EL-12-1895Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 180946 Permit Number: EL -10 -12 -1895
Scheduled Inspection Date: October 30, 2012
Inspector: Devaney, Michael
Owner: RELICK, CLYDE
Job Address: 29 NE 104 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: CPS ELECTRIC, INC.
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1121360120070
Phone: 305 -607 -8221
Building Department Comments
200 AMP SERVICE. REPLACE ALL Receptacle
SWITCHES, CEILING FANS AND LIGHT FIXTURES AND 4
RECEPTACLE ION KITCHEN
Infractio Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
oz�
October 29, 2012
For Inspections please call: (305)762 -4949
Page 15 of 16
ok(,L i(tos
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
.n �q
OC1 i 1201
Permit No. r�
Master Permit No. I L- ° t 5s9
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): CI ‘161.e
Address: 2 of j19 f / 17 `i r6' •S`{"' ./ 9 2® Le ac .w®�•
City: / l cum t Sl % State:
Tenant/Lessee Name:
Email: cA L' X10 CAL 2 . 1 .
Phone #: 70 3— 6B Z ' `( 004,
St-. f}w t ih v. V q- ZZ. ZO 5—
zip: 3 3 i a
Phone #:'7,
ae�
JOB ADDRESS: 2 A2 e.: 10 `T 5�
City: Miami Shores County: Miami Dade
Folio/Parcel #: / / Z / 3 & 0 J 2.620',
Is the Building Historically Designated: Yes NO Flood Zone: (N®
Zip: 73135
CONTRACTOR: Company Name: as- ` Phone #: 505-43 `-CS 7
Address: /600 ,vGPJ -A Act_
City: l 1 i 4l4t ( State: Zip: 03 l/ 5—'
Qualifier Name: 432 6t L- 1 Fax, Phone #:105-' G 3 5-5-4-2C )
State Certification or Registration #: 6E700,102-0 Certificate of Competency #: C2)000 (72 3 "b
Contact Phone #: 'OS' 63 7 0 Email Address: ep5'J!LJ/iL -C..
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ YD r----_ Square/Linear Foo,ge of Work:
Type of Work: ❑Address ❑Alteration ❑New Repair/Replace ❑Demolition
Description of Work: ?ec% ®s�% .:,..k tit C®. �`"` -e— 7 r €
��� ,
S'=.t! f "ICiL�.G -� � 4 /C L.t, va(.C, �� �� ' /lA � k/ �C/
***+ x*** ** *** ************** **** ********* Fees****+ x**** ****** ******** *******:x+x*****a.******
Submittal Fee $ Permit Fee $ A��T �..e CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
(ou e ee Structural Review $
TOTAL FEE NOW DUE $ 210S► CJ
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 AFF'IDAVIT: 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 2
day of %_, 2072 f, by ;
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY P 1 MILTON ROMERO
MY COMMISSION # EE136473
'RES: December 03,,15
Co.
Sign-
Print:
My Commission Expires:
Signature'� ✓ dad
Contractor
The foregoing instrument was acknowledged before me this
day o , 2012 —; bya /2A6 2►✓l1
who is peIssonally known to me or who has produced
as identification and who did take an oath.
My Commission Expires:
*+ x******= t x***x :****+>r******* ** **** * * *** **** *s: ***************** * * *** : ** * ********** ***** ** * *** x** **** ** * *** ****
APPROVED BY
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
11,2969 q
1 'f"04e6ii
45 If Avt
331;'% M1AM1
k`11■7 t"?-r.,P AA :4,
-okr.
1,1( ffeti; tot
'AbiretteVicAt C.ONIRActtW
08/09/2012
02220016001
000045 00
RINI WM
CC 10"ftif64V7es3
WORKIR/S
10
LIoNc„Tr,,W.Aa
1. EtECIRI( INc
ANGEL R(JMEPO PRI'›
I6o0 NW 28 Avt
MIAMI El
ta4,40-47..,31441r: ,.•;f04, ,A44-rt, t 4C: Z>FirS .
TAX
_ .
41y4-,14' /484,04
31,1
30 1/29699 CC NO.
‘,
.Mt] L.,AiIQ N
C P S ELECTRIC INC
161,10 NW 08 AVE
°NNE's' ,C P S ELECTRIC Itic
vAtf?
)1W1
1 / 2969 9
1141S1 CLASS
WS POSTAGE
MAW, FE
.:›1411-r N 231
to.74.14:#44,AA,"
0.11504f5s As A PL n
• SEE BACK OF RECEIPT FOR F1ECTRICAL CONTRACTOR
A LIST OF NON-PARTUIPATING1
MUNICIPALITIES
094410/2012
02240028001
000:°00.00
) Noy r(MW Alm
P fi1.CIR1C INC
ANGFL ROM 1140 PRFS
1600 NW AVE
MIAMI FL 33125
P'
,yetY A.NY NI E;NII:Td1N7„:'
1W)C1 11V LUX :Faw !yflaimum:
.71.41 :377
77CNY '
CIDY11111. rlY:111I')3-1:3
!ISTT190
TtINUC:4;.!
.;=73N:F:21a. Jo
v,)iso.,, IC 4. •,
aw
.1.0110416i mletr.)
ca 4 lepor irgo,,K41r4111
13ONV OBijO 4
(.7
-VS
3N1 31ti.L3313 S
etZ,L10000
itr34 4114M SS3NfSrl
pAK:03 vompli,L4 '40■43e+40Buo;)
013
ACORL„ CEMIFICATE OF
psuar.411
az 21430RANCX a TINANCIAL SVC
508 Z 49 ST
aT T..R8:.33013
3 7 ' 4
C.a.s arsCSIC, tc1C.
1600 by 29 1VZ
XMANX,FL 33125
1NSU
CERT A AS A *ATTER OF Oaf O 1A
ONLY AND CXSTFERS WO moors woos „ CEP-. "F
HOW ER,. THIS CERTIFICATE 30ES Nor Ate, Ervin og
ALTER THE COv'ERAGe S FORGED BY THE POi leA S :SEL n►
2'
mums Ammo covecum #
CC0000
7233Dade; 90CME1243X Broward; ER0011020 Fl
THE POL'.CES CF MIRA N USTED BE! O RAVE A* OLEO TOME INSURED assac $Oia scfs THE POUc moo a EO
ANY REQUIRESIM TERM CONDITION OF ANY COMM= OR OTHER DOC4* O TN RESPECT TO WHICH Th s CERTIFICATE WY -` ISSUE) OR
MAY PERTAIN, TUE NSuRARCE AFFORDED SY � POLICIES DESCRIBED MEW IS SUBJECT TO ALMS TER1 CXCI.US$DNSN O COMMIS OF SUCH
POWER scGSEGATE BISOYMMAYHAVEBES4 MUM," PAID CM S&
X 500 DZD GL- 34425 -3 09/23/12
09/23/13
0 *090
0'
00
Ca- 33303 -0 09/23/12
09/23/13
10,000
MC•602230
06/02/12
06/02/13
1 f'
oE$CRPflOIta�sFpOPERATIOKSILOCSOIONSivEdi 8CE I AOMOSY OS
mm- ECTLUC L
SPECIAL
Miami Shores Village
10050 NE 2nd. Ave
Miami Shores, FL 33138
MOVE OESCRIEDPCtsms
O USURER WILL Lows T
- j TrflG1TM HOWES NIMO TOME
CO MOM OF MY AMID
SMOPensirmaam4
,,x,10 IYR WORM
sums TOOOSOMULL
MOW OS AMOS OR ,
.A 1 -AA
69- tOif d
.01 Y Ale t
---)/06,u) rigri e
LIi -4 01* i'Ofzz
.30 0 4r43.
aoth-r) j Skre-s 33 /3I
)
g
44L)
n
PO cil 5
it) 0 ÷
6 Fe-el thweL,
Shoes VEe
7{—
1-0
\A,I PH ALL FEDERAL
Vtlf2_7-1.‘259
BY
DATE
TT%
OCT 1 12012
.--1. /v 'fly volt) ea
�N 1J (On di�'
C -
riqr e
�l *rte fore V Al
44.142
aOi
a � /7 "Jere_ f• /ij
3/4.--yd kk) e a
I N i Yi. core ut
.4=141 Graor
(2) /`x,/06, (0orIci Svc
A)o+ Cio6cf f /,,
; Fee''/ /row E, % o &a t.-
L(2 —'1rci
BY
DEPT
i
r I i,`, :LE vAj{ [H ALL FEriERAL