EL-12-1880Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 180030
Permit Number: EL -10 -12 -1880
Scheduled Inspection Date: October 16, 2012
Inspector: Devaney, Michael
Owner: BERGERT, NICOLE
Job Address: 11300 NE 2 Avenue Adrian Hall
Miami Shores, FL 33138 -0000
Project: BARRY UNIVERSITY
Contractor: MOODY ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition
Phone Number 305 758 -2000
Parcel Number 1121360010160 -07
Phone: (305)758 -2000
Building Department Comments
ONE RECEPTACLE
Infractio
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 Comments
4')
October 15, 2012
For Inspections please call: (305)762 -4949
Page 39 of 40
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
OCT 10 2012
Permit No. E-1---1 2- -1
Master Permit No.
Permit Type: Electrical ti!') I , OWNER: Name ](Fee Simple Titleholder): Q rr / V Z $ / Phone #:
Address: Il300 / p � rip
City: IMl.I b12ES state: J(..., Zip: 33/32
Tenant/Lessee Name: A) //4 Phone#:
Email:
JOB ADDRESS: /ME Ili'►' ` 200--
City:
Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO 'o Flood Zone:
CONTRACTOR: Co mpany Name: / / 9 61--EcT /C /)JC Phone #:
Address: Qb 9
lo sr
City: i lL /11t t 1� fy State: C
n�
Qualifier Name: [J bo-J JP�OO - Phone #:
State Certification or Registration #: Colo '44 //q Certificate of Competency #:
365 -ACS
Zip: 3 3 /.6
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 74235- Square/Linear Footage of Work:
Type of Work: Address ❑Alteration New ❑Repair/Replace
Description of Work:
UDemolition
b./0F.11 ECep-tAcz_,E,
***.***** **** x*****. ** * **** * * **** * *** ** Fees*** **** * **x:+x** ** ******** ******+r ***x:**** ****
Submittal Fee $ Permit Fee $ /co c ea CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 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 . d a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this Y
day of ticfi , 20 /Z, by 13/2.1ec( G16.0•' s
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
e1��4
Si
g n: Sign:
Print: L Print:
My Commission Expi My Commiss
+1�' Do Notary Public State of Florida
;4 "; Cheryl Saida Gerber
' My Commies on DD966126
****�ka�u��k�k�k�k�kx��k� *** >, , *OrittFFF ___° +k�: **Pla � agat***+k *****
Signature
The foregoin ms ment was acknowl g d bet/ r pe thi
day of , 20 aby
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
MARY PAT BRIGGS
_*�'_"
APPROVED BY
MY COMMISSION # DD 979267
�ki k�k�l: �ke k�k�k�k�knN�k�k�l :�k�k+knkk�kok.., 'uvr
EXPIRES: May11, 2014
', Bonaed Thru N, . Pub9c U
52 A® 6C7' Plans Examiner
Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)