RC-13-2118. Miami Shores Village c.:i
S. Building Department SEP 1.8 zoI3
90050 N.E.2nd Avenue, Miami Shores, Florida 33138 By.
J f Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.R9� 1 _
Permit Type: UILDING ROOFING
JOB ADDRESS: _D �Lk) ' 10
City: Miami Shores County:
Folio/Parcel #: 11 _ � t — 00'12> —
Is the Building Historically Designated: Yes
OWNER: Name (Fee
Address: _ G /0 1
I11r.wi i WE i/ -016,1 JI
NO Flood Zone:
W-1
Tenant/Lessee Name: Phone #:
Email:
115-
CONTRACTOR: Company Name: u( n 0 1 ] C`e- H phone# 4ocf \"L OZ5-
Address: 1� l_ J�� 4Cr+ ,
6
City: State: Zip: 1 `--1_
Qualifier Name: 1 01-' Phone #:
State Certification or Registration #: Certificate Co petency #:
Contact Phone #: -,SOS Z tLf 00 Email Address: `� �
DESIGNER: Architect/Engineer: Phone
Value of Work for this Permit: $
1 ��
Square/Linear Footage o ork:
�ks�
Type of Work: ❑Addition
❑Alteration
❑New e�ace
❑Demolition
��• �������x��. �x. �x��ml�+ �+ x���x�����x�����x���x���x�xFees���x�x���a����x�x���m���xx��x���x��xx��w� +�x���w�m��wu����
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 $
11
Bonding 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
Owner or Agent /
The for iE ment was ac wledged before me s
day of 20 1� by vt who is ersown o me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
The fore oing instrument waJaAn o aged before rae this
day of .20 , by
who i personally known o me or who has produced
as identification and who did take an oath.
Print: d, V
My Commission Expires: er Nolary Public State of FbMa
Heisel Alvarez
My Commission EE 196011
3 oe R Expires 05d86t2016
APPROVED BY S Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Nomry Public State of Florida
E*k" 0sgW016
Clerk
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ADD SMOKEICARBON MONOXIDE DETECTORS.
ANY AND ALL CLOTH AND RUBBER
INSULATED CONDUCTORS TO BE REPLACED.
NO POINT ALONG COUNTER TO BE MORE THAN
2 FEET FROM G.Fi PROTECTED RECEPTACLE.
PUT D/W RECEPTACLE UNDER SINK.
ALL FIXED APPLIANCES ON DEDICATED CKTS.
------------- ------------------------
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Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 202005 Permit Number: RC -9 -13 -2118
Scheduled Inspection Date: October 29, 2013 Permit Type: Residential Construction
Inspector: Rodriguez, Jorge
Owner: CHRISTINA POULOS, RAYMOND SLATE
Job Address: 10 NW 110 Street
Miami Shores, FL 33168-
Project: <NONE>
Inspection Type. Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360030010
Contractor: MG EXCELLENCE SERVICE CORPORATION Phone: (786)247 -7067
comments
REMOVE OLD AND REPLACE NEW KITCHEN CABINETS I " "' ---- . _____ _ ------------
INSPECTOR COMMENTS False
Passed �&fl
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 199415. No access, no one
home
October 28, 2013 For Inspections please call: (305)7624949 Page 32 of 46