EL-14-751Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-213419 Permit Number: EL -4-14-751
Scheduled Inspection Date: June 03, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Owner: MENGE, ROBERT
Job Address: 1102 NE 105 Street
Inspection Type: Rough
Work Classification: Alteration
Miami Shores, FL Phone Number (305)778-9835
Parcel Number 1122320280110
Project: <NONE>
Contractor: HOME OWNER
nt comments
REPLACE EXISTING RECEPTACLES WITH NEW ------ .-.........--
SWITCHES INSPECTOR COMMENTS False
f �
Inspector Comments
Passed
Failed �� l
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
June 02, 2014 For Inspections please call: (305)762-4949 Page 36 of 41
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
APR 14 2014
FBC 20 113,
Permit No. FL �--
Master Permit No. �—? C. i 1- - -1 2-1
JOB ADDRESS: `j'
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: -2-7-5
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): � � � ��q, PhoneO�
Address:
City: State: _ 2, Zip: 3:3/-
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: phone#: 3 b �j 4
Address: C3 <
City: &�� ,/, ,� ,State: �/� Z�i�p:
Qualifier Name: ,�'h, 7 ®UC �iigbone#i'-5
State Certification or Registration #: ®dam Certificate of Competency #: -
Contact Phone#:�' ail Address:
DESIGNER: Architect/Engineer: /L/� Phone#:
""' Square/Linear Foota a of:*6rk: 2 .
Value of Work for 'flus Permit $ ' �� � ®� .-� S
Type of, Work: ❑Address ❑Alteration ONewepaireplace ❑Demolition
_ {
Description of Work:i
Submittal Fee $ Permit Fee $ /!`�'rd�% CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW D
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 Signature 1
Owner or AgT Contractor
The foregoing instrument was acknowledged before me this 3 The foregoing ins ent was acknowledged before me this:3
day of ko. , 20 1by Gbsuday of 40r, -,20)t( , by
who iserg s�___o�to me or who has produced who is personally know„ to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
t
Sign: Sign:
Print: zomlkC Print: Agft& Crista Stefanick
Commission #FF085515 a • ; #FF085515
My Commission Exp' _ My Commission Ex'
,y�, ` Expires: FEB. 03, 2018 ' ,ExAi►es: FEB. 03, 2018
�N�„.n www.AWNNOTA u= ''•• ua www AasOrlNo7awrz11!com
APPROVED BY E! A107/Z - Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)