RC-13-2385 Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972 R Y" w---
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No. 3 —� SI
PERMIT APPLICATION Master Permit
Permit Type: Electrical
JOB ADDRESS: 13 J--o 0 F-
City: Miami Shores County: Miami Dade Zip:
Foho/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): C 14- ti'l I L( Phone#: .3 C" a-
Address: I -.a2 tC- 3 _ fz c�lI
IT
City 641 I A-�1,t 1I �C S State +-7_b K r it 4— Zip:
Tenant/Lessee Name: f j ( Phone#:
Email: �a,�� 11� G.c,�;��I���� C n,
CONTRACTOR:Company Name: �l/�►!�a �� r�� (�i�- c�.��' hone#:_ c`� ,j b- 75
Address:
City: ici II State: L Zip:
Qualifier Name: lcS c o -J4yez Phone#: -7g
State Certification or Registration#: ��_ - /:�6 0 27 '9 Certificate of competency#:
Contact Phone# -7,q C 1 J-g Z L 90 Email Address:
DESIGNER:Architect/Engineer. Phone#:
Value of Work for this Permit:$ f,,�-D Square/Linear Footage of Work- A Ke", l-e,±-a- 1-w Vv�
���� V
Type of Work: ❑Address DAlteration ONew 1�Repair/Replace. ODemolition
Description of Work:
Submittal Fee$ S� . Permit Fee$ CCF$ CO/CC$ .
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUES [14r
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 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
.Z�j
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me thia�t
day of /10✓ ,2013 �-<<-Aa/o+rt day of Lo V' 201by I2A-fviA- e m �t k j e
who is personally known to me or who has produced �(�(_ who is personally known to me or who bas produced
O--G/—�ff$is identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Si � i%� 7 Sign:
Print: /2/ 2( C �lf�/P 2 Print:�0��/Z
My Commission Expires: EtZIRIS GOMEZ My Commission Expir 'RY•:,`�i� ELZIRIS GOMEZ
k * MY COMMISSION#EE 838183 * * MY COMMISSION i EE 838183
EXPIRES:January 25,2017 . EXPIRES:January 25,2017
Banded TMu Budget"Svices orpP�OP Bided Tluu Budge Notafq Services
ara:,tarararrxtarptararitaeararaedriranYarvYar �r�r�r�t,x�r*�r�r�r,�t�rar�r�r,xxar�r�r�r*t,��r**ar*,raa��,�*�r�r*�r,�*ar,��r,�*r,xerar*�r�r*�r*,�,�,t�rtarar�r,rr,�a*,rt*,tom*�r+tsr�r
APPROVED BY Plans Examiner zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/102009)(Revised 3/15/09)
P/'°'v � 3 -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-216528 Permit Number: EL-11-13-2554
Scheduled Inspection Date: July 25, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: CHEF-AWAI, CAMILLE Work Classification: Alteration
Job Address: 1370 NE 103 Street
Miami Shores, FL Phone Number (305)710-3331
Parcel Number 1132050300080
Project: <NONE>
Contractor: F JIMENEZ ELECTRICAL CONTRACTOR, INC Phone: 305/556-5759
Building Department Comments
LOW VOLTAGE Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
� � I
Failed , ✓ ��
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
July 24,2014 For Inspections please call: (305)762-4949 Page 26 of 31