EL-12-1252Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
SC-�1�� l2 X2,5 l
Inspection Number: INSP - 180174 Permit Number: EL -7 -12 -1252
Scheduled Inspection Date: October 18, 2012
Inspector: Devaney, Michael
Owner: YEHEZBEL, HAIM
Job Address: 9806 NE 2 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: KLEAN POWER ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060132241
Building Department Comments
ELECTRIC FOR SIGN
Infractlo Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector CO u
g rte, / �.
October 17, 2012
For Inspections please call: (305)762 -4949
Page 19 of 23
Miami Shores Village
Building Department
10050 NE2nd Avenue, Miami Shore., Florida 33138
Tel: (305) 795,2204 Fax: (305) 756.8972
INSPECIION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
JOB ADDRESS:
City: _ _ Simms
Foii01Parivi4:
Is the Building Historically Designated: Yes
T% Ave
County:
RECEIVE-
JUL 0 6 2 12
BY:
FBC 20 to
Permit No L-1 3--
Master Permit No. a.75)._
3313e
OWNER: Name (Fee Simple Titleholder)
Address:__21.SX f
State: TC
Tenant/Lessee Name: T k4:4 (pit Iry
Etna
Flood Zone.
A E4 Jtv
silt") Nona. 13 0 - 8 6 t.1 kree.
CONTRACTOR: Company Name: ...kars_ Syt.Golli Oft:A-AC,
Address: 66o t 5-i' &ID 5-1t Ae
City: State: _EL, Zip: 334
Qualifier Name: P■n3
30
State Certification or Registration #: ) 0
a'
Contact Phone 0: , 59
zo6e
hr 33 4 I
Phoreett- tiO
3qs 669 4154
Email Addrcs..:
DESIGNER: Architect/Engineerflo 6,2/%1142(ef Orly
Phonea: (.6 - I 53,
Certificate of Competency #:
0 ekfettn,:?064-ev ci&
r.ic-N, 44,v phone* 3 0 442-- 359
Value of Work for this Permit: S'L-1441) Square/Linear Footage of Work: 5.
Type of Work: UAddress ia Alteration
Description of Work:
ASleas °Repair/Replace
i3Demolition
It.0,1,0***** 4$40**414)**04,****424.1t**V40301.,he e Fees*** do****4 P,4.1i,-eifila040954,4***6;111**01:*********Ipt 4,44*,
_ A III Permft Fee $ / S 0 e ell) CCF $
Subirdttal Fee $ CO/CC $
er om- w
Scanning Fee $ _ Radon Fee $ DBPR $ , Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Per $ Structural Review S
TOTAL FEE NOW DUE $ 11 16.0A
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
State
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify dim no work or installation has
commenced prior to the issuance of a permit and that all work will he performed to meet the standar& of all laws regulating
construction in this jurisdiction. 1 understand that a separate permit must he secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: 1 certify that all the foregoing information is accurate and that all work will bc done in compliance with all
licable 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: M a condition to the issuance of a building permit with an estimated value esceeding $2500. the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure teal be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted ar 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 nos be approved and a reimpection fee will be charged.
Owner or Az t
The foregoing instrument was acknowledged before me ibis 10( The for
day of ka-k 20 ir)—,-by H Ct..% Ine. clay of
who is personal y known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Contractor
nstrumem was acknowledg
201?:-. by Gta-I
before me this:G.
ef*Ab Vtoir',4°
MI to me or who has produced
'heation and who did take an oath.
NOTAR C:
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AO COMMISSION # EE025680
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Sign:
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My Commission
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APPROVED BY
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Commission # 00 9454325
My Commission Expires
December 14, 2013
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Mans Examiner
Structural Review
Reviscil 3/1212012)tReviwit (111 110107XRev4nd 06110/2009)tRevi 15109-i
Clerk