DEMO-11-1733Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
— I (oti
Inspection Number: INSP- 170278 Permit Number: DEMO -9 -11 -1733
Scheduled Inspection Date: February 29, 2012
Inspector: Bruhn, Norman
Owner: GOLDBERG, JONATHAN
Job Address: 9901 NE 13 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: DOMINION BUILDERS LLC
Permit Type: Demolition
Inspection Type: Final
Work Classification: Building
Phone Number
Parcel Number 1132050090480
Phone: (305)661 -2700
Building Department Comments
SELECTIVE DEMOLITION
Passe
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 - 164708.
LPL
February 28, 2012
For Inspections please call: (305)762 -4949
Page 24 of 40
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 No.
SEP 2 3 2011
....................
Master Permit No. fC •It 1(,39'
Permit Type: BUILDING ROOFING
OWNER: Name (Fee Simple Titleholder): A1>A7ri . e Phone #: ,� �' SO �• o '
Address: 1,1)1 Ng. /3 4
City: J 1 i, I .Cholbg
Tenant/Lessee Name:
I/fr
State: PC-
Zip:37f3Fr'
Phone#:
Email:
JOB ADDRESS: '190) !i 1444E.,
City:
Miami Shores County:
Folio/Parcel #: /1. 3?}mC • v '9 • Of �®
Miami Dade Zip: s x / 3 y
Is the Building Historically Designated: Yes NO ✓ Flood Zone:
CONTRACTOR: Company Name: , asolc' t) S)
Address: 4t9 V . � 3
City: e�ez, 01, saw State: 61C1-- _ Zip: X .7(t f L
Qualifier Name: a B eirAPAW0 �./ Phone#:
State Certification or Registration #: C- \it C 11 Certificate of Competency #:
Phone#:
Contact Phone#: Z, ,95- Email Address: 04.00 +i, - I,9Av t +.� c 1,441 mvcd g¢ai t"
DESIGNER: Architect/Engin er, , Phone #: 3®5.645 ° ICI "'-
�
Value of Work for this Permit: $ . p C>4:>® Square/Linear Footage of Work:
Type of Work: OAddition. OAlteration UNew ORepair/Replace emolition
Description of Work: 1-:1' vat....fl®ste
ia►
—1>14714 q1,6 t-s 1— *4 Rte- 4J1 cN1.4.4 er Rte. -19 • /6 f
*. x*a. ****** ***** ********* ******.x****:x*** Fees***** a. **x:* ******* ****** **+x*+r*a:a: ******** ** ***
Submittal Fee $ Permit Fee $
/CVO C'`1 CCF$ CO /CC$
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ In
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
1�.
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 A TTORNEY 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 whic..ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be % .13 oved ' nd a reinspection fee will be charged.
Signature ;' eA 44
Signature
0 ' er or Agent / Contractor . •
The fore oing instrument was acknowledged before me this T The fore oing instrument was acknowledged before me this 9/
day of • ,20/f ,, by d74d 1.x'1 4��'a/, , day of 20 J, by
who is personally known to me or who has produced who is personally known to me or who has produced
As ide`, `ci .I i I ` .'l , ■ f' I 1 I1' r q� as iden ifisp
'I;' KARI A CROPPER :Pt
+g • "c MY COMMISSION # EE032278 NOTARY PUBLICS`:
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(407) 3 -0183 "'"olBry orvice.aom (407) 398 -0153 Fioridallotar Sorvice.com
Sigp. f p Sign' .I� f ,
Prin .
NOTARY PUBLIC:
and wbeiti `F3tkaE R
• "c MY COMMISSION # EE032278
My Commission Expires:
My Commission Expires:
7/
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APPROVED BY
r�J' -W Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. I ) _ {v 3
Job Name G yv
Date/2-1/221_____
STRUCTURAL CRITIQUE SHEET
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