EL-15-1482 0
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
I
Phone: (305)795-2204 Fax: (305)756-8972
II
Inspection Number: INSP-236959 Permit Number: EL-6-15-1482
Scheduled Inspection Date:
December 10�2015
Permit Type: Electrical- Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: RANDLE,JULIA Work Classification: Pool - Private
Job Address:285 NE 103 Street
Miami Shores, FL 33138-2430 Phone Number
Parcel Number 1121360130440
Project: <NONE>
Contractor: MESA BROTHERS INC Phone: (305)345-1974
Building Department Comments
RECONNECT POOL PUMP AND REPLACE BREAKER TO Infractlo Passed Comments
NEW GFI BREAKER NO POOL LIGHT ON POOL 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 09,2015 For Inspections please call: (305)762-4949 Page 5 of 44
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10050 N.E.2nd Avenue NES
Miami Shores,FL 33138-0000
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Phone: (305)795-2204
Expiration: 06/0512016
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Project Address Parcel Number Applicant
285 NE 103 Street 1121360130440
Miami Shores, FL 33138-2430 Block: Lot: JULIA RANDLE
Owner Information Address Phone Cell
JULIA RANDLE 285 NE 103 ST
MIAMI SHORES FL 33138-2430
Contractor(s) Phone Cell Phone Valuation: $ 300.00
MESA BROTHERS INC (305)345-1974
Total Sq Feet: 00
Type of Work:RECONNECT POOL PUMP AND REPLACE BRE Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Scanning:3 Final
Light Niche
Bonding
Review Electrical
Alarms
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# EL-6-15-55994
$2.25 12/08/2015 Check#:1285 $ 165.10 $0.00
DCA Fee $2,25
Education Surcharge $0.20
Permit Fee-Additions(Alterations $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $165.10
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,D ORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing informatio i r e and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-nam t or to do the work stated.
December 08, 2015
Authorized Signature:Owner / Applicant / Appr / Agent Uate
Building Department Copy
December 08,2015 1
Miami Shores Village
Building Department 015
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 �U�1
1 2
Tel:(305)795-2204 Fax:(305)756-8972 r
INSPECTION LINE PHONE NUMBER:(305)762-4949
FpB�C 20
BUILDING Master Permit No. �r /5* — h 2 R
PERMIT APPLICATION Sub Permit No. ��S
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
r-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
r �^ CONTRACTOR DRAWINGS
JOB ADDRESS: '9'
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: 1 Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): �./ l 1 U( r4 ,4VA JIL e Phone#:3®
Address: '�'9 5 t") 'r- ) C) 3 H 0
H
T
City: t �t'�1 SIn o it e S. State: (_ ' zip:_3 313 E _
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: � � %7 77 g Phone#: --7K�r�7
Address:
City: y `a State: �� q Zip: ' eC '�
Qualifier Name: � Phone#: N cl
State Certification or Registration#:fie'— 434t%�e/p70 Certificate of Competency#:
DESIGNER:Architect/Engineer: r1 Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 300 . Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New <Repair/Replace El Demolition
Description of Work: Cc7 r�1(1EC( z) re,oLf9cEFb r (,—,e
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ _A —0 nA CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ (GE; • 10
(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 ( SignatureIN x
OWNER or AGENT C T CTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
I U day of --s u J 9 20 by day of vN e _______,20 by
,who is personally known to ,..W H.L94Za ,who is personally known to
me or who has produced v 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: got►;`;��eoo AIDAPEGUERO
MY COMMISSION#FF 185683
* * EXPIRES:October 5,2D18
Sign: Sign: "' 1riruBudget Notary SM*N
—IT
Print: Print:
AIDA
Seal: *yo<�....ao�* MY COMMISSION FRF 1165583
Seal:
EXPIRES:October 5,2018
N' ,F c�oF�C� Booded'hru Budget Notary SeMne
APPROVED BY �- J if Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)