EL-11-1285Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 175598 Permit Number: EL -7 -11 -1285
Scheduled Inspection Date: July 16, 2012
Inspector: Devaney, Michael
Owner: RINCON, NINFA
Job Address: 38 NE 109 Street
Miami Shores, FL 33161 -7040
Project: <NONE>
Contractor: ADT SECURITY SERVICES, INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number
Parcel Number 1121360110370
Phone: (786)331 -3967
Building Department Comments
BURGLAR ALARM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Co = nts
raK
July 16, 2012
For Inspections please call: (305)762 -4949
Page 21 of 35
Miami Shores Village
Building Department
/0050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
JUL 1 8 Rev
1 (0q 2 13,5(
Permit No. FIL ! I t x
Master Permit No.
Permit Type: Electrical /
- Carl Phone #796 .-36 3991
Owner's Name (Fee Simple Titleholder)
Owner's Address J e t 9 (�
54 t
City M vxiAl 5�l®i -e 5 State -Pc_ Zip 3� S 6 1
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done) )1? E 109
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # ft- ?.(36 —0(k-0-570
Is Building Historically Designated YES NO
Contractor's Company Name APT SeC.a.t,tri
Contractor's Address (0-715 es L.va r1
City 9.-ti TGuYt State
52,✓Oi ceS Phone # qo(e 5 7
Zip 33D7.-5
Qualifier Name 6Gp ruf. !i-t AEI l t Phone #
State Certificate or Registration No. Ct=0 00I ! a-1 Certificate of Competency No.
E -MAIL: G Y'n etrY)
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ (ciq / Square / Linear Footage Of Work:
Type of Work: ['Addition. ' : NAlteration ['New ❑ Repair /Replace ['Demolition
Describe Work: ( i m - tP hu. -91ca. -r- ex-Pa-,-171
* * * ** y * *xxxxx * *xxxxx *xxx *xxxxx * *xx xx xFeesxxxxxxxx xxxxxxxxxxxxx * *xxxxx * **w *xxxxx*
®�s r & 0 CCF $ CO /CC
Submittal Fee $ �`� Permit Fee $
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ is
See Reverse side -*
11.4275
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 t
day of � [� , 20 l (, by N ( e-i 1 c't1
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
7
1L Ra,s -eAn
Signatu
or
The fore; `ng instru ent was acknowledged before me this IS
day f quO,j , 20(1 , by Geiriqc, `8a"�Q
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
My Commission Ex ires:
*x**x**xxx** **xxx>i *x' *.*,,x
APPLICATION APPROVED BY:
(Revised 02/08/06)
Notary Public State of Florida
*MI; A Rosengarten
xIMYCerniT s 1 *461x
cr Expires 05/12/2015
A
tr-
Sign:
Print:
4,4
Aracelis Trin
My Commission Expires:
****************w xxxxxxx
APO PQ Notary Public State of Florida
an •a.
oa My Commission DD945622
40n.0"" " Expires 12/10/2013
if/S� Plans Examiner
Engineer
Zoning