EL-13-1431Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
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Inspection Number: INSP- 199698 Permit Number: EL -6 -13 -1431
Scheduled Inspection Date: September 24, 2013 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: KNOWLES, HAROLD & AMY Work Classification: Alteration
Job Address: 129 NE 109 Street
Miami Shores, FL 33161- Phone Number 305 - 758 -8193
Parcel Number 1121360040530
Project: <NONE>
Contractor: MV ELECTRICAL SERVICES Phone: (305)216 -0677
comments
ELECTRICAL FOR BATHROOM REMODEL OUTLET,
RECESSED LIGTH INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
September 23, 2013 For Inspections please call: (305)762 -4949 Page 25 of 29
Miami Shores Village
Building Department JUN 24 a
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972 -.
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 20 tD
BUILDING
PERMIT APPLICATION
Permit Type:
JOB
—to 11L 5 -r
Permit No. rl" ° l
Master Permit No '�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #: it _. 2-1 t_� o 67 6- a 3
Is the Building Historically Designated: Yes
NO Y` Flood Zone:
Ir-
OWNER: Name (Fee Simple Titleholder): CA- t L - - AYA y 14 PJ 0 w C_ J< Phone#: a 09/-;
Address: l ® I A-) e 10q ,a 57'
City: /Y) 195 State: 1. Zip: W13 P"
Tenant/Lessee Name: Phone#:
Email:
�L �.r c am,.. ��
CONTRACTOR: Company Name: tea_ P hone #:_3 04 7%
Address: I g: -Z J/ -Z. C4—"7"
City: (07�1 f f / State: r1A1 Zip:�� /r
Qualifier Name: 177&-L L) Phone#: s
State Certification or Registration #: Certificate of Competency #: e?6 ,i�r ®00
Contact Phone#:
Email Address:
DESIGNER: ArchitecdEngineer: � Phone#:
Value of Work for this Permit: $ ��O �°�° Square/Linear Footage of Work: ® .S r—
Type of Work: DAddress 3'Alteration ONew ORepair/Replace ODemolition
Description of Work: fto 60-rL M . 115,4> r 14)lj7?ru.•
1AJ .S t—_Nu S e.c� o.7Z� OP
Submittal Fee $ Permit Fee $ / -4-1> ° C-P 0 CCF $ CO /CC $
Scanning Fee $
Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
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
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 ommence w t must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issue 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 foregoing instrument was acknowledged before me this
day of .1 d J— , 20 t � by ALAu v- t -/ ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sigr
Prin
My
Contractor
The foregoing instrument was acknowledged before me this /�-
day of am , 20 �3, by ��jAGp f�.G� —o
who is pQRpnally knowaLto me or who has produced
identification and who did take an oath.
NOTARY PIIRLIC:
APPROVED BY /,y ,F i',"Plans Examiner Zoning
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
Clerk