ELC-11-1711Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 164590 Permit Number: ELC -9 -11 -1711
Scheduled Inspection Date: January 18, 2012
Inspector: Devaney, Michael
Owner: , SHORES SQUARE INVESTMENTS
Job Address: 9005 BISCAYNE Boulevard
Miami Shores, FL 33138-
Project: <NONE>
Contractor: K.S. GEISLER INC
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number 1132060110060
Phone: (954)966 -1646
Building Department Comments
TEMPORARY SERVICE
Passed
•
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
7g2
January 17, 2012
For Inspections please call: (305)762 -4949
Page 12 of 49
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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
SEP a 0 7011
Permit No. J1 F Y 111
Master Permit No. C — 1 1 1 0 " 19 5b
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): S ko t G. Sct Va.r C-1 AU eS4" ANcAl$ /At- Phone#:
Address: 3850 (3rd 12,040t I 1
City: m room ; State: et-- Zip: 331440
Tenant/Lessee Name: TI) Bad- iL Phone #:
Email:
JOB ADDRESS: 9 00 5 1 ; 1 ' C ,
City: Miami Shores County: Miami Dade Zip: 331 3 g
Folio/Parcel #:
NO Flood Zone:
Ujvd
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name: 143 G e S led
Address: 2.1 ?/0 IV, 5 t TGrtAGC-
City: 14 O L (. y 1,00 0
Qualifier Name: $$'G Ven 6 {.i S l
State:
Phone #: 940` <<O��
Zip: 330 .
Phone #: Q kto
State Certification or Registration #: LC. 1300 too G Certificate of Competency #:
Contact Phone #: q54-616,6,--1(.14(0 Email Address:
DESIGNER: Architect/Engineer: Phone #:
64evc. c ! S Gcrs Lea.,
Value of Work for this Permit: $ ` i 01)1)
Square/Linear Footage of Work:
Type of Work: ❑Address UAlteration GgiNew ORepair/Replace ODemolition
Description of Work: +e r o r a r, set U i C. .
* * * ***:x:x***:x: * *** :x *** **x *** * * * * * ****** Fees****: x****** ************::x***x:*******x:**** * **
Submittal Fee $ Permit Fee $ / 6 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
I1LI Te
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) h ;"
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 AlFMAVIT: 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 s cam; osted notice, the
inspection will not be approved and a reinspection fee will be charged.
Sig ii" Signature
n
Contractor
The foregoing instrument was acknowledged before me this/ Y1
day of Sbir , 20 `/ , by UY )off jS�Jyl2... ,
o as produced who is personally known to me or who has produced it/P�t/
As identification and who did take an oath. as identification and who did take an oath.
NOTARY P LIC: NOTARY PUBLIC:
y Commission Expires:
* * * * * * * * * * * * * * * * **
Sign:
Print:
My Comnk
on #DD757158
ires: APR. 08, 2012
au ,4 : ,o TRW ATLANTIC BONDING CO., INC.
4f�
APPROVED BY � /!�%� 2 $�P��' Plans Examiner Zoning
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Structural Review Clerk
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