FL-13-80Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
� — 1 INSPECTION'S PHONE NUMBER: (305) 762.4949
Tel: (305) 795.2204 Fax: (305) 756.8972
B Itij. ILD 14 Permit No:° EL' `3
ING
PERMIT APPLICATION
FBC 201c-
Permit Type: Electrical
Master Permit No.
OWNER: Name (Fee Simple Titleholder): &44S 1( 0 6 9 Phone #: 50 Vc6° WO
Address: IP Aib f Oe
�l
City: /r t `Pf I Y' s440 s- State: Zip: 83/3E'
Tenant/Lessee Name: N A •
Phone #:
Email:
JOB ADDRESS: 5
City:
Folio/Parcel #:
Miami Shores
County:
Miami Dade Zip:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: / O061 Le'Tj2IG //JCi Phone #: °r .7CF*- 0
Address: q maJ goocr
City: 1 Arn II State: Fl-' Zip: 33 /S0
Qualifier Name: J® MOO Phone #:
State Certification or Registration #: C.t0 0 /, '7 Certificate of Competency e--- �
�'7 -! pe ten cy #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 625-.00 Square/Linear Footage of Work:
Type of Work: ❑Address OAlteration ONew epair/Replace ODem lition
Description of Work: `1c �Cl/ "--, drt.e
/l 7-6."4-12-e4 e0e) i /2e44.1e-tle. /441.7A � .
**** *** ***** **** ******* **************** Fees ****** * ********** ** * ** : ****** ******** ** * * ***
Submittal Fee $ Permit Fee $ /f ' r �® CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 1 a��
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 CONDmONERS, ETC
OWNER'S AFFLJ)AVIT: 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
Sam
Owner or Agent
The fo r-. ing instrument was acknowledged before me this The forego instrument was acknowledged before me this
day of -`'� , 2013 , by C& LSa r a. , day of ``� ' , 203 , by J ,! 2 h 11, ®O ,
who is p r sonally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC;
Sign: 190 ,' Sign: 12')t44
Print: - Print:
My Commission Expires: 1 My Commiss
NOTARY PUBLIC:
`� ; MYCOOMMMSSIAON #D�D979267
%3 „•t�„ Banded Notary Public�lemlerwriters
MARY PAT BRIGGS
:,r_S' MY COMMISSION # DD 979267
j EXPIRES: May 11, 2014
Bonded Thru Notary Public Underm.+;err. j
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * ** * * * * * * **
APPROVED BY
z v' '9
/ G/ .%✓,d!te Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) r
Zoning
Clerk
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 186905 Permit Number: EL- 1 -13 -80
Scheduled Inspection Date: March 07, 2013
Inspector: Devaney, Michael
Owner: MCCARTHY, RITA
Job Address: 415 NE 102 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MOODY ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060170780
Phone: (305)758 -2000
Building Department Comments
FURNISH AND INSTALL 3 MORE CIRCUIT IN KITCHEN 20
AMP . REMOVE BATH HEATER NEW POST LIGHT OUT
FRONT
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
March 07, 2013
For Inspections please call: (305)762 -4949
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