EL-13-2455Inspection Worksheet 0
Miami Shores Village BN L
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 207052 Permit Number: EL-10 -13 -2455
Scheduled Inspection Date: February 12, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: KUYPER, NICOLAAS C Work Classification: Pool - Private
Job Address: 878 NE 91 Terrace
Miami Shores, FL Phone Number
Parcel Number 1132060050320
Project: <NONE>
Contractor: F JIMENEZ ELECTRICAL CONTRACTOR, INC Phone: 305/556 -5759
smidmg oepanment comments
PUMP/ POOL LIGTH
INSPECTOR COMMENTS False
Inspector Comme >g
Passed
Failed
201 lo�4
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 11, 2014 For Inspections please call: (305)762 -4949 Page 38 of 39
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 (--_
Tel: (305) 7952204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
FBC 20 LO
Permit No. QL t-1 3 24 s-s
Master Permit No. 139 1 Zvi IS Z
JOB ADDRESS: k_ ra o 9
City. Miami Shores County: Miami Dade 7in: 3 22
Folio/Patcel#: _ 1 k ~ ,31it)( - b® r) 3.-), n
Is the Building Historically Designated: Yes NO _ Flood Zone e -
OWNER: Name (Fee Simple Titleholder): N, t CQ L 0th K U LA OPT Phone #. Ili
Address: o Cy 1 ` 2! rrr Ci C
City: { " L a vy� t LS Inri resc state: —F-r— Zip: _a a ( 3R
Tenant/1 -essee Name: Phone#:
Email:
CONTRACTOR: Company Name: � k
Address: l Q 1 to r®.
city. a IA 110 - 6 6aX ,, o s, _state: iLz= zip: 3 3 n r
Qualifier Name: aA C . LO at v,neunaz Phone#:2Wa
State Certification or Registration #• C.s. " Certificate of Competency #•
Contact Phone#: `7�(,��5`"� 1�® Email Address: 04 .ti, eyn p2 �� �s 6P r / ,
L� i
DESIGNER Architect/Engineer: V e_e. ,=he Esca " C, n Phone #• 3p6- 3 c2S —56,31
Value of Work for this Permit: $ gj5&) Rona
Type of W l� DAddre tion "'Rj�ua t.� •,ea ,.,,
s ®eo , , Rem ODemolition
DeNption
Submittal Fee $ Permit Fee $ ? ®lw - 61 C,-1 CCF $ CO /CC $ .
Scanning Fee $ Radon Fee $
DBPR $ Bond $
Notary $ Training/Educadon Fee $ Technology Fee $
Doable Fee $ Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
IV IA
Mortgage Lender's Name (if applicable) Af %
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
EMPROVEMENTS 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.
Signatures Si
Owner or Agent Con r
The foregoing instrument was acknowledged before me this 2? The foregoing instrument was acknowledged before me this
day of�, 20 KA e a 1 -0 e-5 C1A day of 0Y.4it_, 20,(a
wh . is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
'WMI
My Commission Expires:
APPROVED BY
M BULNBB
My Comm. Expires Jim 23, 2017
Commission # FF 030282
krvaed Through National Notary Am.
who is personally known to me or who )has produced
as identification and who did take an oath.
Plans Examiner
Structural Review
(Revised 3 /1=012)(Revised 07 /10 107)(Revised 06/10/2009)(Revised 3/15/09)
NOTARY
Sign: v�-
Print:
M BULN88
MY , Notary Public - state of Florida
e My Comm. Expires Jun 23. 2017
''FOF oae�� S
Bonded ThroughNstiona Notary Assn.
Zoning
Clerk