EL-12-1210Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 177651 Permit Number: EL -7 -12 -1210
Scheduled Inspection Date: August 22, 2012
Inspector: Devaney, Michael
Owner: HOLT, JAMES
Job Address: 112 NE 93 Street
Miami Shores, FL
Project: <NONE>
Contractor: MOODY ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (828)944 -2112
Parcel Number 1132060133140
Phone: (305)758 -2000
Building Department Comments
INSTALL 3 FLOOD FIXTURES IN POOL AREA
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector C
August 22, 2012
For Inspections please call: (305)762 -4949
Page 37 of 38
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
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Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder):
Address: /1 29- Ng q
City: 6 W 1 440c�
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hII
J�am�s golf
JUL 0 2 2012.
Permit No. 1 2- ~- G- t
Master Permit No.
Phone #:
State: FL,-
Zip: 9313
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS:
1(ilugQ3�-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
NO Flood Zone:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name: //k lSt_, c ie/ CA) Phone #: Z.df
Address: / t7 NW '90 61
City: all % Y � State: .R._ Qualifier Name: a f4
State Certification or Registration #: '6. 6040 / / ?
Contact Phone #:
Zip: ✓31-6
Phone#:
Certificate of Competency #:
Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $
Type of Work: ❑Address
Description of Work:
661 6°.00
❑Alteration
Square/Linear F_ooge of Work:
New LYRe air/Re lace
P P
❑Demolition
******** ***** **** ***** ********** ** *** ** Fees************* ******** ******* * ** *** *** ** * ****
Submittal Fee $�� Permit Fee $ h m4, 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 C Zip
Mortgage Lender's Name (if applicable) (�
Mortgage Lender's Address ' VI
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, BOlTFRS, 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
day of JLU\ ,20 (Z,byiC lie 1'f
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
My Commission Ex
Contractor
The foregoing instrument was acknowledged before me this 28
day of J t( () fE , 20 as -by 406) �I f f Lj ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissi
•
MARY PAT BRIGGS
MY COMMISSION # DD 979267
EXPIRES: May 11, 2014
Bonded Thru Notay Po* Underwriters
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) ' YPlans Examiner Zoning
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Clerk