EL-13-2120Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972 ' J
Inspection Number: INSP- 201798
Scheduled Inspection Date: October 23, 2013
Inspector: Devaney, Michael
Owner: CHRISTINA POULOS, RAYMOND SLATE
Job Address: 10 NW 110 Street
Miami Shores, FL 33168-
Project: <NONE>
Permit Number: EL -9 -13 -2120
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360030010
Contractor: AP POWER ELECTRIC CORP Phone: (954)822 -4496
aunding Department comments
KITCHEN REMODEL
INSPECTOR COMMENTS False
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
October 22, 2013 For Inspections please call: (305)762 -4949 Page 17 of 22
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 LSEP
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
Permit TypeC;;;1)
JOB ADDRESS: to �j w 110
City:
Folio/Parcel #:
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple
City: nL)L\ $�
Tenant/Lessee Name:
N��Oy n c ` /�� Flood Zone:
i 6 ` � 1 M) e, Phnne#--3c
State: % T77-i Zip: 5 1-5 k q e
Email:
CONTRACTOR: Company Name: Phone #:
Address: I .
City: -,�-
Qualifier Name:
State Certification or Registration #: Certificate of Competency #: ® E COO Vak
Contact Phone#: z , `-'m Email Address: + 0L Co 6
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 2>50 Square/Linear Footage — of Work:
Type of Work: ❑Address ❑Alteration ❑ C�
New Kpta�air/Replace
❑Demolition
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
i'
LT--"+�
F`onding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature )�4AP
Owner or Agent Contractor
The for ng ins rument was a9kaywledged before me s The fore ing instrument was acknowle�Ciged before me this
day of E3by t tVI ®1 day of 0 �, by � (�
who is ersonal y known to or who has produced who ers nally known o me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
op
Florida
My Commission Expires: ;� `: HeAl Alvarez My Commission Expires: sr �:� Helsel Alvarez
'$ My Commission EE 196011 MY Commission EE 188011
R Expi►es 05/2612016 p Expi ft ilSl28t2016
APPROVED BY 110 l�P Plans Examiner Zoning
Structural Review
(Revised NU/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Clerk