EL-14-2620 Inspection Worksheet
Miami Shores Village
9
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-247861 Permit Number: EL-12-14-2620
Scheduled Inspection Date: November 17, 2015 Permit Type: Electrical- Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: BLEASDALE, DONALD & MAUREEN Work Classification: Service Change
Job Address: 102 NE 106 Street
Miami Shores, FL 33138-2037 Phone Number
Project: <NONE> Parcel Number 1121360050080
Contractor: RAYS ELECTRICAL SUPPLY INC Phone: (786)236-2777
Building Department Comments
RELOCATE OF METER 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.
November 16,2015 For Inspections please call: (305)762-4949 Page 28 of 38
Miami Shores Village s
Building Department DEC o1 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138;,.,
Tel:(305)795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4
F B/C 20 ID
BUILDING Master Permit No
PERMIT APP ICATION Sub Permit No.
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami O l.._.Shores / County: Miami Dade Zip:
! '! l 36
Folio/Parcel#: / ' Is the Building Historically Designated:Yes NO
Occupancy Type: Load: �. tr
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder);L J► ![�_ Pmwo t
Address: 102—
City: [ l7) r State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Na [ 1'10 C Phone#: �}�' C�
u �
Address:
City: State: -- Zip:
Qualifier Name: A, Phone#:
State Certification or Registration#: L, Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ SO- Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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.
"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_' i C-�(��
OWNER or AGENT CONTRACTOR
The foregoing instrume t was acknowledged before me this Theforegoinginstrument was acknowledged before me this
day of 20 1Y by I day of20 , by
who is p onally known 4-)�.,eJdi9 1) who who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: `._ '-`'_.. Sign:
Print: f f ry ,yc� Print:
Seal: 20,. Seal: `
€ MY CO:•1CA SSION #FF020J73 $ `�=: VAL
..._ Q Exp REs JUS,, >>.poi MY COMMISSION YMORE
.A, TOFF oa= #FF020273
_ EXPIRES June 19
407)398-0153 FlondalloiE�ryS�w��o�Q'p 7
***#***** A ************ #********************* (407)39 ***1**** **********
�/y �.
arygervice.com
APPROVED BY G Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)