EL-14-783Miami 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) 762.494!
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
JOB ADDRESS: t 7'5-- /V kA-) 1 0 l S� `7
FBC 20
Permit No. Z� FS
Master Permit No.C, G ' �✓� ��
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
—OWNER: Name (Fee Simple
NO Flood Zone:
—qA3
City: �c 4,46ky State: Zip: 33139*
Tenanvlxssee Name: Phone#:
Email:
CONTRACTOR: Company Name: I l ,/moi ��C Phone#. -3 Q S
Address:
City:
Quali
.2
4-31:A-�'
State Certification or Registration #: C l -n ® 5-�( ® / Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer:
,Value of Work for this Permit:
Type of Work: ❑Address
Description of Work:
Submittal Fee
Scanning Fee $
S,o0,1--
OAlteration
M
Permit Fee $ 00 CCF
Footage of Wilfki�'
r N' 4 a�dds9 e- 4#
Vii►®
CO/CC $
Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
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
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 ' a roved and a reinspection fee will be charged.
Signature oma" " Signature
Owner or Ag
The foregoing instrument was acknowledged before me this Eta
day ofk.O�Q, 20 A, by V&V. M* &rX,- -
who is perinally known to me or who has produced
-� As identification -and w did take an oat
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this -0—r
day of G 20 , by Ano,&J
who is personally known to me or who has produced
and who did take an oath.
"'ia�r "•• ••,�,10NkEE736473 Q
oFc,o�" SIRES:
'800.3-xoraar °� 03, 2015
Sign: nPe4s=
EW REYES Sign:,04
C-
Print: 11,2018 Print:
N EE 108714
My Co i pA My Commission Expires:
APPROVED BY �"j'/� Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012XRevised 07/10/07)(Revised 06/10/2009XRevised 3/15/09)
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FIL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-218365 Permit Number: EL -4-14-783
Scheduled Inspection Date: August 25, 2014
Inspector: Devaney, Michael
Owner: MAE, FANNIE
Job Address: 175 NW 101 Street
Miami Shores, FL 33150 -
Project: <NONE>
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1131010230160
Contractor: CPS ELECTRIC, INC. Phone: 305-607-8221
Building Department Comments
LOW VOLTAGE Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
PassedEl'
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
August 22, 2014 For Inspections please call: (305)762-4949 Page 28 of 31