EL-15-1215Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-235146 Permit Number: EL -5-15-1215
Scheduled Inspection Date: June 04, 2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: PECK, EDITH DAYLE Work Classification: Repair
Job Address: 1298 NE 95 Street
Miami Shores, FL
Project: <NONE>
Phone Number
Parcel Number 1132060144030
Contractor: LONGMAN ELECTRIC INC Phone: (305)758-1211
Comments
REPAIR METER CAN
INSPECTOR COMMENTS False
Inspector Comments
Passed Ef
Failed
Correction L/�� /y
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
,lune 03, 2016 For Inspections please call: (305)762-4949 Page 13 of 28
s" o� Miami Shores Village
n 10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
ap Phone: (305)795-2204
Project Address Parcel Number Applicant
1298 NE 95 Street 1132060144030
EDITH DAYLE PECK
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
EDITH DAYLE PECK 1298 NE 95 ST
MIAMI SHORES FL 33138-2550
Contractor(s) Phone Cell Phone
LONGMAN ELECTRIC INC (305)758-1211
of Work: REPAIR METER CAN
ional Info:
,ification: Residential
nina: 3
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
$9.00
Technology Fee
$0.80
Total:
$165.10
Valuation: $ 350.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL -5-15-55660
06/03/2015 Credit Card $ 115.10 $ 50.00
05/21/2015 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
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 that II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction d zoning. Fu the re, authorize the above-named contractor to do the work stated.
_ June 03, 2015
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 03, 2015 1
BUILDING
PERMIT APPLICATION
Miami Shores Villagec
Building Department MAY
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑BUILDING 'ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL [—]PUBLICWORKS
2015
FBC 20 t p _
Master Permit No�u � S J 121 S
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Az �'F N (- �-j S , S i
City: Miami Shores County: Miami Dade Zip: 33 )
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): l -IVB �A' e- 1 � c_ Phone#: 30.5- 61 Z) S 6
Address: +
City: _I/1�1 n �� ^�.�;� State: EL Zip: 3
Tenant/Lessee Name: Phone#:
Email: e og e e L
CONTRACTOR: Company Name:
Address: q5 A� f
City: 4!k eft
Qualifier Name:
1pz_ Zip: 513 / � g,
A- / Phone#: 3aS® 7�4 .r- `%2//
State Certification or Registration #: r G /I Ye -t->30 `J Certificate of Competency #:
DESIGNER: Architect/Engineer:
Ad
Phone#:
City: State: Zip:
Value of Work for this Permit: $ 9 50' ® Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑(Alteration ❑ New 'Repair/Replace El Demolition
Description of Work: /l til
ep'w .. 117 cl el, C,—zn/
Specify color of color thru the:,
Submittal Fee $, Ez d M Permit Fee $ 1J'2;"61P CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $
(Revised02/24/2014)
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ ! I J
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. 1 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.
Signature Signature
OWNErGENT CONTRACTOR
10
Theor Ing instrum nt was acknowledged before this
— day of 20 by
L.CJI� Ae'K whom s �Ay to
me or who has produced as
identification and who did take an oath.
The foregoing instrument was acknowledged before me this
® day of 67 .20 1 S' . by
M o c h a e l 10n QmAn . who . ersonally know
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign:
Sign:
"1 c
h 11 Ped z_
Print:Print:
l
e e- e
Seal:
r°`.P'PUB`'� R BARBARAZEEMAN
Seal:
# * MY COMMISSION # EE 860789
0. ° Notary Public State of Florida
EXPIRES: February15, 2017
a
" Michelle Perez
BOW ThruBudget NoWyServim
My Commission FF 000321
Expires 04/08/2017
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*
APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)