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EL-11-2323♦ � s Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 188358 Permit Number: EL -12 -11 -2323 Scheduled Inspection Date: April 02, 2013 Inspector: Devaney, Michael Owner: WARD, RAYMOND Job Address: 423 NE 92 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ADT LLC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1132060140240 Building Department Comments BURGLAR ALARM 03/15/2013 - SAME QUALIFIER 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 /72z—ceo'z April 01, 2013 For Inspections please call: (305)762 -4949 Page 20 of 21 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 FBC 2010 Permit Type: Electrical Permit No. Master Permit No. 61-1)-- -1/' OWNER: Name (Fee Simple Titleholder): Phone #: Address: 9Z3 City: State: Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 'y.�3 /V 7 �' 1 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 4J It Phone 9,40W-5..)-7( Address: /670. 0-A5 towy y� City: 4 / a.mf #1 ` State: C Zip: '3//301!' Qualifier Name: �9� �f1-1 / Phone #: 9ri'" k57.2"7.r State Certification or Registration #: Eifr' 0 b 1/ 2 Certificate of Competency #: g ! P Y Contact Phone #: %J 5' ' .f - 7f Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address CIAlterati9.5 UNew ❑Repair/Replace ❑Demolition Description of Work: Reot,c) •-[ - ********* ******* *** *** ********m**:*** *** Fees************* * **** *** * * ** * **** *** * ** * * ** ** ** Submittal Fee $ Permit Fee $ (a3° i--3'3 CCF $ CO /CC $ Scanning Fee $ 3. J,9 Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 423 NE 92 Street Miami Shores, FL 33138- Owner Information Perm Permit NO. EL -12 -11 -2323 Permit Type: Electrical - Residential Work Classification: Alarm Permit Status: APPROVED Address Issue Date: 12116/2011 Expiration: 06/13/2012 Parcel Number 1132060140240 Block: Lot: Applicant LOWELL BREVING Phone Cell LOWELL BREVING 423 NE 92 Street MIAMI SHORES FL 33138- (786)253 -9093 Contractor(s) ADT SECURITY SERVICES, INC Phone (786)331 -3967 Cell Phone Valuation: Total Sq Feet: $ 200.00 0 Type of Work: BURGLAR ALARM Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -12 -11 -42836 12/16/2011 Check #: 0132213 $ 108.60 $ 0.00 Available Inspections: Inspection Type: 1 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. December 16, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 16, 2011 1 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 FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titlehold r). Address: 425 ► `1E Da City: U •l10Y% Tarci Permit No. Master Permit No. t-- I Phone #: State: q. Zip: 9515e) Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 4 'tQ2 City: Miami Shores County: Folio/Parcel #: \157_049014024D Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: i11t) Miami Dade Zip: NO Flood Zone: Phone #: `"P+ Z(0(to 5245 City: ra l_ACOr Qualifier Name: 1 n State Certifications Regis��•tion #r:- g coon Contact Phone #: AJ42L9(Q Email Address: DESIGNER: Architect/Engineer: star( R iko) Certificate of Competency #: , rn (Zi Q.C4 Zip: ✓� ) Phone #: "()" Phone #: Square/Linear Footage of Work: ❑New DRepair/Replace UDemolition Value of Work for this Permit: $ Type of Work: ❑Address ❑Alteration Description of Work: ��' 1 .I -- *+ xs::: x**** **s:: x* ** * * * * * ************** * * ** Fees * *+x***:u:x*+x+x** * **: x**x: *+x**+xx:*x:****** * ******** Submittal Fee $ Permit Fee $ / a/ 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 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 AkkIDAVIT: 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 $2590, 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 sir ` posted notice, the inspection will not be approved and a reinsp e will be charged. Signaturd NOW Owner o Agent The foregoing instrument was acknowledged before me this S The foregoing ' ment was acknowledged before this day of , 20 � , by � _ � , day of 1 6 t , 20 ill, by who is personally known to me or who has produced IF) who is personally known to me or w As identification and who did take an oath. NOTARY PUBLIC: `�� i i i i i /r /�� Sign: Print: My Commission Expires: * * * ** * * * * * * **** * * * * ** APPROVED BY "� • CD- • r,hon niuu,uo�'. 2 !/ ns Examiner as identification and who did take an oath. Structural Review (Revised 07 /10 /07)(Revised 06110 /2009)(Revised 3/15/09) NOTARY P 7 IC: Sign: Print: omnussi' STATE OF FLORIDA COMMISSION: D EXPIRES: MAY 7. 2012 ning Clerk