CC-12-1993Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 181419 Permit Number: CC -10 -12 -1993
Scheduled Inspection Date: November 13, 2012
Inspector: Rodriguez, Jorge
Owner: , BARRY UNIVERSITY
Job Address: 11300 NE 2 Avenue Renne M. Hall
Miami Shores, FL 33138 -0000
Project: BARRY UNIVERSITY
Contractor: DOMINION BUILDERS LLC
Permit Type: Commercial Construction
Inspection Type: Final Building
Work Classification: Alteration
Phone Number
Parcel Number 1121360010160 -18
Phone: (305)661 -2700
Building Department Comments
COLUMN FASCIA REPAIR
Infractlo Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Passed
N vi rL
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
November 09, 2012
For Inspections please call: (305)762 -4949
Page 27 of 36
ioIaLI (IL- (Xl
BUILDING
PERMIT APPLICATION
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 Type: BUILDING
JOB ADDRESS: 1/300 Nd AllgIaeffe
OCT rp@METL,
MI 2 �2 ILh
i
Permit No. /lJ � - I Grn
Master Permit No.
ROOFING
Ri.JNe 4\f\ -
City: Miami Shores County: Miami Dade
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
Zip: 3 1 '3�
OWNER: Name (Fee Simple Titleholder): R f &t -K VI.-)Wu €t? S1 lY Phone #:
Address: // 3 V CS /V t A vein) Q
City: rte, l P, on, \ S 1* d,-. S State: F-71___ zip: 3 313-6
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: VO ial 11/4,10,0 ' v tl..' L.LC..
Address: a.. Ion t-® 5 (."e o
City: COQ— E;P&.€S State:
Qualifier Name: t"# 6€ Ml Co A1A &i t
State Certification or Registration #: C `4.
Contact Phone #: Email Address:
Phone #: 3os 61, i a7cO
Zip: 33145n
Phone #: 10 S tb(o 12"7' �U
Certificate of Competency #:
MGEMi 6NA I01(0 3J0MtNAO NS3U t t.0. Con^
DESIGNER: Architect/Engineer: Phone#:
Value of Woik for this Permit: $ c ! 7 S Square/Linear Footage of Work:
Type of Work: ❑Addition DAlteration New >tepair/Replace ODemolition
Description of Work: Co LV tr.►J Z= S CI A R C° Pph, 1
Color thru tile:
*** a***** ** * * * * * * * ** * * * ** *c * * * * * *l * * ** *p ************* * * * ** * * * *** * * * * *** *** **** * * * * **
Submittal Fee $ Permit Fee $ /� CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 1
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 CONDmONERS, 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 approve `yr.' a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of 20 by bL1 1RdQ_I
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
• ri rm.- 4.: ,...-,AA.s.6tsAvt A
My Commission Ex
APPROVED BY
Contractor
The foregoing instrument was acknowledged before me this ®d
day of Qh l di c?.r' , 20 i, by k'. m
who is rsonally known `to me r who has produced i-/ /a
as identification and who did take an oath.
NOTARY PUBLIC:
d(46Z Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised d7 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Sign:
Print:
My Commiss1 a • ireNy COMMISSION # EE 08459
�•.::�m�;;:,w EXPIRES: March 13, 2015
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Zoning
Clerk
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BLDG DEPT
SUBJECT TO COMPLIANCE WITH ALL FEDERAL
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