EL-15-469Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-229800 Permit Number: EL -3-15-469
Scheduled Inspection Date: March 11, 2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: HOLMES, RICHARD Work Classification: Alteration
Job Address: 160 NW 99 Street
Miami Shores, FL 33150 -
Project: <NONE>
Contractor: HOME OWNER
tsmiamn uepanment comments
RENEWAL OF EXPIRED PERMIT EL09-449
Inspector Com
Passed
Failed
Correction ❑
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Phone Number
Parcel Number 1131010240030
INSPECTOR COMMENTS False
March 10, 2015 For Inspections please call: (305)762-4949 Page 25 of 29
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 9 0 gg
BUILDING Master Permit No�� 15 — (q6 -F
PERMIT APPLICATION Sub Permit No. EL.,l S yGq.
❑ BUILDING Q ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION C61TENEWAL
❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titlehol
Address:
City://��-1- • ��7i1S
Tenant/Lessee Name
Email:
CONTRACTOR: Company Name:
hone#: �4T`a ;7 -�
State: F—/ ; Zip:�J�J
Address:lt,,I] A
City: K1Z L --w C' State: f� Zip:
Qualifier Name: Phone#:
State Certification or Registration #:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: _
Address: p City: State:
Value of Work for this Permit: $ V } rcan Square/Linear Footage of Work:
Type of Work: P -_Addition ❑ Alteration ❑ New Repair/Replace
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ lz:V , op CCF $_
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
(Revised02/24/2014)
Zip:
❑ Demolition
Ir
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ YO
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City 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 jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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.
d
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of /%L3/ I 20 by day of 20 by
1261YI'l who is personally known to who is personally known to
me or who has produced f Z97yS'5-�12-qkz� as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:
Sign
NOTARY PUBLIC:
Sign:
Print: `''po - " " Print:
ubii°State
a� anna M F °f Florida
Seal: eliciano7 Seal:
v�°F �q� ors 01/12/2018 FF 082783
x � _
APPROVED B� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)