EL-14-1292Miami Shores Village
Building Department JUN.I'$
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 �
BUILDING Master Permit No. I`I 12-9 ,
PERMIT APPLICATION Sub Permit No. euLl 1'L�l 2—,
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
-y CONTRACTOR //
JOB ADDRESS: 1-7 00 `� �' , -# /-/-0
DRAWINGS
/
City: Miami Shores County: Miami Dade Zig: 13-3 J � l
Folio/Parcel#: ll ��V -S'& C& / c) Is the Building Historically Designated: Yes NO L,"�
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 0/ Z -A- S i' Phone#:
Address: / -7 ® c> /i l ® S- 5 7cf C7
City: State: /�` Zip: :3 �3 / -3
Tenant/Lessee Name:
Email: /✓ ® A*
CONTRACTOR: Company Name: L5607 , AW6 Phone#: sgf
Address: SSS Oi ZY- U) LqZ ST
City: A4 -f -a" /. State: �/ Zip: -00 /G77
Qualifier Name: MSE IqA MS
Phone#:,
State Certification or Registration #:®®�Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $�®� Square/Linear Footage of Work: (,SES TttAiQ i oy S.F,
Type of Work: ❑ Addition 5l Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:%% �� I(-
Amo
I LD Bppw/Ccam. 20E& ,4
Specify colr of color thru tile:
Submittal Fee Permit Fee$ 2,2.1 1 �r ® CCF CO CC
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $
Structural Reviews
(Revised02/24/2014)
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 96
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
Zi
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose p perry is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the fi st inspection which occurs ven (7 J after the building permit is issued. in the absence of such posted notice, the
inspectio plffikot be approved and a insp /on f will be charged.
Vk—
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of _&� . 20 , by
DX0T% Qk / 5M i1 r , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
as
i WXL
Signature
CONTRACTOR
Theforegoinginstrument was acknowledged before me this
t day of �"' `' . 20 , by
5-6 rypo!V 5 , who is personally known to
me or who has produced �— D Q-wytA— as
identification and who did take an oath.
NOTARY PUlgnili/ /,'-
1
Sign:
i, :!��
Print
Seal:` Seal: tlu`, �u,'�,�$o v:� Pi, .a
..� C e
0```\�\�
>PtdRdRl6k{11� nl
APPROVED BY / Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
MR
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-216226 Permit Number: EL -6-14-1292
Scheduled Inspection Date: July 22, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: SMITH, ORFA
Job Address: 1700 NE 105 Street 404
Miami Shores, FL
Project: <NONE>
Work Classification: Alteration
Phone Number (786)253-2869
Parcel Number 1122300500610
Contractor: SOUTH DOM ELECTRIC INC Phone: (305)626-5904
Building Department Comments
KITCHEN REWIRING AND RELOCATE BREAKER.
REPLACE OUTLETS IN KTICHEN AND BATH INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed 4e� 7—
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
July 21, 2014 For Inspections please call: (305)762-4949 Page 23 of 33