EL-15-2702 I L�" (I K 7
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-253872 Permit Number: EL-6-15-1358
Scheduled Inspection Date: March 03,2016 Permit Type: Electrical - Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: MUSTAD, KRISTEN Work Classification: Alteration
Job Address: 1260 NE 94 Street
Miami Shores, FL 33138- Phone Number (305)661-6633
Parcel Number 1132050100180
Project: <NONE>
Contractor: LONGMAN ELECTRIC INC Phone: (305)758-1211
Building Department Comments
FIXTURES AND RECEPTACLES Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction '�f
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
March 02,2016 For Inspections please call: (305)762-4949 Page 37 of 44
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Miami Shores Village ermrtj ,�) �� esientai=
10050 N.E.2nd Avenue NE
..
Miami Shores,FL 33138-0000 .,. Alteration
Phone: (305)795-2204
xmt'
'. 1$$Uw t Expiration: 12/09/2015
Project Address Parcel Number Applicant
1260 NE 94 Street 1132050100180
Miami Shores, FL 33138- Block: Lot: KRISTEN MUSTAD
Owner Information Address Phone Cell
KRISTEN MUSTAD 1260 NE 94 Street (305)661-6633
MIAMI SHORES FL 33138-
1260 NE 94 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 7,300.00
LONGMAN ELECTRIC INC (305)758-1211
..., _ Total Sq Feet 00
Type of Work:FIXTURES AND RECEPTACLES Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning:3
Fees DLs
Amount Pay Date Pay Type Amt Paid Amt Due
CCF $4.80
DBPR FeInvoice# EL-6-15-55835
$3.84 06/12/2015 Credit Card $235.48 $50.00
DCA Fee $3.84
Education $1.60 06/04/2015 Credit Card $50.00 $0.00
Permit Fe $256.00Scanning $9.00Technolo $6.40Total: $285.48
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,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all t fo oin 'formation is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I a t rize above named esntractor to de4he work stated.
June 12, 2015
Authorized Signature:Owner AppftR nt ! ontractor / Agent Date
Building Departure t Copy
June 12,2015 1
� w
Miami Shores Village WPM
Building Department JUN ®4 2015
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 1C)
BUILDING Master Permit No. 2�e 2 2 Z-57,2
PERMIT APPLICATION Sub Permit No.Z 10. S
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: R66 1')1g- g4 S1
City: Miami Shores County: Miami Dade Zip: /
Folio/Parcel#: 1 f d 3�ZQ5 -ow Is the Building Historically Designated:Yes NO 1/
Occupancy Type: Load: Construction Type: a f3 5 Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): T1 r 1 g � / \V Sk 4 Phone#: 3� - �j j- )663
Address: kqo I ai O
City: cti State: Zip: I
Tenant/Lessee Name: 1 Phone#:
Email: k�sSh VIQVTd�J�('eQl e (�
s
CONTRACTOR:Company Name: �'r '®C Phone#:
Address: q
Yui
City: j"k*,?W State: Zip: 17 -3
0 1
Qualifier Name: q,"' Phone#:
State Certification or Registration#: r:---c- Certificate of Competency#:
DESIGNER:Architect/Engineer: V %CA0V- (�)cUCR- Phone#:
Address: 310 A)a 10 i S+ City: A%ckv n i S6,reS State: FL- Zip:
Value of Work for s Permit:$ 41 3 00 Square/Linear Footage of Work: '+To®
Type of Work: Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ A5-4&r'®a 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 jab 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
qv-e'"'e-�;�4��
L;W'NER®rAGENT'
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 /5 by J- day of 3 v At ,20 15 by
NAn's ,/. k4i k ,who is personally known to M iLtA. l L o4 M atA ,who is personallyknown t
me orwho has produced 70-0,26esO 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:. ('. aA 2Cd► J4U A.-Lt Sign:
Print: ✓ IG} , ' TU4l - fill? Print: eZ
Seal: yr�y , REBECAI.ART1AdATURNER Seal: e' "oav Notary Public State of Florida
MY COMMISSION#FF 130252 : Michelle Perez
OM
EXPIRES:August 24,2018 6boa My Commission FF 000321
Bonded Thru try Pulik UndemBem OF po Expires 04/08/2017
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)