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RC-12-59Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 181868 Permit Number: RC- 1 -12 -59 Scheduled Inspection Date: November 21, 2012 Inspector: Bruhn, Norman Owner: THOMAS, MARIE Job Address: 470 NE 103 Street Miami Shores, FL 33138 -2457 Project: <NONE> Contractor: BUELL VENTURE INC Permit Type: Residential Construction Inspection Type:ns Work Classification: Alteration Phone Number Parcel Number 1132060170720 Phone: 954 - 472 -8470 Building Department Comments REPLACE OF COLUMNS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passe Failed //J/d-- Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 20, 2012 For Inspections please call: (305)762 -4949 Page 23 of 27 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 Type: BUILDING OWNER: Name (Fee Simple Titleholder): Address: City: MAW/ ROOFING Permit No. /2e- h2 J Master Permit No. Phone #: Air State: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: City: Folio/Parcel #: Miami Shores County: Miami Dade Zip: Is the Building Historically Designated: Yes r��- ?�G�lf�. 7'/4-(2_2-6!' CONTRACTOR: Company Nail: � � Phone#: NO Flood Zone: Address: City: Qualifier Name: State: L� State Certification or Registration #: C 6 C._ 0S-5 3 t3 Contact Phone #: 7 so. 6 ®cab Email Address: DESIGNER: Architect/Engineer: Pie Zip: a7,) Phone#:it 3D---S-0 Y Z t Certificate of petency #: E>1..4._ Phone #: t� © PCB 3 3-1-1-(4 Value of Work for this Permit: $ ® (' e / Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration UNew ❑Repair/Replace Description of Work: ,4-1 (a Ft-, Cam' C`_ c- ❑Demolition **+ r** ********+ a* ******+r***************** Fees** ***+ x****** ******* ************** **** * ****** Submittal Fee $ Permit Fee $0 v 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. 0, - /er ory gent Contractor The forgAoing instrument was acknowledged fore me this The foregoing instrument was acknowledged before me this day of Act 1tC U� , 20 / t- , by filar( aT(� U� of , 20 _, by who rso own me or who has produced who is personally known to me or who has produced wa As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Signa NOTARY PUBLIC: Sig /� Print: t,. "1/h-,0?' My Commission Expires: CAI:ANDRA HARRISON 4 ' R Notary a Public, State of Florida • • Gommissiom; DD773161 My comm. expires Apr. 7, 2012 APPROVED BY Plans Examiner Sign: Print: My Commission Expires: Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Permit N. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR I ARCHITECT Owner's Name (Fee Simple Title Holder): Owner's Address: City: Phone #: C ✓f)) 631,267 I 410 N Zip Code: %/ 3eS Job Address (Of where work is being done): City: Miami Shores State : 1 State: Florida Zip Code: Contractor's Company Name /Of"— L4ii i 6Phone #: 2 2-0 Address: C I b City: s al t __ State: Zip Code: 32 Qualifier's Name : Lic. Number: b Architect/ Engineer of Record Name: t Address: City: AL,s, State: Phone #:3-t-34-'1 Zip Code: Describe Work: I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal ment. Signatur 1 owne/Age.r The fore ping ins ment was aknowledged befor this . day of ,20#2,by l °lG7 w Who is personally known to me or who has produced Notary Pu Sign: Seal: as indentification. 110 DRA HARRISON Notary Public, State of Fbrfda CommIssion# DD773181 My comm. expires Apr. 7, 2012 Signet Contractor or Architect oregoing instrument was aknowledged before me this day of , 20 by who is personally known to me or who has produced as indentification.