ELC-13-2110 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-199339 Permit Number: ELC-9-13-2110
Scheduled Inspection Date: October 02, 2013 Permit Type: Electrical - Commercial
Inspector: Devaney, Michael
Inspection Type: Final
Owner: Work Classification: Addition/Alteration
Job Address:9823 NE 4 Avenue
Miami Shores, FL
Phone Number
Parcel Number 1132060170330
Project: <NONE>
Contractor: MOODY ELECTRIC INC Phone: (305)758-2000
Building Department Comments
INSTALL 2 RECEPTACLES REPLACE 2 INSTALL 100 AMP Infractio Passed Comments
RAINTIGHT DISCONNECT WITH BREAKER INSPECTOR COMMENTS False
Inspector Comments
Passed ✓�
Failed ✓ 0/
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
October 01,2013 For Inspections please call: (305)762-4949 Page 7 of 14
Miami Shores Village
Buildin g Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 sEP 1,7 2013
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949 ��
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. IC /2 -2)
Permit Type: Electrical
JOB ADDRESS: gz 3 l e°
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): one#:�" 79`°3
Address: 4&
City: State Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: el G �' Phone#:
Address: 5-r
City: M f 4 1b/ State Le Zip:
Qualifier Name: Z2h 0 1& di Phone#•
State Certification or Registration#: /I Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ 'J • Square/Linear Footage of Work:
Type of Work: DAddress DAlteration ONew XRepair/Replace ODemolition
Description of Work:
Submittal Fee$ Permit Fee$ f ®��' 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) A
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.
"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. r
Signature Signa
er or Agent Contractor
The foregoing instrument was acknowledged before me this �� The foregoing instrument was acknowledged before me this
day of ,204-�.by U J t Q 1 day of 20 a,by o
who is personally 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: NOTARY PUBLIC:
r
Sign: Sign: P&f
Print: MARY PAT BRIGGS
•��a Print:
M COII1miSSlOn Expires: op.' EXPIRES:May 11,2014 ."'Y" MARY PAT B
Y p e . Bonded Thru Notary Public Underwriters My Commissl ,*s MY COMMISSION#DD 979267
EXPIRES:May 11,2014
oQ Bonded Thru Notary Public Underwriters
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APPROVED Y '�_, / �9eef' Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012XRevised 07/10/07XRevised 06/10/2009XRevised 3/15/09)