EL-13-1194 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INS P-192470 Permit Number: EL-5-13-1194
Scheduled Inspection Date: October 16, 2013 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: MARY ELLEN BENTON, DOUGLAS Work Classification: Addition/Alteration
OAOUCC
Job Address:10108 NE 1 Avenue
Miami Shores, FL Phone Number
Parcel Number 1132060131560
Project: <NONE>
Contractor: LS CURTIS INC Phone: 305-892-0115
Building Department Comments
RELOCATION OF SWITCH AND 2 CEILING FANS AND Infractio Passed comments
ADD TWO ADDITIONAL OUTLETS INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
October 15,2013 For Inspections please call: (305)762-4949 Page 9 of 48
Miami Shores Village `
Building Department MAY 3 0 201
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 r
Tel: (305)795.2204 Fax: (305)756.8972 {
INSPECTION'S PHONE NUMBER:(3057 762.4949
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. —'
Permit Type: Electrical
JOB ADDRESS: 101 Ll iQ AJ
City: Miami Shores County: Miami Dade Zip:
Foho/Parcel#:
Is the Building Historically Designated:Yes— NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): Phone#:
Address: iw a e yE i "
City: Y_ 211g� State: Zip:
Tenant/Lessee Name: Phone#:
Email: / J
CONTRACTOR:Company Name: � ,zeVV Phone#:
Address:2r,,1)?4// Ao ew ,ge-A 7
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City: Z*1_t,4n<4" State:�./�l Zip:
�../ Phone#:7 �yAree /
Quali Name: /Jf
State Certification or Registration#: /'da�3 l Certificate of Competency#:
Contact Phone#: Email Address: /� %ld C •�►C
DESIGNER:Architect/Engineer: Phone#:.
Value of-Work for this,Permft:$ d �4 Square/Linear 1♦ootage of;Work:
Type of Work: ❑Address ;;Alteration ONew �� ORe/p�air/Replace / ,�ODemolit/ion
Description of Work: wjac z �'y►-" 9 cu"'I..D A`�tit pt,,_� 4444 h 1 C_
AMA Q„ffAk
Submittal Fee$ Permit Fee$40 CCF$ 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 4)rior.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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The ftgmnstrumer3tas ac wle g be ore this The foregoing instrument was acknowled before me i�2 r day o 0 by day of I - ,20eT,by ___ho i =cation
who ha produced o i a y mown to or who has produced
and who did take an oath. as 1 tification and who did take an oath.
NOT AR P LIC: NOTARY P IC:
Sign: coe���0¢at�aa
Sign: •, CASSANDRA N N�BIA
Print: ta'v PUbt,c'„es$ep 23.10 Print: MY COMMWON ti EE218418
My Co - sion Expires: `= ;' "�y CGI m�sg;o�a tooa�Notat`J p$5° M Commis oaa
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APPROVED B / l9 V Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)