EL-15-2899 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-248043 Permit Number: EL-11-15-2899
Scheduled Inspection Date: November 20,2015 Permit Type: Electrical- Residential
Inspector. Devaney,Michael Inspection Type: W. W.
Owner: , Work Classification: Temp for Test
Job Address:501 NE 96 Street
Miami Shores,FL 33138-2735
Phone Number (305)333-7700
Parcel Number 1132060171550
Project: <NONE>
Contractor MV ELECTRICAL SERVICES Phone: (305)216-0677
Building Department Comments
TEMP FOR TEST 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 19,2015 For Inspections please call: (305)762-4949 Page 18 of 28
Miami Shores Village 6 ,iF a1 'rA�-� L-3
Building Department Nov 17 MS
>` 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 04
BUILDING Master Permit No. l C 1 5-- Z 7 3 9
PERMIT A=ON Sub Permit No.1E S —� *il
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL
❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
�(� C� CONTRACTOR DRAWINGS
JOB ADDRESS:
/ °`" S
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Olt/1� G er;w•be O Phone#: �0� 3Z 3 770'
Address: Z5 3 NE G.Z 4 f
City: )M rn vh Slnc✓l S State: FL- Zip:
Tenant/Lessee Name: Phone#:
Email:��S Mel h It,,& q v>r'A � •G�✓1 -^
CONTRACTOR:Company Name: 14 V�1eezrl �aUIC� �°d Phone#: ( `?��
---PI-5-:7
Address• 6LI A)60 'f A Or—
City:.
r—City: D State: Zip: / gOrp 7 7
5 3 0 lS
Qualifier Name: �dGd Cho,1_ C leS Phone#: Til ed
State Certification or Registration#: C. 'C 13005008 • Certificate of Competency#:
DESIGNER:Architect/Engineer. Phone#:
Address: Gty: State: Zip:
Value of Work for this Permit:$ ' Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New UP Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thm die.-
Submittal
ile:Submittal Fee$ Permit Fee$ 10,9167V CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ ,p
TOTAL FEE NOW DUE$ v
(Rev1sed02/24/2(14)
a
Bonding Company's Name(if applicable)
dbnding Company's Address
r 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$250, 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
O GENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
A�day of_Alc e' 4ex- .20_4!5 by day of NOW K*76e 20 L by
who
is
personally known to who. personally know to
me or who has produced �,/ R� as me or who has produced as
identification and who did take an oat�d �011111111)iI/o/ identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
. ¢, • ices ,
Sign: — = Sign: IINTWINIMIM
Ivivff1
Print: ���i\1� Print: * EXPIRES:April 6,206
•'•
g'iii s,�- �, ��— '°moi�Ftid``c Bonded T1eu B 1t Sees
Seal: TATE Seal:
t'S
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
' Miami Shores Village
Building Department
■"■ ■�" L , S i�C/ 10050 N.E.2nd Avenue
1 / Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
AFFIDAVIT FOR 30 DAY TEMPORARY-ELECTRIC SERVICE
NOTE: ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE"UPON 30 DAY
TERMINATION UNLESS APPLICATION IS RENEWED.
It is understood that the temporary-electrical approval by the Miami Shores Village,Building Department given
in connection with the building d ng being constructed under:
Building Permit N: Electrical Permit N: F,�.is --~ vin
At Address: ► N ST Miami Shores, FL
For Owners: 'DA,,7 Q,0A M5,Frz-t n,G M a f-eZ C , and is being given only for
construction purpose or for testing the following equipment in said
structure: O%l 4�_
The owner does herby agree to assume the responsibility of maintaining the installation in such manner that
there is no hazard to life or property. Such approval is in no event to be considered a RELEASE of
pP said m
structure for the purpose of use and occupancy, and no occupancy shall be granted or permitted until further
inspections have been called for and approved by the inspection divisions concerned, and/or a Certificate of
Occupancy or Completion is obtained.
The undersigned also understands that the temporaryelectric approval is subject to rescission and
^incellation and electric ower can be cut off at the discretion of the building official and will be disconcerted of
9
e building concerned is occupied before final inspections are approved and/or obtained a Certificate of
Occupancy or Completion. Note: Failure to comply with the provisions of this affidavit will result in your
being unable to obtain future Temporary for Test permits.
I, '�A,y 10 I'ogol m 0912-1 , being first duly sworn, depose and say that I am the own\gK\ad th9/,,
above described property, and that I agree that the structure covered in this agreement shall not oc �''%,
until the building contractor has obtained approval of final inspections and/or obtained a Certifite of"'o
Occupancy of Completion. Note: Failure to comply with the provisions of thl affidavit wit es�
being u fut fr erary for Test permits. - �� o�
o :¢_
:m
/ J
co ZZ
Si o Owner x
y.
Sin
9 Signature of Notary ��....
1
y
I, rn V�t..DM Z- , being duly sworn, depose and say that I am the Electrical CorS4�aatcart
the abo ascribed pro d that the electrical installations as now exi ' g will not create a safety hazard
if temp r service ' ed. A c li�HM
it lit
Si u f Electri o ctor CMR Comte#E
my c omm.expires My 4,2016 Of O
1, C-A 't�. , being first duly sworn, depose and say that I am the Building Contractor
of the above described property and that I will not permit occupancy of this building until ficial inspgoblh'�'�p�'j,
been called for by the contractors and sub-contractors concerned and final approval by the insR�tion.di
obtained and that I have the authority insofar as the owner of said property is concerned to pr(tOibit-6_
t until such fin ins ctions are obtained and/or a Certificate of Occupancy or Co letion is i iscf. LU
,�
jnatu a of ui ontractor Signature of Notary %Le e;*..
Signature of Inspector Signature of Notary