EL-13-139Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 184696 Permit Number: EL -1 -13 -139
Scheduled Inspection Date: March 28, 2013
Inspector: Devaney, Michael
Owner: VALENCIA, MARIA
Job Address: 164 NE 105 Street
Miami Shores, FL 33138 -2033
Project: <NONE>
Contractor: RFABRAMS INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360130660
Phone: (305)803 -5441
Building Department Comments
REPLACE PANEL SERVICE METER, DISCONNECT ADD
ONE LIGHT FISTURE AND 5 CARBONE MONOXIDE
DETECTORS
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
D
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
g /VA 2.6?(Y
March 28, 2013
For Inspections please call: (305)762 -4949
Page 2 of 12
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
Permit Type: Electrical
,7 E LOS S - L
JOB ADDRESS:
JAN 2 4' �1I
BY.
FBC 20
Permit No. L L3M39
Master Permit No.
City: Miami Shores
County:
Miami Dade
Zip: 33(38'
Folio/Parcel #:
Is the Building Historically Designated: Yes NO V Flood Zone:
OWNER: Name (Fee Simple Titleholder): `� 4.Ek% �o �� Phone#: 15-4 89 T (#2'
Address: / b y N. / OS- "It S r°`
City: 44 th` SI'W&G. S
Tenant/Lessee Name:
Email- FO aP • 4 Lin% € BT nt C`a 3 7T • C 04/\
State:
CONTRACTOR: Corn y Name:
Address: 3 12 - C3 I' d e EA-
City. ^y -i S
Qualifier Name: CIO"' Cke G ;,43
Phone #:
zip: 2 313 V
Phone #:
State Certification or Re stration #: l.� C t 3 co (2 e 2—
Contact Phone#: 3 ® O ra 035V i r Email Address:
DESIGNER: Architect /Engineer:
Phone #:
oS B'Q)2s7y7
Zi:33tGC
7g-6 4/23 G Y37
Certificate �p�ency #:
To & a rot/AS OL0(> ee/h
Phone #:
Value of Work for this Permit: $ $ 00 '~± t ada Square/Linear Foo
Type of Wokka DAddress l]Alteration ;. ❑New
Desc on of Work: i C I'�t'� S i V e Gp
of Work:
e r/Reep a Demolition
p`1' C e.a v �
e. I Co2TS
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * ** * * ** **** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
2�s ��� 7/rs/
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 $
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
a�r
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 Fr FCTRICAL 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 auachrnent. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs even (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a'proved and reinspection fee will be charged.
—
AO
Signature i
The foregoing instrument w. acknowledged before me this
day of -Dan- , 20 12•, by C3 1 t (1 ,
who is personally known to me or who has produced f L -
DL.
As identification and who did take an oath.
NOTARY PUBLIC:
My C
Signature
Contractor
The foregoing instrument was acknowledged before me this AO
day of VOL/ , 20 / 2-, by (70/(4.641 C Y /Ms
who is rsonall) known to me r who has produced
as identification and who did take an oath.
APPROVED B
NOTARY PUBLIC:
Sig
Pri
My
e
m. 8, 2014
fif
Commission EE 2 # EE 2
'5
']Through National Notary Assn.
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Plans Examinrr
Structural Review
(Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk
tAN
A 1,
tiiYELYN NRTOLA
Florida
ommissionExpires:
;;.,.
Notary Public, State of
Commissiont EE 167448
My comm. expires Feb. 7, 2016
APPROVED B
NOTARY PUBLIC:
Sig
Pri
My
e
m. 8, 2014
fif
Commission EE 2 # EE 2
'5
']Through National Notary Assn.
* *** *H *****+ Hd++ Y****+ k******** *& ******M *41K<**** *& **************W*********** **N ****
eg
Plans Examinrr
Structural Review
(Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk