ELC-12-2056•
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 10)460
Inspection Number: INSP-197554 Permit Number: ELC-10-12-2056
Inspection Date: August 19, 2013 Permit Type: Electrical - Commercial
Inspector: Devaney, Michael Inspection Type: Rough
Owner: , CHARTER SCHOOL Work Classification: Addition/Alteration
Job Address: 11301 NW 5 Avenue
Miami Shores, FL 33138- Phone Number
Parcel Number 112136000060
Project: DOCTORS CHARTER SCHOOL
Contractor: FOSTER & SON ELECTRICAL CONTRACTORS, INC. Phone: (305)644-5869
Buildina Deoartment Comments
ELECTRICALL WORK TO CONVERT EXISTING
STORAGE ROOM IN COMPUTER LAB
Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Co efts
Passed
Failed
Correction
Needed
❑
Re -Inspection
❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
For Inspections please call: (305)762-4949
August 16, 2013 Page 1 of 1
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
FBC 20
pr,
OCT 2.9 2012
SY---- o�moo4�oom, mm�
Permit No.E_6 1
Master Permit No. I
JOB ADDRESS: I V I North w C St Er Oy C
City: Miami Shores County: Miami Dade Zip: J
Folio/Parcel#: 612 ' � 0 5 0 (0 0
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): G 1✓ d Gf h Phone#: 30G` 54 " 2 3'� t
Address: I I '3 C I N Q -44� w c u t 5'01 c-
city: PA i Qm I' state: F -L
Tenant/Lessee Name: Phone#: 3 09 - 5'q' 23 ?1
Email: f )CM di+hrs e 60CAQCS R grlffScy^eri or(�
CONTRACTOR:moa Company Name: �® *Mm 5o" Phone#:
�y�. 3� �l�
Address: cig �,l -W a 3 K i &nj -F(c- 3 3 0 2
o a
City t -A 4 t.1 State: (U 0 4 Zip: 3�l
Qualifier Name: 3 C> q5� L, Phone#3)±2 •313A -
State Certification or Registration #.-OL ®® 151440 Certificate ofCompetency#: q 1R EC�00-✓ 9
Contact Phone #:( ) fo 4-t- ? 15 4-- Email AddresA ,!;on "I km~ CA ® t , Coxvn
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $� Square/I:inear Footage of Work:..
Type of Work: UAddress ((Alteration ONew ORepair/Replace ODemolition
Description of Work:rY-L 9. Chi ej S$C1f
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 $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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 jutfsdiictlon: I understand that- separate permit -must -be secured WORK; PLUMS !NO,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 reinspection fee will be charged
Signature Jm4 Signature Z1
Owner or Agent V �ntiactor
The foregoing instrument was acknowledged before me this
day of 1 , 20 byC'�T P tea tr�
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
N ry Pubic State of Florida
Sign: an
Print: y Commission EE 166M
� V
My Commission Exp' : 131 L 1
The foregoing instrument was acknowledged before me this
day of 0QZs&-S?, . 20 _LZ by 1. q� 0-51—< ,
who i eronally kno to me or who has produced
as identification and who did take an oath.
Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
M
No Publiida
Sign: uan tibio
Print:
My Commission Expires: epi r ( 4>1 ?( -)l 179
Zoning