RC-08-615 --------------------------------------------------------------------------------------------------------------........................................-..............................................._.................................................................................
r• ����•
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL _
Phone: (305)795-2204 Fax: (305)756-8972
49
:. ...
Inspection Date: January 08, 2009 Permit Type: Electrical - Residential
Inspector: Devaney, Michael Inspection Type: Underground Rough
Owner: LUBETSKY, CARYN Work Classification: AdditionJAlteration
Job Address: 9953 NE 4 Avenue Road NE
Miami Shores,FL 33138- Phone Number
Parcel Number 1132060171250
Project: <NONE>
Contractor: JC ELECTRIC INC Phone: (305)754-6949
Building Department Comments
Inspector Comments
Passed
Failed El
Correction
Needed ❑ ��
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
Wednesday, January 7, 2009 Page 1 of 1
Miami Shores Village rhu2 J zoe
Building Department
10050 N.E.2nd Avenue,Miami Shores,.Florida 33138 BY-=--_--
Tel:(305)795.2204 Fag:(305)756.8972
BUILDING Permit No. / _ '� .
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type(circle): Building Roofing
Owner's Name(Fee Simple Titleholder) &WaO 4 4 4ne
w -P4- .
Owners Address 9CIE E 3 1
City 1 DSM t I_kLcj9-�,' State Zip—:3:5)
- TenandLessecName -> - Phone#
Job Address(where the work is being done) ` ` s Al t VIW- Aida—AdW
city Miami Shores Village County Miami-Dade Zip '33 3 PU
FOLIO/PARCEL# ( I -- 3 - O
Is Building Historically Designated YES NO,�_
Contractor's Company Name EfE ZSV 1 4 0-1r"S L1<2+ 2 Phone# �05 60- �V
`E
Contractor's Address_ rg0 ll\� Q � J '- 18, �y
cistate
Qualifier Name' '9Gr'1 e,.lC T-7-AW-40 Phone#
State Certificate or Registration No.CGI 1501!4 % 6 —'Certificate of Competency No,
tqMngineer's Name(if appli 1e)�1�-0.�IM��(��_ Phone# 3 j�G
Value of Work For this P Square/Linear Footage-Of Work:
Type of Wo r ❑Alteration - ❑New ❑ Repair/Replace ❑Demolition.
Descri o l a X- TO 5
Submittal Fee$ Permit Fee$ CCF$
Notary$ TrainingJEducation Fee$ Technology Fee$
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ 6 0 °`' Total Fee Now Due$
See Reverse side
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 RECORD G YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated vale e ' $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law r c r be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of co eme t be posted at the job site
for the farst inspection which occ seven (7) days after the building permit is issued In abs a such posted notice, the
inspection wi not be approved a reinspection fee will be charged
Signature SignatureBoll
Owner or Agent C to
The foregoing instrument wasacIm led ed before me this The foregoing instrument was acknowI ed before me this o�D
day of b V ,20 Q�,by t i CL.0 '[S r`7 , day of ill D J' .20 p!by CXJ C
who is personally known_ to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as-identification and who did take an oath.
NOTARY PUBLIC: NOTARY,PUBLIC:
'Sign:, Sign: '
Print: L) �-+`'GC�C� Print:
My Commission Expires: JUDITH L�KREGG My Commm
APPLICATION APPROVED BY: Q- -
x , I`Z S [t r( shu G rammer
Engineer
Zoning
(Revised 07/10/07)