EL-12-508Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 171463
Scheduled Inspection Date: October 16, 2012
Inspector: Devaney, Michael
Owner: FREDRICKS, THOMAS
Permit Number: EL -3 -12 -508
Job Address: 433 NE 91 Street
Miami Shores, FL
Project: <NONE>
Contractor: JACQUES ELECTRIC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060140120
Phone: (954)214 -8711
Building Department Comments
INSTALL NEW 200 AMP SERVICE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
(l4gc7- 69/2-
October 15, 2012
For Inspections please call: (305)762 -4949
Page 2 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
Permit No. \ 12
MAR ;2
BY �ooeeeevo ®ao�e°aoe
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name ee Simple Ti eholder :
Address: °% / 5
City: !!' die State: /-
Tenant/Lesseee Name:
Email: rrre V W 7 9 0 f 4D4,CC'i
Master Permit No.
p /ath9s kelf,cKS
Phone #: 9S SaS r/ 7 0 ° 9
Zip: 3/3??
Phone #:
JOB ADDRESS: `! 5.7 4,(� 9/0
City: Miami Shores Y / County: Miami Dade Zip:
Folio/Parcel #: /i 2(96-- 0` —O/ao
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Compan ame: jacapoes Vr! �C J�'/
Address: / y $ D / rj#72€j (J%/ L7%�
J
City:
Qualifier Name:
State Certification or Registration #:
Contact Phone #: 95—
DESIGNER: Architect/Engineer:
Phone #:
9611-07N47//
State:
Soh 1/ a a6 Phone #:
/�
coiD % %? Certificate of Co ?
etency #: OOb / 7t? 'j
Email Address: gtiCeadNel
M, /fret Phone #:
Zip: T30ay
Value of Work for this Permit: $ 0?000 00 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: 7/1‘,7,4 6/. 6 73 4-Usra .
m+ x° x**** **° x° x° x° x***** ***°xx°x°*****x°x°*x° **°x*** Fees**** ****** **x° ******** *** ** **+x+x *+x*°x**°xx°*°x° * **
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 $ I 1 V '10
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
The foreg ' ing ins .'
day of ,IGJ
who is personally known to me or who has produced P-Z
Owner or Agent
ment was acknowledged beforne is as
20/Z, by j0,2t'S free i ,
�
The forego
day of
who i
ng ins
Contractor
ment was acknowle��,d //re�ed before methi �2��
, by �.�A'�� /�'Sae/,
e or who has produced
personally known t
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign(
Print:
My Commission E
MY COMMISSION 6 DD961586
1- 800' . ,e SIRES: April 19, 2014
4,NOrnxv n. Notes). Innate
NOTARY PUBLIC:
Sign: ' i. 1,
Print:
My Commis
4�
GWENDOLYN B. STEWART
iron COMMISSION # DD961586
P FIRES: April 19, 2014
1-8004-NOTARY n. Notery Di.00vm Malt Ca
Hs*** kph+k+k**sk+k*rp******* **************************************************** *******************************
APPROVED BY
�"i' - Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)