ELC-12-1496Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
1r)--V-JnY
Inspection Number: INSP- 177059 Permit Number: ELC -8 -12 -1496
Scheduled Inspection Date: September 19, 2012
Inspector: Devaney, Michael
Owner: CHURCH, ST ROSE OF LIMA CATHOLIC
Job Address: 415 NE 105 Street
Miami Shores, FL
Project: <NONE>
Contractor: EDD HELMS ELECTRIC & A/C INC
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)758 -0539
Parcel Number 1122310430010
Phone: 305 - 653 -2520
Building Department Comments
DISCONNECT AND RECONNECT FOUR RTU'S
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Com
57- 7�
//9-_---6nt'(3rzz"/r--z-,
September 18, 2012
For Inspections please call: (305)762-4949
Page 9 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
Permit No. fLC (2- I `IC,P
Master Permit No. Ml L — 1 1/411,r
BUILDING
PERMIT APPLICATION
FBC20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder):
Address: 415 N E 9®S St.
14
6
Phone #: 3os--15 6
City: `v iry i 1tW State: "► L
Tenant/Lessee Name:
Email: acasfieg SrlSc pool . corn
JOB ADDRESS: L1-15 NE 105 street
Zip: I
Phone #:
City:. Miami Shores
Folio/Parcel #: 11 2.. 2 °" O
County:
6
Miami Dade
zip: '381.38
Is the Building Historically Designated: Yes
NO
x
Flood Zone:
CONTRACTOR: Company Name: VCIC1 f4 .I rins, E f 'cii'► c.. Phone #: 30 (63 5-3-0
Address: ulso t tits.
City: M Ical m I
State: Zip: 331 Co 2.. c
Qualifier Name: J v 3 dph k 1' c 1i ki Phone #: 3o5 53 ^ 0 2520
State Certification or Registration #: CC. 13 ®® 1$.3e Certificate of Competency #:
Contact Phone #: g0532.9 X. a-1 , Email Address: ,kel (it C edd latb.ii 5. Co,
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 3 39 s 30. Square/Linear Footage of Work:
Type of Work: DAddress liAlteration UNew ❑Repair/Replace UDemolition
Description of Work: D 1 s c o fi n e t1" and re con n ec A- -four ('i) i i'sii �s
* * * * * * ** . * * * * * * * * * * * *** * *** *** * * *** ** ** Fees************* * * ** *** ******* * * *** * * *** *** ** **
Submittal Fee $■idet# Permit Fee $ 30 /11 / f'e"
Scanning Fee Radon Fee $
Notary-$ Training/Education Fee $
Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE
AIMS
*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
RI
Contract9r
The fore g instrument was acknowledg,d i efore me thi The foregoin ; instrument was acknowledged before me thisgle
day o � , 20 f , b. k, i/ l /iJt U 47( , . day of % A l'� - 20 /1-by C �j
[
who is personally known to me or who has produced , who is per on• .own ..e or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: i /L / 1• i
wo s i aminfai 4.,.
My C....u'' - 3,;a, NOTARY " zLIC
4 STATE OF rLORIDA
Comm4 EE095931
Ex ire t 5/28/2015
****************:*****************:****:*** * * * ** * * *** * * * * ** * * * * * * ** * * * * * **
/51-..‘"Plans Examiner
ssion Expires:
Sign1 . �/ S
Print:
My Commiss
APPROVED B
STACTMARIECUSANQ
MY COMMISSION 0EE009310
EXPIRES August 30, 2014
Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)