EL-13-2530Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 203028
Scheduled Inspection Date: November 14, 2013
Inspector: Devaney, Michael
Owner: PETERSON, DIRK & ELIZABETH
Job Address: 1350 NE 101 Street
Miami Shores, FL
Project: <NONE>
Contractor: SOUTH DOM ELECTRIC INC
timiaing uepartment comments
LOW VOLTAGE TELEPHONE & TV
Permit Number: EL -11 -13 -2530
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number
INSPECTOR COMMENTS False
Inspector Comments
Passed
11,2
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
1132050230020
Phone: (305)626 -5904
November 13, 2013 For Inspections please call: (305)762 -4949 Page 29 of 31
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Miami Shores Village
Building Department
10050 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: 1350 N. E. 101 STREET
M
FBC 20 lb
NOV 08
Permit No. e u 3 — 9 ,530
AP—
Master Permit No. 12 -1984
City: Miami Shores County: Miami Dade gip; 33138
Folio/Parcel #: 11- 3205 - 023 -0020
Is the Building Historically Designated: Yes
NO X Flood Zone: VE11 & AE9
OWNER: Name (Fee Simple Titleholder): DIRK PETERSON & ELIZABETH PETERSON phone #:
Address: 1350 N.E. 101 STREET
City: MIAMI SHORES State: FLORIDA Zip; 33138
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: SOUTH DOM ELECTRIC, INC. Phone#: 305 - 335 -9124
Address: 5860 N.W. 192 STREET
City. MIAMI State: FLORIDA Zip: 33015
Qualifier Name: Jose Del Carmen Matos Phone #: 305 - 335 -9124
State Certification or Registration #: EC 130DE5_21 Certificate of Competency l:
Contact Phone #: 305 - 335 -9124 Email Address: AAf}! �S � DLlA %ice
DESIGNER: Architect/Engineer: A &I Associates Phone#: 305 - 310 -5030
Value of Work for this Permit: $ `so ` I -o Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: Low voltage - Telephone & TV
Submittal Fee $ Permit Fee $ ®� r� 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) N/A
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) N/A
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
EWROVEMENTS 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 a a reinspection fee will be charged
� I
Signature Signature e
Owner or Agent V Contractor
The foregoing instrument was acknowledged before me this 08 The foregoing instrument was acknowledged before me this 08
day of November , 20 /J, by Elizabeth Peterson day of November , 20 43-, by Jose Del Carmen Matos
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Awl,
Print: 0(ga L. Cruz
My Commission Expires:
APPROVED BY
OLOA L CRUZ
M7
PWftr 23, 2017
Banded 11m, NOWYPV* undezlers
?e-:' /?
Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
Sign: `
pmt. JOlga L. Cruz ».
My Commission Expires: f�
OIOALCRIIZ
MY COMMISSION i FF02B437
EXPIRES: SepwnW 23, 2017
Zoning
Clerk