EL-13-0110Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972 ) , k ®9
Inspection Number: I NSP-1 94807 Permit Number: EL -1 -13 -110
Scheduled Inspection Date: July 09, 2013 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Owner: BENSON, ERIC
Job Address: 361 NE 102 Street
Miami Shores, FL
Project: <NONE>
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060135090
Contractor: ATLANTIS ELECTRICAL CORP Phone: (305) 551 -4043
rsuna
comments
NEW ELECTRIC FOR ENCLOSED FRONT PORCH • __......_.._
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
July 08, 2013 For Inspections please call: (305)762 -4949 Page 26 of 31
0194115 Miami Shores Village
Building Department
90050 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
JOB ADDRESS:
FBC 200
JAN 2 2 Z013
Permit No. ffA-11 2.> —I 10
Master Permit No. r
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #: i i --?ZOG Q ®ls a OCID
Is the Building Historically Designated: Yes NO %y Flood Zone:
n
OWNER: Name (Fee Simple Titleholder): eiLw (OLy0;1 r- Ro&&).elf Phone #:
City:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:: �� CU=91 c— Phone#:
Address: ,3( Iq 1 yy
City:
Qualifier Name: j Ci S cp t +-- Phone #:
State Certification or Registration #: Cc_ 800191 q — 670 Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $�TQ(� t Square/Linear Footage of Work:
Type of Work: ❑Address DAlteration IFNew DRepair/Replace ODemolition
Description of Work: P Ow t C � &A.L C..6K: c M 112ze- — 1Cfy4-
Submittal Fee $ t-70 ° 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 $
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
(_-1-1, Owner or Agent
The foregoing instrument was acknowledged before me this
day of j 209- by
who is personally known to me or who has produced
[) tJ El L-k' As identification and who did take an oath.
NOTARY PUBLIC:
Signature Ff g,-A
Contractor
The foregoing instrument was acknowledged before me this
day of � __, 20k?— , by .tS W
who is personally known to me or who has produced'
as identification and who did take an oath.
NOTARY PUBLIC:
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
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