DEMO-13-2581Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 203073
Scheduled Inspection Date: November 25, 2013
Inspector: Devaney, Michael
Owner: SEPE, ELLEN
Job Address: 1066 NE 94 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: HOME OWNER
5miaing Department comments
REMOVE GENERATOR
Permit Number: DEMO -11 -13 -2581
Permit Type: Demolition
Inspection Type: Final
Work Classification: Building
Phone Number
Parcel Number 1132050120120
INSPECTOR COMMENTS False
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
November 22, 2013 For Inspections please call: (305)762 -4949 Page 20 of 33
Miami Shores Village
"� 13 Building Department
1 ` 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 APPLICATION
Permit Type:
JOB ADDRESS:
BUILDING
/ e C 6- X) �:- -/
City: Miami Shores County:
Foho/Parcel #:
Is the Building Historically Designated: Yes
OWNER: Name ee Sim 'tlehd r
j (� le T ol
Simple
Address: /
City: State:
Tenant
Email:
Permit No.
NU4 132 r3
By. oa ® ®o -- - - ----
FBC 20 IC'N
Master Permit No.1)CM o 13 —'Rs FrI
ROOFING
-�-I—re
NO Flood
0
CONTRACTOR: Company Name: ®�
Address:
City: State:
Qualifier Name: Phmfe #:
State Certification or Registration #: Certificate of Competency #: _
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $ & Square/Linear Footage of Work:
Type of Work: ❑Addition DAlteration UNeV ORepair/Replace emolition
Description of Work: IL mo c---e--
Color thru tile:
Submittal Fee
Scanning Fee $
Permit Fee $ / ® ® &,r;l CCF
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CO /CC $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $ _-d 3
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
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 r'ae", Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this
day of NN , 20 _, by WQV 1 r--t SFLRIIL- ,
who is personally known to me or who has produced FI-10
As identification and who did take an oath.
The foregoing instrument was acknowledged before me this
day of , 20 _, by ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
��"1 ° " " "'�w,
NOTARY PUBLIC•
.
Sign:
_ g016
Sign:
Print:
Q� _
Print:
My Commission Expires:
=
My Commission Expires:
.�
e-::- ice`
APPROVED BY A/ 4&1 4- Plans Examiner
Structural Review
(Revised 5 /2 /2012)(Revised 3/12/2012) )(Revised 06/10 /2009 )(Revised 3/15/09 )(Revised 7/10/2007)
Zoning
Clerk
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