EL-13-1777Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972 2
Inspection Number: INSP- 201364
Scheduled Inspection Date: October 17, 2013
Inspector: Devaney, Michael
Owner: CARROLL, JAMES
Job Address: 1269 NE 98 Street
Miami Shores, FL
Project: <NONE>
Permit Number: EL -8 -13 -1777
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132050090260
Contractor: LS CURTIS INC Phone: 305 - 892 -0115
13unaing Ueparitment c:ommen,<s
INSTALL GFI
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 16, 2013 For Inspections please call: (305)762 -4949 Page 26 of 27
Miami Shores Village
.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 APPLICATION
Permit Type: Electrical
FBC 20
Permit No. c// 3 — /77-7
Master Permit Nq& J3
JOB ADDRESS: - _ d 2b q �3E W14- -4.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #: It EaC)5 CcYQ o,2 L_.o 0
Is the Building Historically Designated: Yes NO 1C Flood Zone:
OWNER: Name (Fee Simple Titleholder): (--F-AC Pr tTc. kfC12L, Phone#: �' Ce[ 0 - -1-1 -2 L
Address: 1'20q M
City: (6 [ *M I S A4p e�ES State: 1:71- Zip:
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: a •. � �� �` } -[ I Phone #: ° 0 ,6
Address: 02 = , :41101&
City: _ P -U (1_-UUA State: Zip: � I
Qualifier Name: E: (1017(5 Phone #:166 C.P ° 4&(-Q ° tgLQOI
State Certification or Registration #: e-C Q(D a 1-1 S Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Vaime of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Address UAlteration ONew PRepair/Replace OI)emolition
J)escriptlon_of Work:
Submittal Fee
Scanning Fee $
Permit Fee $ wv ®® 019 CCF $ CO /CC $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Strmctaral Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ S -
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 ed notice, the
inspection will not be ap r _ a reinspection fee will be charged.
Owner or Agent Contractor
The fore oing ins ent was acknowledged before me this P The foregoing instrument was acknowl ed before me this
day of y day of 20 q by /
who s perso to me or who has produced p ersonally own to me or who has produced.
As- identification and who did take an oath.
NOTARY
Sign::
Print:
� Notary Pu►Iic State of Florwa
akow P-Hester --
• My Commission EE009819
My CO.-�ik4 elrkpir88 07/1912014
APPROVED
Structural Review
(Revised 3 /1=012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My
MY COMMISSION # EE219418
EXPIRES July 2S, 2018
zoning
Clerk