EL-12-1155Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 175085 Permit Number: EL -6 -12 -1155
Scheduled Inspection Date: July 03, 2012
Inspector: Devaney, Michael
Owner:
Job Address: 9823 NE 4 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: MOODY ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Repair
Phone Number
Parcel Number 1132060170330
Phone: (305)758 -2000
Building Department Comments
REPAIR LIGHT FIXTURES, CHECK FOR SHORTS
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
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July 02, 2012
For Inspections please call: (305)762 -4949
Page 13 of 19
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BUILDING
PERMIT APPLICATION
Fsc 20
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. EL- (2- 1155
Master Permit No.
Permit Type: Electrical
Ill(clami Shorts Gounill GhI, . -759_a
OWNER: Name (Fee Simple Title o/�l�d,�e�r)��: Fh
Address: b O�o toe Ate.
City: Na'm 1 '&r5 State: rt., Zip: 33135
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS:
6614116,
City: Miami Shores
County: Miami Dade
Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: Name: J)� 1 81k-cm-K.- (3C
Address: O$1 AM) 40 a-1
City: M IPa t M State: c Z°
Qualifier Name: J-p1 11 �r� n
State Certification orRegistration #: C�6+6'1 `79
Contact Phone #: "305-758°M Email Address:
DESIGNER: Architect/Engineer: Phone #:
Phone #:.J74g°Z
Zip: 33/
Phone#:
Certificate of Competency #:
Value of Work for this Permit: $ .0 0 Square/Linear Footage of Work:
Type of Work: ❑Address UAlteration
Description of Work:
UNew QRei air/Repiace
ODemolition
******** * * * * * * * * * * * *44 * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ 5.0.0 0 Permit Fee $ l C eft / (' ® CCF $ CO /CC $
Scanning Fee $ 17A10 Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
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 gent
The foregoing instrument was a
day of 'qt.' , 2041.2 , by
who
NOTA
onall 1 wn to me or who has produced
As identification and who did take an oath.
LIC: • `
Sign:
Print:
My Commission Expires:
Contractor
The foregoing instrument was acknowledged before me this
ay of J , 20 d y J0 W\ 4
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
* * * * * * * * * * * * * *,e * * **
APPROVED BY
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Sluw
s
l�l Z mState of Flo
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• 1 mExire S •
;9 } Co EE 12 B
Bonded 'Donets National aAssn.
Print:
My Commission
_ 12 zeP /Z
/e. Plans Examiner Zoning
MARY PAT BRIGGS
wi MY COMMISSION # DD 979267
;IP EXPIRES: May 11, 2014
' Bonded Tin Notary Pubfie Underwriters
a _
* * * * * * * * * * * * * * * * * * * * * * * * * * * **
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Clerk