EL-13-2580 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972M_S�
Inspection Number: INSP-203065 Permit Number: EL-11-13-2580
Scheduled Inspection Date: December 05, 2013 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: WILLIAM J.JURBERG, R. ANDREW DE Work Classification: Temp for Construction
once
Job Address:9350 NE 12 Avenue
Miami Shores, FL 33138- Phone Number (305)609-3851
Parcel Number 1132050070150
Project: <NONE>
Contractor: HIGHGRADE ELECTRIC CONTRATORS CORP Phone: (305)576-8807
Building Department Comments
TEMPORARY FOR CONSTRUCTION OF NEW HOUSE Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
December 05, 2013 For Inspections please call: (305)762-4949 Page 6 of 27
Miami Shores Village
Building Department artment i NUS 1 - 'ups
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972 BY
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20 LC)
BUILDING Permit No. I LI 3 —
PERMIT APPLICATION Master Permit No. RG � -
Permit Type: Electrical ,, nom+
JOB ADDRESS: /P2'5-0 /\/�i /;—,
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): Al � �� Phone#:
Address: 9 529
City: State: Z- Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: fl/C G L.C-C/ J �. y
Phone#: � Q'G�Z Fj _
�/�. f� ( RA• R a 3o S 9 T
Address: l;r I d`'7 ky/a
City: MIA A Mk A State: EL. - zip: 130 A 7
Qualifier Name: /1/l.1_ Sd Al PA L.A4.4 Phone#: 3�
State Certification or Registration#: E R Oo &*13 Certificate of Competency#: !7 YF_ Q&
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T e of Work•
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Description of Work:
*************«*************************Fees**************************«*****************
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$—.(2 0 0
I
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip 1
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 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, CSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YO. 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 abse ce of such poste notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature ,Signature
Owner og�e .I Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ZX
day of&Cr ,20L' ,by day of ,20l_',by_,VA�L,So Al Pi41i
who is ersonally o to me or w ucR���'�who is ' nally lino me or who Pias produced
As i a ion an
NOTARYPUBLIC: JOK M.sANTANA Wary Public-stab d/Ng1s
• Notary PubNe-saes a Oona NOTARY P
_ My Com.Expires Feb 24,2017 w My Comm.Expires Feb 24,201
Commission.•EE 87443 '+ '�a'Aa Commission EEE 877443
•'��.°,°„�••° Bonded TW"Ok Nat"Notary Man.
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Sign: Sign:
Print: Print: r K
My Commission Expires: My Commission Expires:
APPROVED BY •, /L-/ Plans Examiner Zoning
Structural Review Clerk
(Revised 3/122012XRevised 07/10/07)(Revised 06/10/2009XRevised 3/15/09)
CERTIFICATE OF LIABILITY INS URAN CE9
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BELOW. THIS CERTIFICATE OF KSURANCE DOES NOT CONSTMITE A CONTRACT BETWEEN THE ISSUING INSURENS). AUTHORIZED
REPRESENTATIVE OR PRODUCM AND THE CERTIFICATE HOLOM
—IM-—PORTAW--: It the cedificato holder Is an ADDITIONAL URED,the poillesl must tw endotted- It SUIRROGATION IS WAIVED,;aRt to
the terms and owulitiams of the policy, olain pofties may require an endorsement, A Makinliont ort thW Certificate do"mat confer rights to the
rertificate biAdec In lieu of swh oodatsememial
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Fot TempDrary Ass qment To: Hiqhqrads Ekictrw ConbaOas Corp
CERTIFICATE"OLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C06NCELLED BEFORE
THE EXPIRATION DATE, 11HEREOF, NOTICE WILL BE VILIMED IN
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10050 RE 2nd Ave
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0 1904-2010 ACORD CORPORATIOIN. All rights reserved,
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