EL-13-2782 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
inspection Number: INSP-204371 Permit Number: EL-12-13-2782
Inspection Date: December 17,2013 Permit Type: Electrical- Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: , Work Classification: Temp for Test
Job Address: 10650 NE 10 Court
Miami Shores, FL 33138- Phone Number
Project: <NONE>I Parcel Number 1122320280930
Contractor: CASSIA ELECTRICAL CONTRACTORS INC Phone: (954)650-5840
Building Department Comments
TEMP FOR TEST 30 DAY Infractlo Passed Comments
INSPECTOR COMMENTS False
Inspector Comments-
Passed ET
Failed El
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
For Inspections please call: (305)762-4949
December 17,2013 Page 1 of 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972 2 13 J1,
INSPECTION'S PHONE NUMBER:(305)762.4949 ,
FBC 20
BUILDING Permit No. V' LA 6
PERMIT APPLICATION Master Permit No. �VG 3 r (COS
Permit Type: Electrical
JOB ADDRESS: rib M�n C t
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): 21AIA dV hone#:
Address: �Z �,A5,�° 5
City: �t 1�1 �� State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:CompanyNanie: C. ` Phone#: —9's
Address: SZA/ Ala j V
City: Stater Zip: 15.33
Qualifier Name: tt/A,/A,e Phone#:
State Certification or Registration#: q!F—A1:%n 1 7,n 13 Certificate of Competency#: 09 6d)
Contact Phone#: 1JALk Email Address: A9
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: DAddress 2 ❑Alteration ONew ORepair/Replace QDemolition
Description of Work: 3 b DM W
Submittal Fee$ Permit Fee$ lddr 010" 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 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.
• n
"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 COMMYNCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value erx&dink$2500, Yht applicant must
promise in good!aith that a copy of the notice of commencement and,construction lien law brochure!wN.,be dehv�rO tq 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 orA t Coaacfar
The foregoing instrument,w�as acknow ged before me this The foregoing instrument was aclmQwledged.l e%fe"me-this
day of ,20 ,by 1�&dA 7XI ^J , `day-of' L 0/ �"
wha-Up� M l)-Gbm6 Mme or who has produced swho'is pdrso ym"tome or who has produced t
ft idea£ h+lay d-whe d AhV . i-� 4&tifleation wW* !&-did take an oath.
NOTARY PUBLIC: u i n NOTARY PUBLIC:
Gd,.
Sign: Sign:
Print: -': °' a'' :f o= Print:
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My Commission Expires:, My Commission Expires: _ N
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APPROVED BY / &e-Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012XRevised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Building
MIAMI-DADE 11805 SW 26th Street
Miami,Florida 33175-2474
786-315-2100
miamidade.gov
AFFIDAVIT FOR 30 DAY TEMPORARY ELECTRIC SERVICE
ELECTRICAL CATEGORY 26
ELECTRIC SERVICE WILL BE DISCONNECTED"WITHOUT NOTICE" UPON 30 DAY TERMINATION
UNLESS APPLICATION IS RENEWED OR CERTIFICATE OF OCCUPANCY OBTAINED.
It is understood that the temporary electrical approval by the Miam i-Dade Bui[din Depa�tmentis given inconnection
with the building bei cons r cte under the Building Permit # and Electrical
Permit# at address - .1/�j
for owner: A an is b ing iven my far ion u i n rposes r for
testing the following equi men in said strut re:
The owner does hereby agree to assume the responsibility of mai taining the installatio in such ma ner tfiat there
is no hazard to life or property. Such approval is in no event to be considered a RELEASE of said structure for the
purposes of use and occupancy, and no occupancy shall be granted or permitted until final inspections have been
called for and approved by the inspection divisions concerned, and/or a Certificate of Occupancy or Completion
is obtained.
The undersigned also understands that the temporary electric approval is subject to rescission and cancellation
and electric power can be cut off at the discretion of the Building Official and will be disconnected if the building
concerned is occupied before final inspections are approved and/or a Certificate of Occupancy or Completion
is obtained.
; being first duly sworn, depose and say that I am the owner of the above
described roperty, and that I agree that the structure covered in this agreement shall not be occupied until the
building contractor has obtained approval of final inspections and/or obtained a Certificate of Oc gh 'Pri,,�
Completion. Note:Failure tqeomply with the provisions of this affidavit will result i your being Aunee to �Wb' Z"',
future Temporary for Test permits.
Signature of Owner Signature of Notary
My Commission Expires: - �' ° �'•
I, v7��,c��31�� (�i k being duly sworn, depose and say that I am the Electrica �i ttl`a or•frir
the above-described property and that the electrical installations as now existing will not create a sarN PAI 8 if�����`�
temp service is connected. )Z
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Signature of Electrical Contractor Signature of Not n MY C : ,::AISStON#EE1144J116
My Commission Exp' "
being first duly sworn, depose and say that quill 'r -5
of the abo described property and that I will not permit occupancy of this buildin
been called for by the contractors and sub-contractors concerned and final approval by the inspection division
obtained and that I have authority insofar as the owner of said property is concerned to prohibit cupanVgnlltM�iT'��i���,,
such find inspections re obtained and/or a Certificate of Occupancy or Com a ion is iss \���X Ar/e�'�.,��
9 aoaP*:`P-=
Signature of uilding Contractor Signature of Notary o
b My Commission Expires: -""
Date:
Signature of Electrical Inspector 11"-'YIDW
Date released to FPL:
123_01-124 6/06
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July 20,2015
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