EL-12-1809Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 � e;�
Inspection Number: INSP-186904 Permit Number: EL -10-12-1809
Scheduled Inspection Date: March 07, 2013 Permit Type: Electrical - Residential
Inspector. Devaney, Michael
Inspection Type: Final
Owner: WOLSTENHOLME, BRIAN
Job Address: 380 NE 91 Street
Miami Shores, FL
Project: <NONE>
Work Classification: Addition
Phone Number (305)758-3477
Parcel Number 1132060190200
Contractor: NAVARRO PLUMBING & MECHANICAL CO Phone: (305)244-5832
comments
INSTALL NEW OUTLETS
INSPECTOR COMMENTS False
Inspector Comments
PassedCREATED AS REINSPECTION FOR INSP-186620.
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
March 07, 2013 For Inspections please call: (305)762.4949 Page 45 of 46
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: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
Pt -07, ffJ-, I _If E 07,
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FBC 20 (®
Permit No. U_L� 2�\ 8' 0 C1
Master Permit No, (V_ -C 1 1�12 rZ--
JOB ADDRESS: 3$o Al W q ; +
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO ✓ Flood Zone:
OWNER: Name (Fee Simple Titleholder):g4qiAN" V • Wo jWjaJa 4 at Phone#: _705'716-793 /
Address: 3 Bo AtC'' 41)1% a • rz-
City: (ff; 4ti''� •' �! O c) State: Zip:
Tenant/Lessee Name: Phone#:
Email:
Company Name:
Address: X O V) 04 Z24 2 -
r
City: ZI(lt�r^-, State:
Qualifier Name: fi'vx1 Phone;
State Certification or Registration #: , 13 ® -0 41` t t Certificate of competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ G,` d4) Square/Linear Footage of Work:
Type of Work: DAddress DAlteration
��escrip�oaro�r� � {
ONew epair/Replace
r ."
Zip: 33�2z
%2.03
Submittal Fee $� Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
ODemolition
TOTAL FEE NOW DUE $
.-- i oai - i n
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
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 lain 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. n the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The f of g in tru t was ac owledged ore a The foregoing .n went was acknowledged beforr� epe this
i
y of 0 U, by k , 20 ,�by W �®
h is onall�wn to(,�me or who has produced ho is personally known to me or who has produced ' / ntification and who did take an oath. as identification and who did take an oath.
NOT.
Sign:
Print:
My Commission Expires:
APPROVED BY
FiEf 1;!11�1
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P
NoComm.`SS\oR
04 Gamin VoR9RN
WOW
r25`4j' Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
NOTARY
Sign:
Print:
Commission Expires:
1;;�i>xk:::n�sa�:y 11,i41b
7..9wng . _ • x
Clerk