EL-15-1102 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-236017 Permit Number: EL-5-15-1102
Scheduled Inspection Date: June 04,2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: TOMMIE, QUENTIN Work Classification: Low Voltage
Job Address:124 NE 111 Street
Miami Shores, FL Phone Number (772)237-9346
Parcel Number 1121360040101
Project: <NONE>
Contractor: R&R ELECTRIC OF BROWARD INC Phone: (954)319-5630
Building Department Comments
LOW VOLTAGE INSTALL 1 CAT 6 CABLE FROM OUTER Infractio Passed Comments
WALL ON WEST SIDE TO LIVING ROOM. INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
June 03,2015 For Inspections please call: (305)762-4949 Page 23 of 28
yia+ s y, Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204
Expiration: 11/00/2015
Project Address Parcel Number Applicant
124 NE 111 Street 1121360040101
Miami Shores, FL Block: Lot: QUENTIN TOMMIE
Owner Information Address Phone Cell
QUENTIN TOMMIE 124 NE 111 Street (772)237-9346
MIAMI SHORES FL 33161-
124 NE 111 Street
MIAMI SHORES FL 33161-
Contractor(s) Phone Cell Phone Valuation: $ 150.00
R&R ELECTRIC OF BROWARD INC (954)319-5630
Total Sq Feet: 0
Type of Work:LOW VOLTAGE INSTALL 1 CAT 6 CABLE F Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# EL-5-15-55502
$2.00 05/12/2015 Check#:2337 $ 108.60 $0.00
DCA Fee
$2.00
Education Surcharge $0.20 4
Permit Fee-Additions/Alterations $100.00
Scanning Fee $3.00 r
Technology Fee $0.60
Total: $108.60
._4111�1
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 all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction anding. Futhe re, horize the above-named contractor to do the work stated.
May 12,2015
Authorized Signa ure:Owner / Applicant 1 Contractor / Agent Date
Building Department Copy
May 12,2015 1
Miami Shores Village _ ` E
-sl 1 t � is MAY 0 8 2015
Building Department _
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 -
Tei:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)752-4949
FBC 2010
BUILDING Master Permit No.RC-1-15-119
PERMIT APPLICATION Sub Permit No. %-L,Is - i 10Z
❑BUILDING P
ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL
❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 124 N.E. 111TH ST
City: Miami Shores County Miami Dade Zig):
Folio/Parcel#:11-2136-004-0101 Is the Building Historically Designated:Yes NO X
Occupancy Type: 10 Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Quentin Tommie Phone#:772-237-9346
Address:124 N.E. 111th St.
City: Miami Shores state: FL Zip: 33161
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: R & R Electric of Broward, Inc. Phone#: 9319-5630
Address: 7958 Pines Blvd., Suite 238
City: Pembroke Pines State: FL Zip: 33024
Qualifier Name: Erin Richardson Phone#: 954-319-5630
State Certification or Registration#: EC 13006319 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$150.00 Square/Linear rootage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition
Description of work: Install (1) Cat 6 cable from outer wall on West side to living room LCW ym-rAc"E)
Specify color of for thru tile:
Submittal Fee$ Permit Fee$ /61,01-4110 CCF 9 ®-( CO/CC$ ct�'
Scanning Fee$ Radon Fee$ - DB $ Q>00 Notary$ -m
Technology Fee 5_ (D•k0 Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
(Revtsed02(24/2014) TOTAL FEE NOW DUE$
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 weft not a approved and a rei spe ion fee will be charged.
4 �
A��/
Signatu Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of_ *,. 20 by day of /X!!!!� ,20 f '� ,by
pity°w�sonally, known to EA;a✓ ed✓q�c%la� who is personally known to
me or who has produced ELmk—AJc:a. 'briyer�E`as&z_ me or who has produced X444 ✓k," L;- as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: 47 NOTARY PUBLIC:
Sign: Sign:
Print: -In Print: �!� /�f ( V4 �/C
Seal:
Seal: °�F,av pis LUlS A l?:L y
dlN- 13E713
GILBERT PIERRE SAINT
Notary Public-State of Florida +hid 3ddget�L' 5 rrices
;;4P` Commission#EE 211426 �r �J ��'
APPROVED BY Plans Examiner _Zoning
Structural Review Clerk
(Revised02/24/2014)