RC-13-2255Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 211367 Permit Number: RC -10 -13 -2255
Scheduled Inspection Date: April 28, 2014 Permit Type: Residential Construction
Inspector: Rodriguez, Jorge Inspection Type: Final Building
Owner: MACDONELL, ORRIN & CHARLENE Work Classification: Alteration
Job Address: 9760 NE 5 Avenue Road
Miami Shores, FL
Phone Number
Parcel Number 1132060171480
Project: <NONE>
Contractor: HOME OWNER
tiuuamg uepartment comments
REPAIR LEAK FROM FLOOR BATH INTO KITCHEN AND Infractio Passed Comments
FIX BROKEN TILES AND PAINT I INSPECTOR COMMENTS False
April 25, 2014 For Inspections please call: (305)762 -4949 Page 17 of 24
Inspector Comments
Passed �
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 25, 2014 For Inspections please call: (305)762 -4949 Page 17 of 24
r 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: BUILDING
JOB ADDRESS: 6 t 6® u. E. 6- L)
OCT
FBC 20 L"
Permit No.
Master Permit No. I'3 ° � S S
ROOFING
City: Miami Shores County: Miami Dade Zip: .33131?
Folio/Parcel #: L d 1%
Is the Building Historically Designated: Yes 9/ NO Flood Zone:
OWNER: Name (Fee Simple Titleho )0 J '' c /z' Dwye(lo 3
Address: 7 / 0 ff/- 5 /4 y 4E�_ Ia
City: f:. t&fhe S HO k5 state: /-- (00" zip: 3 3 / 3g
Tenant/Lessee Name: Phone #: `3 (3 5 ' XS-1�6 60 7
Email: tVQ L )^
CONTRACTOR: Company Name: ® Lj toe, r Phone #:
Address:
City: State: Zip:
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #: _
Contact Phone #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $ zi :5- ® Square/Linear Footage of Work:
Type of Work: ❑Additiogn� DAlteration ONew W6air/Replace
Description of Work: l u:, P,4 <a, L- c-e al's F'Do ^ z y" F-loo 2 134
l
ODemolition
fN %(D
Submittal Fee $��, � �'� Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
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
zip
City State 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 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 f be char ed.
Signattu Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of , 20 0, by " rn aoa,&M L day of .20 _, by ,
who ' ersonally 1 me or who has produced ' who is personally known to me or who has produced
As identification and who did take an oath.
identification and who did take an oath.
My Commission Expires:
Structural Review
(Revised 5/2/2012XRevised 3/12/2012) XRevised 06 /10/2009XRevised 3 /15 /09)(Revised 7 /10/2007)
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