EL-12-2399 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 =.;t3qY_
Inspection Number: INSP-193848 Permit Number: EL-12-12-2399
Scheduled Inspection Date: June 20,2013 Permit Type: Electrical- Residential
Inspector: Devaney,Michael
Inspection Type: Final
Owner: FLOYD GONZALES, ROBER IRWIN Work Classification: Alteration
Job Address:68 NE 91 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1131010200020
Project: <NONE>
Contractor: EMPIRE ELECTRIC MAINTENANCE&SERVICE INC Phone: 305-264-9982
Building Department Comments
Kitchen electrical. Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comme
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
June 20,2013 For Inspections please call: (305)762-4949
Page 22 of 40
Miami Shores Village
Building Department DEC 19 2012
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 e,5L
Tel:(305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20 t
BUILDING Permit No. i�1,-- tZ- 239 9
PERMIT APPLICATION Master Permit No. RC- I z - Z Y)
Permit Type: Electrical r
JOB ADDRESS: G5 N F `p 4 .5+'
City: Miami Shores County Miami Dade zip: 33 3
Folio/Parcel#: H -25101 — 0 Z-O -0 V 2-`Q
Is the Building Historically Designated:Yes NO Y Flood Zone:
OWNER:Name(Fee Simple Titleholder): LLD Q ���� LB;a Phone#.305 Z Z;— i ( 3
Address: Fa f')y
City: State: lr�- Zip: 33 3
Tenantlessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#: 5&j
Address:
5L4 J
City: / /! State: Zip:
Qualifier Name: /U �_ !/ 2- Phone#: 310.5.2 -9 2,
State Certification or Registration#: ,�� � Certificate of Competency#: \f 4--
Contact Phone#: -.2 9 Email Address: C
DESIGNER:Architect/Engineer. C*N 5M to
L
Value of Work for this Permit:$41 4OV'r Square/Linear Footage of Work:
Type of Work: ❑Address Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work:Kr q-) 15F C�L
Submittal Fee$ Permit Fee$ ���° �� CCF$ CO/CC$
Scanning Fee$ V� 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.
"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 tot son
whose property is subject to attachment. Also, a certified copy of the recorded notice o commencement must be posted at a job in
for the first inspection which occurs seven (7) days after the building permit is ed. the absent such poste ice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
'6kOwner o�Ag t Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged be f me this
�V
day of f-C ,20 afby I--t-0 17 day of Dt nl 20 ,by ek
who is personally known tome or who has produced who is personally known to me or who has p ced
As identification and who VAkd4n ath. as identification and who did take an oath.
NOTARY PUBLIC: N% '� .......... :IA;, � NOTARY P IC:
-a • '6S061L33''•.�
uoissiwmo�•� —
Sign: = s��� d latil��e _ Sign ELPf)MAD 111
'
Print: t9��Ea print; Notary Pub c State of Florida
MY comm.EXPI
My Commission Expires: �'��i °��1/!S•S%Va����� My CO -
ttfr NI io 0D 85734
Bonded Through Nation Notary Assn.
t 111
1
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07XRevised 06/10/2009)(Revised 3/15/09)