * * * * * *, * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $
DBPR $
Technology Fee $
CO /CC $
Bond $
TOTAL FEE NOW DUE $
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 a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this `7
day of ✓f , 20 1 (, by , day of r P F- i C , 20 f (, by -57,6\_1-4e4 2 Ie..4441A.4 -1
who is personally known to me or who has produced who is personally known to me or who has produced let--t 7
As identification and who did take an oath. as identification and` w1 did y an oath.
,,
NOTARY P IC: NOTARY PUBLIC: ��� g .......... .,;9p /' %,
\ �� == o
Sign: Sign: L1 ,►
Print: is �- � :, • Print:
Signature
//, /,77
ontractor
My Commission Expires:
APPROVED BY , r!` d ,12./.4. Plans Examiner Zoning
(Revised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09)
Structural Review Clerk
MIAMI•DADE
COUNTY
Building
11805 SW 26th Street
Miami, Florida 33175 -2474
786 - 315 -2100
AFFIDAVIT FOR 30 DAY TEMPORARY ELECTRIC SERVICE
ELECTRICAL CATEGORY 26
miamidade.gov
ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE" UPON 30 DAY TERMINATION
UNLESS APPLICATION IS RENEWED OR CERTIFICATE OF OCCUPANCY OBTAINED.
It is understood that the temporary electrical approval by the Miami -Dade Building Department is given in connection
with the building being constructed under the Building Permit # /,c -- 2- S r and Electrical
Permit # /0 -- E' b7- at address /3. N Gt/ / 0 1-
for owner: and is being given only for construction purposes or for
testing the following equipment in said structure:
The owner does hereby agree to assume the responsibility of maintaining the installation in such manner that there
is no hazard to life or property. Such approval is in no event to be considered a RELEASE of said structure for the
purposes of use and occupancy, and no occupancy shall be granted or permitted until final inspections have been
called for and approved by the inspection divisions concerned, and/or a Certificate of Occupancy or Completion
is obtained.
The undersigned also understands that the temporary electric approval is subject to rescission and cancellation
and electric power can be cut off at the discretion of the Building Official and will be disconnected if the building
concerned is occupied before final inspections are approved and /or a Certificate of Occupancy or Completion
is obtained.
1, C/' D Q1"41 , being first duly sworn, depose and say that I am the owner of the above
described property, and that I agree that the structure covered in this agreement shall not be occupied until the
building contractor has obtained approval of final inspections and/or obtained a Certificate of Occupancy or
Completion. Note: Failure to comply with the provisions of this affidavit will result n yo being unable to obtain
future Tempora or Te permits.
Signature of Owner
1, Jack e l /�;Ll/ co_ CIO , being duly sworn, depose and say that I am t
the above - described pro
temporary ice is connected.
ature of Nota
.•.
My Commission Ex
and that the electrical installations as now existing will not c
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S. nature of El el icai Contractor Signature of Notary
My Commission Expires: ?IDis�+er
I, 22-T rC r /4. K 15.4 f .-i , being first duly sworn, depose and say that I am the . u
of the above described property and that I will not permit occupancy of this building until final in cO r t
been called for by the contractors and sub - contractors concerned and final approval by the inspectie'IY't*iwl§ton
obtained and that I have the authority insofar as the owner of said property is concerned to prohibit occupancy until
such final inspections are obtained and /or a Certificate of Occupancy o Completio is issued.
ignature of Building Contractor
Signature of Electrical Inspector
123_01 -124 6/06
Signature of Notary
My Commission Ex
Date released to FPL: