RC-13-2612 (3)trN
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 211520
Permit Number: RC -11 -13 -2612
Scheduled Inspection Date: April 30, 2014
Inspector: Rodriguez, Jorge
Owner: MARCELO BORODOWSKI, AAM
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Job Address: 10659 NE 11 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: WEINTRAUB RUIZ CONSTRUCTION CORP
Permit Type: Residential Construction
Inspection Type: Slab
Work Classification: Alteration
Phone Number (305)466 -4243
Parcel Number 1122320280320
Phone: (305)466 -4243
Building Department Comments
REPLACE KITCHEN CABINETS / 2 BATHROOMS
CABINETS AND FIXTURES
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
41/
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
April 29, 2014
For Inspections please call: (305)762 -4949
Page 23 of 28
New Construction Subterranean Termite
Soil Treatment Record
This form is com feted by the licensed Pest Control Corn
Public rOmrti burden for this collection of information is estimated to average 15 minutes per response, Including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This information is mandatory and is
required to obtain benefits. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control
number.
OMB Approval No. 2502-0525
(exp. 11/30/2008)
Section 24 CFR 200.928d(b)(3) requires that the sites for HUD insured structures must be free of termite hazards. This information collection requires the builder to
certify that an authorized Pest Control company performed all required treatment for termites, and that the builder guarantees the treated area against infestation for
one year. Builders, pest control companies, mortgage lenders, homebuyers, and HUD as a record of treatment for specific homes will use the information collected.
The information is not considered confidential.
This report is submitted for informational purposes to the builder on proposed (new) construction cases when soil treatment for prevention of subterranean
termite infestation is specified by the builder, architect, or required by the lender, architect, FHA, or VA.
All contracts for services are between the Pest Control Operator and builder, unless stated otherwise.
Section 1: General Information (Treating Company Information)
Company Name- IDEAL PEST CONTROL INC
Company Address 6520 SW 138 CT #605 City MIAMI State FL zip 33183
Company Business License No. ,ra214806 Company Phone No. (786)370 -6180
FHANA Case No. (if any)
Section 2: Builder Information
Company Name AAM INVESTMENTS LLC.
Phone No. (305)300 -1353
Section 3: Property information
Location of Structure (s) Treated (Street Address or Legal Description, City, State and Zip)
10659 NE 11 AVE MIAMI SHORES, FL 33138
Type of Construction (More than one box may be checked) F-.1 I Slab Basement Crawl n Other
Approximate Depth of Footing: Outside Inside 3 ft Type of Fill
Section 4: Treatment Information
Date(s) of Treatment(s) 04/21/2014
Brand Name of Product(s) Used TERMID"
EPA Registration No. 7969 -210
SC
Approximate Final Mix Solution % 0.125.
Approximate Size of Treatment Area: Sq. ft. 73'77 Linear ft. Linear ft. of Masonry Voids
Approximate Total Gallons of Solution Applied 10
Was treatment completed on exterior? f Yes No
Service Agreement Available? 17 Yes No
Note: Some state laws require service agreements to be issued. This form does not preempt state law.
Attachments (List)
Comments
Name of Applicator(s) Carlos N
Certification No. (if required by State law) 0E170164
The applicator has used a product in : «. b: ce with the product label and state requirements. All treatment materials and methods used comply with
state and federal regulations.
Authorized Signature
Date 04/21/2014
Warning: HUD will prosecute false : '" statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010.1012; 31 U.S.C. 3729, 3802)
Form NPCA -99-B may still be used
form HUD - NPCA -99-B (14/2003)