EL-11-613Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NS P- 164535
\ 0--
Permit Number: EL -4 -11 -613
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: Alteration
Phone Number
Parcel Number 1131010220080
Phone: (954)520 -2748 —
Building Department Comments
LOW VOLTAGE FOR CABLE AND PHONE
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- 161566.
4--?"--C7-
October 04, 2011
For Inspections please call: (305)762 -4949
Page 24 of 49
BUI TANG
PERMIT APPLICATION
FBC 20
I � 2� l � -��C�
iami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. El
Master Permit No. (
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder):?
Address:
City: State: Zip:
Tenant/Lessee Name: Phone #:
Email:
Phone #:
JOB ADDRESS: 139 '14 ( 0°2_
City: Miami Shores
County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company ame:
Addr s: (
% 1
City: 6i^"1 S21, L- (-14 • State: F(
Qualifier Name: j0 /
State Certification or Regis f 79 Certificate of Competency #:
Contact Phone #:
Registration #: ,L.. W �Z
Flood Zone:
Phone #: CV-CZ 71/0
Zip: / U
Phone #: ?s y,5-7 ,517 Q ? 7 1/61
Lj L5c 0 9790 Email Address: e-^ez i J G tit - ,-.(2„.(--
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $eo Square/Linear Footage of Work:
Type of Work: New ❑Repair/Replace ❑Demolition
❑Address DAlteration
Description of Work: ILO GO
9)c-e- 6A-6u) e_.
Phone#:
)c-
******** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ /0'4e t CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
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]
day of , 20 / (, by
Signature J
ontractor
The foregoing instrument was acknowledged before me this .
day of �pt t(_. , 20 (l , by -5 -Ar
who is personally known to me or who has produced who is personally known to me or who has p(Rduead „ft— 1
as identification aRs\who did. s'frath
As identification and who did take an oath.
NOTARY P
Sign:
Print:
LIC:
My Commission Expire
MY commis' ON N EE53276
�,'�r EXPIRES: arch 16, 2015
1. 3 tARY fl. Notary Discount Assoc. Co.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
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APPROVED BY
4#2 /1
Plans Examiner
Structural Review
(Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09)
Zoning
Clerk