ELC-11-2320Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 167921 Permit Number: ELC -12 -11 -2320
Scheduled Inspection Date: June 26, 2012
Inspector: Devaney, Michael
Owner: CHURCH,
Job Address: 602 NE 96 Street
Miami Shores, FL
Project: <NONE>
Contractor: GOFF COMMUNICATIONS INC
Permit Type: Electrical - Commercial
Inspection Type: Rough
Work Classification: Addition /Alteration
Phone Number (305)754 -9541
Parcel Number 1132060141410
Phone: (941)955 -7106
Building Department Comments
REPLACE 3 ANTENNAS ON CHURCH STEEPLE
Passed
1/
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
June 25, 2012
For Inspections please call: (305)762 -4949
Page 3 of 23
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Pam (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No.
Master Permit No. CC- 1 ° ?Ne3 19
Permit Type: Electrical !�
OWNER Name (Fee Simple Titleholder): /1/orn/EAS7 ii�ESg Ru4& 6144t1Phunet
Address: 6001 NE Ql, "' S7
City: 4/./.N t /1�..0)VES State: �L Tapes: ,ga t Sk
Tenant/Lessee Name: ,4 ;r7— �o qs
Phone#: 7• 42/(• 3el0
Email: 5 N7 1.7 OAA
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JOB ADDRESS: ece)a Me- 9WO T
City: Miami Shores County: Miami Dade Zip: 33 /38-
Folio/Parcel#: /1. &9O rn • O!41. /qt/!
Is the Building Historically Designated Yes NO Flood Zone:
CONTRACTOR: Company N r 7ti d f It e4 .ismi1U- 77d•JC Phone#: "icr-7iO4
Address: SO O4/' ,49-71. Aver e= s%
City: RR4box.froomi State: I . Zip: 3 a
Qualifier Name: 5,....>r,d /Ff 4 r e" CAA,' Phone# 940'• 7 /64 .
State Certification or Registration #: Et / 34 d' '37 Certificate of Competency #:
Contact Phone#: 9Y/ :7 104 Email Address: KMTE. FJ Zi &agree 14(4ov1G/RT70"ls't'_o
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 0100 d Square/Linear Footage of Work:
Type of Work: ❑Address WAlteration ONew ORepair/Replace ODemolition
Description of Work: g Mum 4S okJ egoteki $ f
ear *m ***ea **i *axe m+raaw*** pees *****a*aeax **** xaanmo******area *aatiw *a**
Submittal Fee $ 3- (-) )Permit Fee $ ` e# ( 4'1" CCF $ COICC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ TYaining/Edi cation Fee $ Technology Fee $
Double Fee $ Structural Review $
Y
Bonding Company's Name (if applicable) I�
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Ito Pk
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, }}EATERS, 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 mast
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 as 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
inspe not be approved and a reinspection fee will be charged
Signature
Owner-or Agent
The foregoing instrument
g �'pS�.'� was acknowledged be r+eme this �
ot�L ilri "nt>- 20 � I.J�i►rl �NGtli�a/
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day 1, by , day of
(is personally know/NO me or who has produced
As identification and who did rake an oath.
NOTARY PUBL
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Ltliary Public - State of Florida
• e My Comm. Expires Mar 24, 2013
C. mission # DD 868922
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otary Assn.
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APPROVED BY
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Structural Review - -- - Clerk
(Revised 07/10/07)(Revised 06t1012009)(Revised 3f15/09)