EL-14-333Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
inspection Number: INSP- 208846 Permit Number: EL -2 -14 -333
Inspection Date: March 13, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Owner: REYNOLDS, LORRAINE
Job Address: 578 NE 93 Street
Miami Shores, FL 33138-
Project: <NONE>
Inspection Type. Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060141050
Contractor: SAME & Q ELECTRIC INC Phone: (305)219 -0427
Buildinca Department Comments
TAKE OUT LAMP'S AND CIRCUIT FROM FRONT OF
Infractio Passed Comments
INSPECTOR COMMENTS True
HOUSE TO RESOLVE A VIOLATION
Inspector Comments
Passed
1E
CREATED AS REINSPECTION FOR INSP- 208714.
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can
be scheduled until
re- inspection fee is paid.
March 13, 2014
For Inspections please call: (305)762 -4949
Page 1 of 1
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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: (3057 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
FBC 20
Permit No.
Master Permit No. k-1-1 ! `/ -,3.3 �?
JOB ADDRESS: ng
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City: Miami Shores
o County: Miami Dade
Zip: 3A `S
Folio/Parcel #: // — LDS "ICJ, Ulf 7 —
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Titleholder)
NO Flood Zone:
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City: � rxj State: iQ Zip:3����°
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: 5 3 1 D S L
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City: e Dgz.8 L E) & e L-e-- S' State: f L Zip:
Qualifier Name: M A N vC-L F— At - Phone#•
State Certification or Registration #: C C _� ® -F ®� Certificate of Competency #:
Contact Phone#i A rf) 21 Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 23-6 ` ® Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑Newepair/Replace ❑Demolition
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Description of Work: _
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Submittal Fee $ Permit Fee $ / 6 0, ®® CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Educadon Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
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
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
EMPROVEVIENTS 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 g tha a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose pro r2y. i s bject toy ttachment. Also, a certified copy of the recorded notice of commencement must, be posted attthe job sate
t for the fit ec on wh occurs seven (7) days after the building permit is issued In the absence of. sued pds'teli°;; notice,', the ° F;
insAection ; all no •' a appr ed and a reinspection fee will be charged. ` A t -J
Signa a Signature it
r �t P'
E 1,. Owner or Agent Contractor y�
The foregping�strtunent was acknowledged before me this The foregoing instrument was acknowledged be ore nh this
day of / d, by L 'T° �� , ay of (d 20 l by Jr d
who is personally known to me or ho has produced) ho is personally Aown to me )r who has produced
53 4) ~ 7-3 `a .3As identification and who did take an oath. as identification and who did take an oath.
Z0iy
Structural Review
(Revised 3 /12/2012)(Revised 07 /10/(Y7)(ReAsed 06110/2009)(Revised 3/15/09)
Commission # EE 79436
led Through National Notary Assn.
Clerk
y
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
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COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME:
& "„1VI (--
BUSINESS ADDRESS: �5-3l V ( W ? f lw M / A-M I
STATE ZIP CODE
BUSINESS PHONE: ( nr) ' I B °l 9 06-%AX NUMBER(__)
CELL PHONE ( Or ')
QUALIFIER'S NAME: I y V
QUALIFIER'S LIC NUMBER: —c 0- TLL- 10 � 0000 q 2 � 13-0
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