EL-15-1207Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-235955
Permit Number: EL -5-15-1207
Scheduled Inspection Date: June 03, 2015
Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: CHALLENOR, JOHN
Work Classification: Alteration
Job Address: 29 NE 109 Street
Miami Shores, FL 33138-
Phone Number
Parcel Number 1121360040600
Project: <NONE>
Fee
Contractor: MOODY ELECTRIC INC
Phone: (305)758-2000
Building Department Comments
INSTALL A POLE LIGHT & FIXTURE. INSTALL 2 LED mrractio rassea kwomments
LIGHTS ON SIDE OF HOUSE I
INSPECTOR COMMENTS False
June 02, 2015 For Inspections please call: (305)762-4949 Page 26 of 28
Inspector Comments
Passed
El
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid
June 02, 2015 For Inspections please call: (305)762-4949 Page 26 of 28
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Parcel Number Aoolicant
29 NE 109 Street 1121360040600
Miami Shores, FL 33138- Block: Lot: JOHN CHALLENOR
Owner Information Address Phone Cell
JOHN CHALLENOR 29 NE 109 Street
MIAMI SHORES FL 33168-3224
Contractor(s) Phone Cell Phone
MOODY ELECTRIC INC (305)758-2000
of Work: INSTALL A POLE LIGHT & FIXTURE. INS
itional Info:
;sification: Residential
nning: 1
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.25
DCA Fee
$2.25
Education Surcharge
$0.20
Permit Fee - Additions/Alterations
$150.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$159.10
Valuation: $ 500.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL -5-15-55648
06/01/2015 Credit Card $ 109.10 $ 50.00
05/21/2015 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Review Electrical
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. F rmor authorize th name tractor to do the work stated.
June 01, 2015
Authorized Sig weer / Applicant / Contractor / Agent Date
Building 114fiartment Copy
June 01, 2015 1
BUILDING
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
PERMIT APPLICATION
Permit Type: Electrical
JOB ADDRESS: 2 q /i &
5F
- -T: D)1
MAY 2 0. 015
j.__LA
FBC 20 K3
Permit No. FL4 is; Q
Master Permit No.
City: Miami Shores County: Miami Dade Zip: 331-3
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder):. Jo �� Phone#:� �'� ��
Address: Zq AJ1Q Q .5 %
City: W h am l 5ho r State: �c
Tenant/Lessee Name: �� Phone#:
Email:
CONTRACTOR: `Company Name: 4 (Zdu �/ e,&W6 / Phone#: �9--/6
J ®9
Address: 7i -�V
City: I
Qualifier Name:
State Certification or Registration #:
Contact Phone#:
DESIGNER: Architect/Engineer:
rz,l Zip:
Address:
Certificate of Competency #:
Value of Work for this Permit: $ 0 Square/Linear Footage of Work:
Type of Work: ❑Address OAlteration/ONew, ORepair/Replace
Description of Work:: f1.j / ®l , / i h
1 6-C)
'. ODemolition
Submittal Fee $ So `C,)�_ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $ 1 ll 3 .`i+!—
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 su h posted notice, the
inspection will not be approved and a einsp ectionfee will be charged.
Signature , Signature
Owner o Agent Contra or
The foregoing instrument was acknowledged before me this 2 l
day of 20 6, by br) Chcfl not' ,
who is ersonall known to me or who has produced
P Y
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
MARY PAT BRIGGS
My Comm. Expires May 11, 2018
Commission # FF 120746
The foregoing instrument was acknowledged before me this
day of 20 �J by c
who is personally known to me or who has "0's
as identification and w
APPROVED BY V Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009XRevised 3/15/09)
NOTARY PUBLIC:
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Sign: 3
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Print: AA*n
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My Commission Expires:
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Zoning
Clerk