EL-13-1002 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 I ��
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Inspection Number: INSP-191112 Permit Number: EL-5-13-1002
Scheduled Inspection Date: June 25,2013 Permit Type: Electrical- Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: TIBBITT, DANIEL AND SERENA Work Classification: Addition/Alteration
Job Address:11 NE 110 Street
Miami Shores, FL 33161-7043 Phone Number
Parcel Number 1121360040300
Project: <NONE>
Contractor: CARIBE S ELECTRIC Phone: (786)255-6212
Building Department Comments
ELECTRICAL WORK FOR KITCHEN AND BATHROOM Infractio Passed Comments
REMODEL INSPECTOR COMMENTS False
Inspector Comments
Passed
DT
Failed %e l
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
June 25,2013 For Inspections please call: (305)762-4949 Page 7 of 30
Miami Shores Village MAY 0 8 2013
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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 No.
PERMIT APPLICATION Master Permit No. & S
FBC 20
Permit Type: Electrical _
OWNER:Name(Fee S'm le T' eholder): �� C / Phone#: � ���'�7 3l
Address:
City: /V1 (Ci/—, �74.-,r g State: 'L Zip: 3 370
Tenant/Lessee Name: Phone#:
Email: 06 0!1 4
JOB ADDRESS: A 1_ S71�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
CONTRACTOR:Company Name: Chi r�,-e 5. - C Phone#: ®� �a• >�
Address: �® �—V
City: wi e-44 State: �t� Zip: � —
Qualifier Name: giov A"( n e�
Phone#: -;'6&• �!¢Z/2-
State Certification or Registration#: 3lg/ Certificate of/C�Competency#: 67 PJOD!'eZ
Contact Phone#: V r. 9 A�•W�9 Email Address: Prsiri A2.Q��L�(�M •ice!e_7(-
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit: tPO Square/L near dotage of Work:
Type of Work: DAddress OAlteration ONe* i4Repair/Replace ODemolition'
Description of Work: rqw/ t� LiF d yOO
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$
I
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.
"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 r Contractor
The fore o' instrument was owled before this ®y The fore oin instrument was acknowled ed before me this
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of / y- e .
day ,20 by ;U/'1 !/ ! day of z0 ,by 1
who is person ly known to me or who ha�c=dac @rl who i onally�know�n me or who has produced
A.,rig&I"Patinn an who did take an th. as identification and who did take an oath.
NOTAR P BL 6,0-1,%. '=1?. NOTARY P"J.I oil "fiv, .
Sign Sign:
Print: Print: RAY ROQUE
•'~'RAY COMMISSION#DD947723
My Commission Expires: �� My Commiss on � EXPIRES December 17,2013
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APPROVED BY Le Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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