EL-12-1192Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
nspection Number: I NS P- 175253
Permit Number: EL -6 -12 -1192
Inspection Date: March 26, 2013
Inspector: Devaney, Michael
Owner: KARLSON, THOMAS
Job Address: 1000 NE 91 Terrace
Miami Shores, FL
Project: <NONE>
Contractor: MOODY ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132050010290
Phone: (305)758 -2000
Building Department Comments
GROUNDING SYSTEM. INSTALL JUNCTION BOX IN
ATTIC, CHECK OUTLETS FOR POLARITY AND MISC
REPAIRS
Passed
Inspector Comments
17/1,4t
_-I,
Failed
H/4 &- /3"
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
For Inspections please call: (305)762 -4949
March 28, 2013
Page 1 of 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
S i ki
Tel: (305) 795.2204 Fax: (305) 756.8972
J 9 _ n ��a�° \ c y� INSPECTION'S PHONE NUMBER: (305) 762.4949
BUIL ING Permit No.
PERMIT APPLICATION Master Permit No. 2- 1 19 2
FBC 20
Permit Type: Electrical
OWNER: Name (Fee l Simple Titleholder): ei as 1'/dul Phone #:
Address: IPoo kg 41 / %€,Q
City: l4 / J '''f) S HDE.ES State: FL' Zip: N3 g
Tenant/Lessee Name: /�� Phone #:
Email:
JOB ADDRESS: 5
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO � Flood Zone:
CONTRACTOR: Company Name: MOO EL 7 2JC, /1t phone #: 3/5-753
Address: 66 9 /J id q0 Si-
City: Sta e: lr� Zip: 53 /CO
Qualifier Name: _ n r®$ &J Phone #:
State Certification or Registration #: e9 1 iel9 Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration New ORepair/Replace
Description of Work:
ODemolition
/EE,/r ct -b -/z -/192
*: **** **** ** x ********* *** ****+x ****** ** *Fees********** * ** ***** *** * **** *** * *** ** x ******** ..
Submittal Fee $ Permit Fee $ &✓� ®r !r a CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 150.
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address 10 II-
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of ,20_,by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Signature
Contracto
The foregoing instrument was acknowledged bete, ,e this
day of VVIAg644 ,203,by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
APPROVED BY T2 'L Plans Examiner
Structural Review
(Revised 07/1 0/07)(Revised 06 /10 /2009)(Revised 3/15/09)
Sign: j ' j1 '%
Print:
My Commission Expires:
MARY PAT BRIGGS
4 *. pi MY COMMISSION # DD 979267
�:< le EXPIRES: May 11, 2014
Miami Shores Village
Building Department
JUN 2 7 jui2
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
( a77
INSPECTION'S PHONE NUMBER: (305) 762.4949
B ILD Permit No. L 1(9:119
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): lifte'IS %.1 PC1 Phone*: 1g6 °g Z!
Address: 1060 ).) E. 61 I Taleft6t,
City: 11{!) Qtt�y / State: f= Tenant/Lessee Name: fv A- Phone #:
Email:
Zip: 33139
JOB ADDRESS: citin
City: Miami Shores
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
Address: 6) eq j w go
County: Miami Dade Zip:
NO Flood Zone:
Ocki 64-C-GTOc /m6
Phone #: 3O$ -1 S'2ao
City: IMAM
Qualifier Name: � l i
State Certification or Registration #:
State: rt.-
G060101
Zip: /7 %g)
Phone #:
Certificate of Competency #:
Contact Phone #: / Email Address:
DESIGNER: Architect/Engineer: kJ J A Phone #:
Value of Work for this Permit: $ C ` .01" Square/Linear Footage of Work:
Type of Work: DAddress PP DAlteration UNew DRepair/Replace ODemolition
Description of Work: giI.A1D I 1364 STEM f M ar ` )pfd
ppi,[. Ci 1L b L�4S rota, pot-Alan-Li + Misc. Rellti 2s
* * * * ** ** * * *** * * **x:**** * * *** * * * * * * * *** ' Fees` `* `* ` ` *' **+x**+x*+x ****x:*** ** * * ** ax:***********
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 $ 15c 1 10
Bonding Company's Name (if applicable)
• Bondinj Company' s Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address -
City
4-.
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 1— <
The for
day o I'kY , 20 -�., b
Own "r : r Agent
ing instrument was
b - fore me
Sign:
Print:
My Commission Expire
* ,.�; •: My Comm. Expires Sep 23.2015
';, «'� 4,5 Commission # EE 128810
%,
tiTi f s Bonded Through National Notary Assn.
�4nne
Signature
Contractor
The foregoing instrument was acknowledged before me this /45—
day of .J U , 20 12-, by SOthanfitODJ ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
a.
n
MARY PAT BRIGGS
MY COMMISSION # DD 979267
EXPIRES: May 11,2014
Bonded ilvu Notary Public Underwriters
1
************************************************ ********************** * *** *****
Plans Examiner
APPROVED BY
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk