EL-13-2256Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 210969
Scheduled Inspection Date: April 17, 2014
Inspector: Devaney, Michael
Owner: MACDONELL, ORRIN & CHARLENE
Job Address: 9760 NE 5 Avenue Road
Miami Shores, FL
Project: <NONE>
Contractor:
R & A ELECTRIC
tsunaing uepartment comments
REPLACE OLD CLOTH WIRE AND SWITCH IN
BATHROOM
Permit Number: EL -10 -13 -2256
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number
INSPECTOR COMMENTS False
. Inspector Comments
Passed
Failed
Correction / 6rla
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid
April 16, 2014 For Inspections please call: (305)762 -4949
1132060171480
Phone: (305)331 -3710
Page 30 of 30
Miami Shores Village
Building Department 11) OCT v 4 2j r
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 L�
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
Permit No. FLI �3 —'22ff4'
Master Permit No. �,C it °a
JOB ADDRESS: _6 C) 1_)C g T -�
City: Miami Shores County: Miami Dade Zip: 3 ®B f5
Folio/Parcel #: �! °` �' �D s'3l " ! 0
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple
Address:
City: J %%J
Tenant/Lessee Name:
Email:
0
CONTRACTOR: Company Name:
Address:
City:
0 5 - 9:57/ - 6 ® o-7-
State: 1�9 zip: 3
Phone #:
Phone #: 3_4Sm' 3 -3/ -r 3 57l0
0
Qualifier Name: ? �' i'�a' ��� 'x b `phone #: 3-OS – 3 -31– 3 i /®
State Certification or Registration #: � ®1°5/��� Cetti*ate of Competency #: �' t? 00® �
Contact Phone #: ,L�5 —3 9l / —3 -7 10 Email Address:
DESIGNER: Architect/Engineer. Phone #:
Value of Work for this Permit: $ 6 o ® Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration DNew Repair/Replace
DDemolition
T
Submittal Fee $ S-1) f 00 Permit Fee $ l j2? P ®P CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $ 10 -
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 shade fo obtain a permit to do the work and installations as indicated. I certify that no work or installation has
comffi&6ed 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. n A
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of C, 20 1:5by 0*012.4r4 MQLD W\.Wday of Q 20 !- rbyyc��
who is personally known tome or who has produced taeD _ who is personally known tome or who has produced M FI) CU
As identification and who did take an oath.
NOTARY
Sign:
Print:
My Commission Expires:
APPROVED BY
1\,%%J1111111
�,t�enis
' "n,
�N9j.'•�F913p f9
0F ci
Plans Examiner
as identification
NOTARY PUBLIC: `\,�o�c\Wta,
or
My Commission Expires:
take an oath.
�'1�1tn,;11'•���
F�t4t4eJr�Y�traY4t &4t9teY4t9t9a kFeBr
zoning
Structural Review Clerk
(Revised 3 /12 /2012)(Revised 07/10/07 )(Revised 06/ 10/2009 )(Revised 3/15/09)