EL-15-2267 V
Inspection Worksheet
Miami Shores Village ts-a�g j
10050 N.E.2nd Avenue Miami Shores, FL 1�
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-256419 Permit Number: EL-9-15-2267
Scheduled Inspection Date:April 08,2016 Permit Type: Electrical- Residential
Inspector. Devaney,Michael
Inspection Type: Final
Owner. CAMPBELL,MARK Work Classification: Alteration
Job Address:373 NE 92 Street
Miami Shores,FL
Phone Number (305)754-2318
Parcel Number 1132060136400
Project: <NONE>
Contractor: ATLANTIS ELECTRICAL CORP Phone: (305)551-4043
Building Department Comments
NEW KITCHEN AND SMOKE DETECTORS Infractlo Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed P�r
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-Inspection fee is paid
April 07,2016 For Inspections please call: (305)762-4949 Page 21 of 27
t
a
Miami Shores Village
10050 N.E.2nd Avenue NE
•'• Miami Shores,FL 331380000 F1111"
z :
lw Phone: (305)795-2204
W X 3 1 _
4 , Expiration: 04/0212016
Project Address Parcel Number Applicant
373 NE 92 Street 1132060136400
MARK CAMPBELL
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
MARK CAMPBELL 373 NE 92 Street (305)7542318 (305)528-3037
MIAMI SHORES FL 33138-3133
373 NE 92 Street
MIAMI SHORES FL 33138-3133
Contractor(s) Phone Cell Phone Valuation: $ 750.00
ATLANTIS ELECTRICAL CORP (305)551-4043
Total Sq Feet: 00
Type of Work:NEW KITCHEN AND SMOKE DETECTORS Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# EL-9-15.56959
DBPR Fee $2'25 10/05/2015 Credit Card $115.10 $50.00
DCA Fee $2.25
Education Surcharge $0.20 09/04/2015 Check#:3912 $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
ScanningpNe $9.00
Technolofy�Fee $0.80
Total. J $165.10
Q
LpJ
O
In considetion 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 IMs permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required ftLECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
C=
OWNERSAFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructic�and zoning. Futhermore,I authorize the above-named contractor to do the work stated.
October 05,2015
Authorized Signature:Owner / Applicant ! ont / Agent Date
� I
Builiffing Department Copy
Octol> 5,2015 1
Miami Shores Village cF ' ,I r
g SEE 0 4 2015
Building Department BY: LD;��a
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20/y
BUILDING Master Permit No2C /f 20
PERMIT APPLICATION Sub Permit No.
❑BUILDING a ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 3 1 3 &/t- i -" S- T—
City: Miami Shores County: Miami Dade Zip: 33 t g
Folio/Parcel#: It. 3,20G . oil , L 4y O Is the Building Historically Designated:Yes NO �C
Occupancy Type: Load: Construction Type: Flood Zone:_ BFE: FFE:
OWNER:Name(Fee Simple Titleholder): iA jqvj�- e. P d �-� Phone#: �'S '� '•30 3
Address: 3 -
City: Mk*'A t State: Zip:
�C7
anant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Phone#:
Address: 1 ?,6-0 3 S v.) 20'4 -170 q A-Z--
City: kti!A-V-, / State: F-U Zip: 0 t ?n-
Qualifier Name: FtL&12•Cc,Se) ?ft52 Phone#:
State Certification or Registration#: t56 11 W 101 IV Certificate of Competency#:
DESIGNER Archite ngineer: del,AAAA.- ChsN►Pd Z LL Phone#: -�DS S 2 '3 d 3 7
Address: "Il l 3 /,c: PlL S i City: 5 Statc<< Zip: 3
Value of Work for this Permit:$ 1 S1 Square/Unear Footage of Work:
Type of Work: ❑ AdditionAlteration ElNew ElRepair/Replace ElDemolition
Description of Work: K-►�1? c,1. �j,onek� � eecsY'S
Specify color of color thr�/utile:
Submittal Fee$ ��• 40(/ Permit Fee$ 140106 CCF$ CO/CC$
inning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ S-
(Revisedo2/2a/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: a condi Ion to the issuance of a building permit with an estimated value exceeding$2500,�t-he applicant must
promise in good ith that a py of th tice of commencement and construction lien law brochure will be delivered to the person
whose prope is subject t ach n . ,a certified copy of the recorded notice of commencement must be posted at the job site
for the f! inspection ch o u (7) da ft the building permit is issued. in the absence of such posted notice,
inspect. n will not be r a a r nspe ' n w' be charged.
Si ature Signature
OWNER AGENT CONTRACTOR
The for oing instrument was
�acknowledged before me this The foregoing instrument was acknowledged before me this
day of `"~" ,20 —J by _��day of 1111 .20 15-- .by
�ts -�_�-�-�- knn��u�qq to who is rsonall kn o
J 4� T;rom�if fQo
me or who has produced J 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 Ari Sign: a4
Print: =y:'c� o�O:. Princ�P.CYC
m?FF ;�P m nea�eR
Seal: :o: 3 '� _ Seal: REBBCARPASTRANA
{ MY COMRSS10N d EESM24
EXPIRES:Fy07 2017
"'� ,� �h /4 Plans Examiner g
APPROVED BY �� Zoning
Structural Review Clerk
(RevisedO2/24/2014)