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EL-15-1754 C . 2 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239368 Permit Number: EL-7-15-1754 Scheduled Inspection Date: July 20, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: SUPREME, GERARD Work Classification: Alteration Job Address:535 NW 112 Street Miami Shores, FL 33168-3317 Phone Number Parcel Number 1121360210900 Project: <NONE> Contractor: JERUSALEM ELECTRICAL INC Phone: (305)206-5564 Building Department Comments ADD AND DISCONNECT TO THE BACK OF THE PANEL. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed El Failed Correction ❑ Needed �v 1rt Re-Inspection ❑ �f � U r r.� JAY,!-�L Fee � No Additional Inspections can be scheduled until re-inspection fee is paid. July 17, 2015 For Inspections please call: (305)762-4949 Page 32 of 35 Permit Na L-? -" � SNORES�.'f Miami Shores Village ,+ P8 ?1t 7y1 Etricai ,.,I�t0lill< ` 10050 N.E.2nd Avenue NW K4, classitit tion MAMter�atn Miami Shores, FL 33138-0000 �. Status.,APt Ramat . eN ` Phone: (305)795-2204 FLORIDA Isla 7/1712015 Expiration: 01/13/2016 Project Address Parcel Number Applicant 535 NW 112 Street 1121360210900 GERARD SUPREME Miami Shores, FL 33168-3317 Block: Lot: Owner Information Address Phone Cell GERARD SUPREME 535 NW 112 Street MIAMI SHORES FL 33168-3317 Contractor(s) Phone Cell Phone $ 500.00 JERUSALEM ELECTRICAL INC Fval on (305)206-5564 � q Feet: 0 Type of Work:ADD AND DISCONNECT TO THE BACK OF T 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 Invoice# EL-7-15-56330 DBPR Fee $2.00 DCA Fee $2.00 07/14/2015 Cash $50.00 $63.60 Education Surcharge $0.20 07/17/2015 Cash $63.60 $0.00 Notary Fee $5.00 Permit Fee-Additions/Alterations $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $113.60 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 accur nd tha II work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-nam*contra o t ork stated. July 17, 2015 Authorized Signature:Owner / Applicant / Contra gent Date Building Department Copy July 17, 2015 1 Miami Shores Village Building Department I 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 JUL W 2015 Tel:(305)795-2204 Fax:(305)756-8972 �r. INSPECTION LINE PHONE NUMBER:(305)762-4949 - --"-- —4W FBC 2M Y BUILDING Master Permit No.L�Ao_ 15 PERMIT APPLICATION Sub Permit No. ( S ❑BUILDING 50 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [—] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:—", OV L-) City: IVB, 'J Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: hh OWNER: Name(Fee Simple Titleholder): G f f-CI tP Su 1psr 2kil a Phone#:) J fib A19 //�U Address:5 3 `> I\f (k) I/aq City:Ni A VVI, S go R es State: ��aR d� Zip:33/6// 8 Tenant/Lessee Name: Phone#: Email: // / ) CONTRACTOR:Company Name: `�CRy 6"6c'Y✓I ��f�_P� P Phone#-�a d'/ Address: /j ° 6 City:.& Q&M HIA-7i State: /'1L Zi ?i i Qualifier Name: f Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ : do t Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: i3 est � Specify color of color thm tile:P Submittal Fee$ S J -CfD Permit Fee$ /4," CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 15G (Revised02/24/2014) 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. 0 "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 _. OW ER or AGENT //CONTRA T R The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of / 20 � by �(� day of U L-- 20 k _ by e U r2whoyis�p/ersonally known to 1 �U1E [ &-v-- who is personally known to me or who has produced. as me or who has produced � � 1,(c Ns identification and who did take an oath. identification and who did take an oath. NOTARY P IC: NOTARY PUBLIC: Sign. Sign: Print: Print: I w.,�. Seal: i ODA!�SLOR[S i t r 1+a SION Et 1N 9 1 Seal: ov41n NotaryPuolic State of Florida fig,-, 6rSindia Alvarez Rona d h m N��'�ry Public Underwriters Mq Commission FF 156750 Expires 0910312018 APPROVED BY /jam Plans Examiner Zoning r Structural Review Clerk (Revised02/24/2014) ek 70 ,y 1'� .,.••. •' C ��2,P— • • • •.s..• O Y1 It C. • • a • (f un e C4 •....• m 1- to 4 V31Nc JUU 14 ZbI5 14 1 e:.` 4 i,�.rL 4444 D r 4.0000 '00 6960% 4444. 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