EL-06-2810Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 176290 Permit Number: EL -11 -06 -2810
Scheduled Inspection Date: August 27, 2012
Inspector: Devaney, Michael
Owner: WATSON, LEONARD
Job Address: 165 NW 99 Street
Miami Shores, FL 33150-
Project: <NONE>
Contractor: F JIMENEZ ELECTRICAL CONTRACTOR, INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Pool - Private
Phone Number
Parcel Number 1131010230390
Phone: 305/556 -5759
Building Department Comments
FOR POOL
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 32698. Service has to be
relocated.
2/12
August 24, 2012
For Inspections please call: (305)762 -4949
Page 11 of 20
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING IE ' W ;_ Permit No. ELF (06� o � Q
PERMIT APPLICATION NO \' it' aster Permit No.
FBC 2004
City lUtbi
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) C V1I0-1 00 Phone # (1 ::=A; 2-6 — 4
Ovvner's Address I t../' 5 AAA) 11 4i-
61, A ti State \
Tenant/Lessee Name
Zip CO
Phone #
Job Address (where the work is being done)
City Miami Shores Village
County Miami -Dade
FOLIO / PARCEL # - 3) U I - c '3 - 03q0
Zip J�� SO
Is Building Historically Designated YES NO
J 1 0 ^ en e c - 1/4 - r ; L.
Contractor's Company Name c / o< / Phone # /305, S 5't - (e.:2 C.)
Contractor's Address /21.101 tt), Luc/abet.
City 6 l cf h-r r State Zip 53()/8
vre - - Phone , Qualifer Name
z:15 -2LEtC)
State Certificate or Registration No.
�C )3c 2 J-2°I
Certificate of Competency No.
Architect/Engineer's Name (if applicable) 1// Phone # C 30S i S J Z ° c5(9
Value of Work For this Permit $ 15CO •
Type of Work: ['Addition
Describe Work:
❑Alteration
(T
Square / Linear Footage Of Work:.
❑ Repair/Replace
❑ Demolition
********* * * * * * * * ** * * *** * * * * * * ** * * *:r * *** Fees;************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ 4'' CCF $ CO /CC
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $
Total Fee Now Due $-
.Z27,
See Reverse sideC
r} n PAID
CK- t4t
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 ekM/Z2/6 ,�`� �x�V%U Signature /f. ,,z
' Owner or Agent /�, L - G
The foregoing instrument was acknowledged before me this t-C�C The foregoing instrument was acknowledged before me this
day of ,..56 , 20 by &a,0 &6 / day of ?r0 , 20 46, by ' <,'l(Y<J j7)/4/44,1:12.,
who is personally known to me or who has produced b,, 61 iy t,/ who is personally known to me or who has produced 'ji)`ykl(fitf
knit, t - As identification and who did take an oath. A.2_ „.\___as id ratification and who did take an oath. /
NOTARY'PUl( I. IC:
L;
1L401 wuKru'«^ ✓F
Contractor
NOTARY PUBLIC:
Sign:
Print:,
rte, MARIA VERONICA BUTCHER
s MY COMMISSION # DIJBBI69
Co* EXPIRES: Oct. 3, 2010
(407) 398-0153 Florida Notary Service.oam
Sign:
Print:,
eloef, MARIA VERONICA BUTCHER
MY COMMISSION # DD601613
OF Fp EXPIRES: Oct. 3, 2010
(407) 398-0153 Florida Notary service.com
My Commission Expires: My Com 'ss \on pires:
*************,***,***************,*************** * * * * * * * * * * * * * * * * * * *** * * * * * * * * ** , * * * * * * * * * * * ** * * * * * * * *,* * ** * * **
APPLICATION APPRCWED BY
(Revised 02/08/06)
40°
3d
fans Examiner
Engineer
Zoning
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. `- 0 28/0
BUILDING
PERMIT APPLICATION
FBC 20 7
Permit Type: Electrical
Master Permit No3 re 6, 6 Z 69 0
OWNER: Name (Fee Simple Titleholder): .n.a n. -c-i 63 Li .a-L.'---' Phone #: :495-3->3 ±' / 12—
Address: /6 6. /\( tj 9 -
City: `-771,,Lrt pk. ' State: l 4 Zip: V / J C)
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 1 (0'5- N7 tki 9 9. , 1-`
City:
Folio/Parcel #:
Miami Shores
County:
Miami Dade Zip:
Is the Building Historically Designated: Yes
NO Flood Zone:
F. •L �
CONTRACTOR: Company Name: 1 ' 6 I i Cr h(i 2 , / ( . 41- .-r '�& Phone #:
Address: 12_q (3 \ Jl E�3`r el K E 62-4 Li t3 6. E" %� . � `� 1 )
City: �j4L l' 1■1A r e State: Zip: 3 el (6'
Qualifier Name: < k,$ (t Phone #: r Z a( 80
State Certification or Registration #: CT, (.% 0 (2 2 7 .7 I Certificate of Competency #:
Contact Phone #: -736 Z ° ci 5- 2 ( 3 0 Email Address: X-1. Pi cl ii 122'/L5�
DESIGNER: Architect/Engineer: Phone #:
305 Gq x '75'7
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration :New ❑Repair/Replace ❑Demolition
Description of Work: �ty\ � ^ L C ' Pct -1 c -1 L- C� �' ` ° 103
******** * * * * * * * * * * * * * * * * *** * ****** ** *** Fees************* * * ** * * * * * * * * * * * ** * * *** ** * ** * * **
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 $ 2 2 5' 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 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 z C vI i9-c.
Owner or Agent
The foregoing instrument was acknowledged before me this
day of a �ti--, 20 DT; by L LO O VV L
who is personally known to me or who has produced {---1
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: \ . Q ��_ �.s_
.s
Print: - -.:I. + • t40 '� p
My Commission Expires:
Signature,
Contractor
The foregoing instrument was acknowledged before me this 11
day of -a Nt> p `( ,20/2, , by FgA1/40F'4 -( Ctt /}'I e'i✓e"c"
who is personally known to me or who has produced - 1
as identification and who did take an oath.
NOTARY PUBLIC:
APPROVED BY Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Sign:
Print:
vyAAA AA1i!!llil' 1,,
1 to
—JOWL , .
My Commission Expires= a)
Zoning
Clerk