EL-12-1576Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
12--1 93
Inspection Number: INSP- 177614 Permit Number: EL -8 -12 -1576
Scheduled Inspection Date: October 11, 2012
Inspector: Devaney, Michael
Owner: GROPPER, ADAM
Job Address: 9901 NE 13 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: MOODY ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132050090480
Phone: (305)758 -2000
Building Department Comments
NEW 40 AMPS CIRCUIT AND 2 120 VOLTS 20 AMPS
CIRCUITS FOR DOCK
Passed
v
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
October 10, 2012
For Inspections please call: (305)762-4949
Page 7 of 22
414-(Liq
BUILDING
PERMIT APPLICATION
FBC 2010
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
AUG G _ i'5 G2
B'
Permit No. [ 2 l(.0
Master Permit No.fiDOC4C 1 Z 1 I 110
Permit Type: Electrical
OWNER: Name (Fee, Simple Titleholder): Adair) Gr®ff &r
Address: /V e /3 /h) cut-
s
City: 1& 1AM gl o V s State: (L zip: 3g/3 k
Tenant/Lessee Name: )1/4)/a Phone #:
Email:
Phone #: 505- -Qq(iq
JOB ADDRESS: 6 Q
City:
Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO ' Flood Zone:
CONTRACTOR: Company Name: f I £L,Eef JC-. 1 �.i� Phone #: 30s--15g- WOO
Address: (O2 Mai Q w I
City: (Yl) DM'i(V l 1 - ry� State: Zip: 33/S0
Qualifier Name: ib it A �1 / /(iQ� / Phone #:
State Certification or Registration #: G ®tom 11479 Certificate of Competency #:
�(�n IY1�r P�P� �c
Contact Phone #: i� - %S8 -moo Email Address: e ' f T a c.Gp%v
Phone #:
DESIGNER: Architect/Engineer: N/A-
Value of Work for this Permit: ` cc o Square/Linear Footage of Work:
Type of Work: DAddress
Description of Work:
DAlteration
❑New DRepair/Replace
DDemolition
cen e-
*** * * * * * * * *** * * * * *** * ***************** Fees* *+ a+ x****** ************ **********************
Submittal Fee $ Permit Fee $ If a (to`j CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ b
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
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 properly 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 pproved and a reinspection fee will be charged.
•
Signature /// AN/, _ A
/
• wner or Agent
The foregoing instrument was acknowledged before me this b. The forego' g instrument was acknowledged before me this 9
day of , 20{ by �[I 1 9r? /ft' , day of
who is per nally known to me or who has produced who is personal (9 known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sigua ure
Contracto
,20Llby -- c // //I
NOTARY PUBLIC:
Sign:
Pri
y Commission Expir
** * ******** * * * ****
KARMA GROPPER
• 'MY COMMISSION # EE0322713.
.*, EXPIRES October 05, 2014
407) 398 -3153 FlofldallorarvServico.aom
********** ** * *******************************
¢ e
C! "v
Plans Examiner Zoning
Sign:
Print:
My Commission
MARY PAT IRIGGS
14 MY COMMISSI01911DD 1979267
EXPIRES: May 11, 2014
Bonded Thru Notary Public Umienvriters
APPROVED BY
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)