EL-14-491Miami 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
FBC 20
Permit No.
Master Permit No
Permit Type: Electrical
JOB ADDRESS: i t b ® i f • C & i 4 • t i
City: Miami Shores County: Miami Dade Zip: ?
Folio/Parcel #: ii- ®C- Cb ( 0410
Is the Building Historically Designated: Yes NO X. Flood Zone:
OWNER: Name (Fee Simple Titleholder): tWariott22.41q. osr Phone #:
Address: U 61 1. ' 12- PtC r�
City �,e��tr>�. ��..� State: mac.. Zip: � cb
ZS
Phone#:
Tenant/Lessee Name:
Email: Wf u10 6 �� 'Yl�ta. • CMYl/l,
CONTRACTOR: Company Name: 'j1A° l ( Phone#: C!�) �?��— CR (,Z
vv
Address: 5g(00 11/41 U.) V 2 od. acr'e--r_
City: State: tot_
Qualifier Name: a -.1./ 01:48"-/5 Al 14/4 l 1,S, Phone #: 7336 Ci/Z(
3s tate Certification or Registration #: EC1 3 00 66Z / Certificate f Competency #:
Contact Phone #: „VS 3 s 7/29 Email Address:
.�.r:. e ; ,
DESIGNER: Architect/Engineer: Phone #:
Zip: 7)Q LS.
Value of Work for this Permit: $ 0 Square/Linear Footage of Work: ± ( ZOO
Type of Work: ❑Address DAlteraaion °New *Repair/Replace °Demolition
Description of Work: -,
Submittal Fee $ Permit Fee $ 2& 1 ' CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ a . t6
Bonding Company's Name (if applicable)
Bonding`6ompany's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
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 joe-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.
Owner or Agent
The foregoing instrument was acknowledged before me this ,4
day of Hare") ,20 /9 by ear Q'r4 Pr tyoA
who isonally knoWnlo me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Contractor
The foregoing instrument was acknowledged before me this //
day of /� , 20 l�/, by�S, A r%j .
who is personally known to me or who has produc
1p?1775'2 .s'",e1 as identification and who did take an oa
NOTARY PUBLIC:
y Commission
Sigx:
My Co
Notary Public State efl' orida •
Joanna M e�a'ario
res 01/7218 082753
************* * * * * * * * * * * * * * * * * * * * * * * * ** * * * * ** * * * * * * * * * * * * * * * *1 ************ * * ** * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
4L / 3 /,o/a- Plans Ex
Zoning
Structural Review Clerk
(Revised 3 /12/2012XRevised 07 /10 /07)(Revised 06 /10/2009XRevised 3/15/09)
Re ft-1- Vo?
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 211430 Permit Number: EL- 3 -14 -491
Scheduled Inspection Date: April 28, 2014
Inspector: Devaney, Michael
Owner: TER HORST, BARBARA
Job Address: 1130 NE 91 Terrace
Miami Shores, FL
Project <NONE>
Contractor: SOUTH DOM ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)432 -1775
Parcel Number 1132050010410
Phone: (305)626 -5904
Building Department Comments
ELECTRICAL REPAIR AND IMPROVEMENT
Infractlo Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
7 /f/K-.0W
April 25, 2014
For Inspections please call: (305)762 -4949
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