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PW-12-802Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 173139 Permit Number: PW -5 -12 -802 Scheduled Inspection Date: July 02, 2012 Inspector: Bruhn, Norman Owner: FREDRICKS, THOMAS Job Address: 433 NE 91 Street Miami Shores, FL Project <NONE> Contractor: MARS POOLS Permit Type: Public Works Inspection Type: Final Work Classification: Public Works Phone Number Parcel Number 1132060140120 Phone: (954)214 -2844 Building Department Comments REMOVE SMALL SECTION OF Asphalt FOR UNDERGROUND ELECTRIC Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 29, 2012 For Inspections please call: (305)762 -4949 Page 11 of 38 Miami Shores Village Public Works Department 10050 N.E. 2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Public Works Permit Application FBC 2ee4 2610 Permit Type: m. Public Works WATER 0 ^ S � Phone l J / - S-`J }7� Owner's Name (Fee Simple Titleholder) 7 tr v l� ✓) rl ck at/ state zip 37in TenanUtessee Name Phone $: MAY 0 4, a BY Pernik M. Puv2 Job Address (where the work is being done) ✓ 3��r 9/ V f City Miami Shores Village County Is Building Historically Designated YES Miami Dade Zip 3 3/ / NO Contractor's ComPanY Name PC01 Phwre f q5W/115 Conhacdors Address P ©S.- NV /0,1 1% #1/38- vnr, s ( state P —� zip 3/76-1 Architect/Engineers Name (if worktable) $ Value of Work For this Permit Type of Worlc Addition Work e' o fie Phone S: Lineal Footage Of Work: ❑Alteration ❑ Now ❑ RepahlReplace ❑ DemoH6on aar"Ittlfillit Fees Submittal Fee $ Pemdt Fee $ d CCF $ • Nary $ 1 Training/Education Fee $ Scanning $ Radon $ Code Enforcement $ Structural Plan Review $ Total Fee Nov Due $ (Continued on opposite side) Technology Fee $ Bond $ Bonding Company's Name (if applicable) Bonding Cc 4ipany's Address City N/A State Mortgage Lenders Name (if applicable) Mortgage Lenders Address City State N/A 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, W ELLS, 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 this issuance of a Public Works pemnit with' an estimated value exceeding $2500, the applicant must promise in goad faith that a copy of the notice of commencement and construction lien law brodwre 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 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1 day of , 20 , by day of _, 20L4r who is personally known to me or who has produced Who is personally know to me or has produced D as identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: o`, 4• Print Print . , = 9 : N .0* 4,3 3 My Commission Expires: o�\ a�\ : �� • • as identification and who OTMJW oath. yi PUBsI .. My Commission Expires: APPLICATION APPROVED BY: L=�%" T:! "-- 11/17/2005 Public Works Director or his designee.