EL-11-1617 (2)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
IPPR 12 2012
. yF®maoa »_ a000
C
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
Permit Type: Electrical
JOB ADDRESS: l 75 ,/()&) /0I o4 -
City: Miami Shores County: Miami Dade Zip:
Foho/Parcel#: //- 3/4D/ - 0 Zz --0160
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): Phone#:
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
La
CONTRACTOR: Company Name: AM,. � ec.�lz, c. &-e/,ibe -�; LPhone#:
Address: I /1)L^ A,4
City: tGi141State: Zip: J3 (0?
Qualifier Name: Phone#: ` Lt r `
State Certification or Registration #: Gam' L.wQ Q 0 T CertiAtate of Competency #:
Contact Phone#: - L? S -19-t Email Address: 4110-G � C- q � C 0
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ J , SUV C)•7 Sq
Type of Work: ❑Address UAlteration ONe <'URt j ii3r/Replace ClDemolition
Descri tion of Work: VGA
MVAi
a
Submittal Fee $ Permit Fee $ 0- CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
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
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 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
Owner or Agent
The foregoing instrument was acknowledged before me this g
day of % 20 Ley A'�
who is personally known to me or who has produced off, i acre
Li Ct/u,.e As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Signature
Contractor
The foregoing instrument was acknowledged before me this��
day of=known
y Jewh is pr who has produced
as identification and who did take an oath.
NOTAW PUBLIC:
Sign:
My My Comm. Expires Maq 4, 2048 M Ctssion ExpiresM Commission Ex o.� �, � �'rt '�ie� � e
•,,Fo, „o?, Commission �► EE 85485 � v�;` , cm , ,jai
At 11.29, 2012
09a Mau ,:rt WrtC Zormnra Co., INC.
APPROVED BY ;�F Plans Examiner Zoning
Structural Review
(Revised 07/10/07XR6vised 06/10/2009)(Revised 3/15/09)
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-164019
Scheduled Inspection Date: August 25, 2014
Inspector: Devaney, Michael
Owner: MAE, FANNIE
Job Address: 175 NW 101 Street
Miami Shores, FL 33150 -
Project: <NONE>
Contractor: CPS ELECTRIC, INC.
Iiuuaing uepartment comments
RELOCATE ELECTRICAL METER PANEL AND RE WIRE
BATHROOM AND KITCHEN
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Permit Number: EL -8-11-1617
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number
1131010230160
Phone: 305-607-8221
August 22, 2014 For Inspections please call: (305)762-4949 Page 2 of 31