EL-13-1065Miami 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
FBC20L®
Permit No. ELI 3 -1 ObS
Master Permit N(�'
Permit Type: Electrical
JOB ADDRESS: /6 .4 2. /zS ## /Z 5f
City: Miami Shores County: Miami Dade Zip: 33/58
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Y Flood Zone:
OWNER: Name (Fee Simple Titleholder): 1404 /°T ® 47)v {. eta h' Phone#:
Address: 12 )U L it* .sr
City: M j aim S h o res state: 1-
Tenant/Lessee Name: I) IA" 1
Finail'
p: 313 '
Phone#:
CONTRACTOR: Company Name ki .l kt.1 ?fC - c' re/e, 7A,e, Phone#: 3/3?-3> g j,_ly
Address: 37 / ci) /4 O x471 -
,a
Ci6 e ' Zip: - /
ty;� S te:
, ,, .;
Qualifier Name: ®r ("(' f % 1:A Phone#: 7 —2-16 71 46
State Certification or Registration #: ,%_" 2--ei 'J Certificate of Competency #:
Contact Phone#:((4 c € (, C., Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 00a Square/Linear Footage of Work:
Type of Work: ❑Address )) Uil Iteration ❑New epair/Replace ❑Demolition
Description. /A
of Work: di zyis lire �t,d ❑
********* ****** ****** *** ********** sty **F a*** ******* eeeee+ ** spa * ******* **** ***** a *e
Submittal Fee ___ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
• rhding Company's Name (if applicable)
Bonding Company's Address
City State rap
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 FT FCTRICAL 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 reinsp will be charged
Signature
The foregoin
day of
Owner or Agent
instrument was ac .i, . ledgecl before met ,t s
20 j
j,by �a,n -/o rj e r S2
" p
ms perso
y known to
or who has produced
As identification and who did take an oath.
NOT
Si
Print
My Commission Expires:
...01.Z4'40 JULIA A. TAQUECHEL
•
* MY COMMISSION # DD 67882
,i 1: EXPIRES:Au ust8,2013
ss*•se e�e�a a.'.. .. � * * **a ***a* ties* *** *ma **s *s *et*e *e *s *s *area ****n*ea **a* e
z co 410
APPROVED BY � Mee Plans Examiner
Contractor
The foregoing instrument was acknowledged before me this 6 y
day of ,20by , .
who isnallyown to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
G
BLANCO
MY COMMISSION # DD906052
My Commission op � EXPIRES July 09, 2013
(ion 39801$3 FioridallotarySotvice.com
Structural Review
(Revised 3/12/2O12)(Revised 07 /10/07)(Revised O6/1OR009)(Revised 3/I5/09)
Zoning
Clerk
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 208906
Permit Number: EL -5 -13 -1065
Scheduled Inspection Date: March 17, 2014
Inspector: Devaney, Michael
Owner: QUESADA, HUMBERTO
Job Address: 125 NE 106 Street
Miami Shores, FL 33138 -2036
Project: <NONE>
Contractor: KLEAN POWER ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1121360060350
Building Department Comments
REPLACE EXISTING WIRING AND PANEL
Infractio
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
Sid
At4A2- 062-iv
March 14, 2014
For Inspections please call: (305)762 -4949
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