EL-13-1600Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972 o
Inspection Number: INSP- 205423 Permit Number: EL -7 -13 -1600
Scheduled Inspection Date: January 15, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Owner: KILPATRICK, JOHN
Job Address: 621 NE 92 Street 3 -A
Miami Shores, FL
Project: <NONE>
Inspection Type. Final
Work Classification: Alteration
Phone Number (305)910 -1581
Parcel Number 1132060430090
Contractor: KELING ELECTRIC INC Phone: (954)520 -0000
tsunamg uepartment comments
PROVIDE POWER TO AC
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed L/
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid
January 14, 2014 For Inspections please call: (305)762 -4949 Page 26 of 36
Miami Shores Village
O13 I 77 Building Department JUL f Pz,
1"0 N.F.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 �0
Permit No. f—c L.- 13 _iw3
Master Permit No. O 3 -A Sc7`% 1
JOB ADDRESS: (0Z 1 (a P I. tbA
City: Mimi ShQrf..a County: --mimiDak zip:
Folio/ParceW
Is the Building Historically Designated: Yes NO 10(A ZA311e:
OWNER: Name (Fee Simple Thlehokler): Phone#:
Address: G 2- V- C?z SL_
City: Stele: t lap: _3313 r
Tenant/Lessee Name: Plane*:
Email:
CONTRACTOR: Company Name: Phone#:
Address: k0-1 1-4
City: , 1�- L C— W'ft6— _State: Ie l Zip: 3 3 3 3
Oualifier Name: T`, 0 & 5 �%'- I- —Phone#:
3�d�ccrtificale of Competency 4:
Contact Phone#: Email Address:
DESIGNER: Architect/13righwer: Pix)ne4f:
Value of Work for this Permit: $ �C' C, Square/Linear Footage of Work:
Type of Work: UAddress UAlteratioii L3New ❑Rept&/Repluee Ul)cluolition
Description of Work:
Submittal Fee 411ZI . f =
, Permit Fee $ Af�C '& -0 CCF $ CO/CC $
*anning Fee $ Radon Fee $ DBPR $ Bond
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
I I
TOTAL FEE NOW DUE$_( 1
i
Bonding Company's Nana; (if applicable-)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certifv that no work or installation tra
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laivs regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING. SIGNS
WELLSi POOLS. FURNACES. BOILERS, HEATERS, TANKS and AIR CONDITIONERS. ETC.....
OIVNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with al
applicable laws regulating Lonstruction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OI
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOF
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIr
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant. As a condition to the issuance of building pennit faith an estimated vyrlue exceeding $1.500, the applk.ant nuts
promise in good faith that a cope of the notice of cxommencermerat anti rvnstruction lien law brcx-hurre will be delivered to the perso)
whose property is subject to attachment. A lso. a certified copy of the recorded notice of cormmtencerment must be posted at lire jolt sit,
for the first inspection which occurs . n (7) dads after the building permit is issued. In the absence of such posted notice. th,
inspection will not �!provd and reins cti fee will be charged.
JJ tl
Signature Si nature P � 7"'—
Owner or Agent ContraLtcor
Tpte foregoing instrument was acknowledged before me this l The foregoing instrument was acknowledged before me this.
daycof ` Sa1t , 20 Aa. by �i�►r. �•��t�a.. L day of i%+L , 20 L . by _ [� w.,,t►a V"e,ve
wli o is personally ktu wn ttr me ur wlaco has prtoduced l ��w► �-�" . who is personally known to me; or who has produced
As identification avid who diet take an oath. as identification and wixr did take an oath.
NOTARY PUBLIC: NOTARY PL Li
t
Sign: �. Sign: .�
Print:`"`' *' �`� MY Print: ' *t
1 10
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My Commission Ex si's o�s3 EXPIRES November 06, 2015 My C 'CIS November 06, 2015
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APPROVIM BY Plans Examiner I�roing
Structural Review Clerk
(Revised 3 1212012)(Revised 07 /101071{Revised 06 /10f-1009)(Revisi 3/1''09)