EL-12-506Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
t3'Ff- I2-SOS
Inspection Number: INSP - 171452
Permit Number: EL -3 -12 -506
Scheduled Inspection Date: July 02, 2012
Inspector: Devaney, Michael
Owner: FREDRICKS, THOMAS
Job Address: 433 NE 91 Street
Miami Shores, FL
Project: <NONE>
Contractor: JACQUES ELECTRIC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Pool - Private
Phone Number
Parcel Number 1132060140120
Phone: (954)214 -8711
Building Department Comments
HOOK UP POOL EQUIPMENT
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comm
June 29, 2012
For Inspections please call: (305)762 -4949
Page 6 of 38
Miami Shores Village
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 Type: Electrical
Permit No.
Master Permit No.
OWNER: Name (Fee Simple Titleholder): 7»o,#iq 5 ,P ?e�S Phone#: 959 452 7i
Address: 53 p (= "/ 5/-
City: ® - /ref State:
zip: 33/38
Tenant/Lessee Name: Phone #:
Tiredly ? 9V V1100 atvl
Email:
JOB ADDRESS: If 33 -416-, W S/-
City: Miami Shores Counnty: Miami Dade
Folio/Parcel #: /— 30706°' all'. i07 y
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACT-O�R:: Company Name: 7t)h
Address. 1 t 6-0 11 tJ /
City State: Zip:
Qualifier Name: 70 h 14 , 14 £{C1 i Phone#:
State Certification or Registration #: ;a 00/0 9 72 Certificate of Competency #: 10 00017p2Jo2
Contact Phone#: ' S / — /1 E i1 Address: J"AeicdQdOL J 4) .49�, (l-).1
Zin:
DESIGNER: Architect/Engineer:
Kars
Phone #:
Value of Work for this Permit: $ ( O( , f%v Square/Linear Footage of Work:
Type of Work: Address Alteration _ ew DRepair/Replace
Description of Work: (? /() lip/ Cf)V IA/ %ton
ODemolition
************ *+ x**+ x**** Aux: ****** **** +x*****Fees*+x******* * * ** ***** *m************************
Submittal Fee $ Permit Fee $ 3 d 0 ' 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature' / .; - J/ _ Lli� Signature
Owner or Agent
The fore �.ing instrument was acknowledged befo me his /19 The foregoing instrument was acknowledged before me this 2
day of i , 20 g., by 7 /4 e0rC '$ , day of
who is -rsonallyknown to me or who has produced R.-- who i
L- if" As identification and who did take an oath. as identification and who did take an oath.
e or who has produced
NO ARY PUBLIC:
Sign: V)/
Print:
My Commissio
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EXPIRES: Avid 19, 2014
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NOTARY PUBLIC:
Sign:
Print:
My Commis
JENDOLY'V hr. ,"JLlqR
Ulf COMNaS61ON w DD96 i586
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APPROVED BY
Z f - Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)